Perceived racism, cardiovascular disease risk, and neurocognitive aging

越来越多的人认识到种族主义会让我们生病。美国黑人的可能性是美国白人的两倍- 阿尔茨海默病(AD)不受遗传风险的影响。尽管有这些知识，但我们知之甚少。 关于慢性种族主义经历是否以及如何对内侧颞叶海马(MTH)和 前额叶-执行系统的完整性，在AD中表现出严重的神经变性的系统。尽管Comor- 疾病和社会经济地位是导致AD健康差距的原因，但差距依然存在。这突出了 了解导致大脑健康差异的社会和社会因素的关键需求尚未得到满足。一位少校 在美国，造成健康不平等的因素是由于种族主义对生活的累积影响造成的长期压力- 时间到了。虽然慢性应激对MTH和前额叶系统的负面影响是众所周知的，但很少有 了解长期的人际和体制/结构性种族主义、独特和突出形式的种族主义的影响 美国黑人的慢性压力，对这些大脑系统的神经认知完整性的影响。自从感受到种族主义以来 在心血管疾病(CVD)风险因素方面造成健康差异，这些因素也是AD的风险因素， 感知到的种族主义也应该对AD的健康差距产生重大影响。为了支持这一点，我们的前 初步数据显示，老年黑人女性感受到的种族主义预示着未来主观记忆力的下降， 这在一定程度上是由抑郁症状介导的，而更大的社会歧视意识预示着 老年人记忆力较差，杏仁核和海马头体积较小。尽管有这样的知识， 种族主义对黑人老年人神经认知完整性的累积影响尚不清楚。的目标是 本研究旨在研究种族主义对神经认知、MTH记忆和前额叶执行的影响。 在黑人老年人中的系统完整性，并检查潜在的潜在生物学机制。我们的中央- 假说是，认知健康的黑人老年人经历了更高水平的长期种族主义将 表现出更高的心血管疾病风险(目标1)和更差的MTH和前额叶完整性(目标2)比那些有经验的人- 一生中发生的种族主义事件较少。我们进一步假设心血管疾病风险和心理健康 调解(即，解释)感知到的种族主义和神经认知完整性之间的关系(探索性 目标)。将通过有组织的面谈和机构/结构评估感受到的人际种族主义 基于种族居住隔离的种族主义。将使用2013年动脉粥样硬化评估10年期心血管疾病风险- Rotic CVD(ASCVD)风险算法，使用从空腹血液测试和血液中获得的脂质和其他生物标记物 来自动态血压监测的压力。神经认知MTH和前额叶系统完整性将 分别使用情景记忆和执行功能的认知评估进行检查，并构造- 结构性核磁共振检查。此外，我们将使用结构方程模型来检验种族主义、心血管疾病 风险、心理健康和神经认知完整性。解决这一知识差距对于开发新的 卫生政策以及促进健康老龄化的生物行为和社会干预措施。

There is increasing knowledge that racism makes us sick. Black Americans are twice as likely as White Ameri- cans to have Alzheimer’s disease (AD) independent of genetic risk. Despite this knowledge, little is known about whether and how chronic experiences of racism contribute to medial temporal hippocampal (MTH) and prefrontal-executive system integrity, systems that exhibit profound neurodegeneration in AD. Although comor- bid illnesses and socioeconomic status contribute to the AD health disparity, disparities remain. This highlights a critical unmet need for understanding social and societal contributors to disparities in brain health. A major contributor to health inequities in the U.S. is chronic stress due to the cumulative effects of racism over the life- time. Although the negative impact of chronic stress on the MTH and prefrontal systems is well known, less understood is the impact of chronic interpersonal and institutional/structural racism, unique and salient forms of chronic stress in Black Americans, on neurocognitive integrity of these brain systems. Since perceived racism contributes to health disparities in cardiovascular disease (CVD) risk factors, which are also risk factors for AD, perceived racism should have a significant impact also on the AD health disparity. In support of this, our pre- liminary data show that perceived racism in older Black women predicts future subjective memory decline, which was in part mediated by depressive symptoms, and that greater perceived social discrimination predicts poorer memory and lower amygdala and hippocampal head volumes in older adults. Despite this knowledge, the cumulative impact of racism on neurocognitive integrity in Black seniors remains unknown. The objective of this application is to investigate the impact of racism on neurocognitive MTH-memory and prefrontal-executive system integrity in Black seniors and to examine potentially underlying biological mechanisms. Our central hy- pothesis is that cognitively healthy Black seniors who have experienced higher levels of chronic racism will show greater CVD risk (Aim 1) and poorer MTH and prefrontal integrity (Aim 2) than those who have experi- enced fewer instances of racism over the lifetime. We further hypothesize that CVD risk and mental health will mediate (i.e., explain) the relationship between perceived racism and neurocognitive integrity (Exploratory Aim). Perceived interpersonal racism will be assessed with a structured interview and institutional/structural racism based on racial residential segregation. Ten-year CVD risk will be assessed using the 2013 Atheroscle- rotic CVD (ASCVD) risk algorithm, with lipid and other biomarkers obtained from a fasting blood test and blood pressure from ambulatory blood pressure monitoring. Neurocognitive MTH and prefrontal system integrity will be examined using a cognitive assessment of episodic memory and executive function, respectively, and struc- tural MRI. Further, we will use structural equation modeling to examine interrelationships between racism, CVD risk, mental health, and neurocognitive integrity. Addressing this knowledge gap is critical for developing new health policies and biobehavioral and social interventions for healthy aging.