IKE Kapuna (Elder Wisdom) Project

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RESEARCH PROJECT 2: ABSTRACT The prevalence of Alzheimer’s disease and related dementias (ADRD) is rising in Hawai`i, where it is projected that 10% of people aged 65+ will be diagnosed with ADRD by 2025. Nationwide, Native Hawaiians and Pacific Islanders (NHPIs) are more likely to have early-onset ADRD than Whites, Asians, and African Americans. NHPIs have a higher prevalence of hypertension, obesity, diabetes, and dyslipidemia than other US racial and ethnic groups, which increase the likelihood of ADRD. ADRD is often preceded by subjective cognitive impairment and mild cognitive impairment, which offers an opportunity for early intervention to prevent or delay ADRD onset. Interventions that promote physical activity, healthy diet, and social and cognitive activities can prevent or slow cognitive decline. Notably, dancing can preserve or improve cognitive functioning and neuroimaging parameters, while reducing vascular risk factors. However, very few studies have tailored a dance program for ADRD prevention for racial or ethnic minorities, and none have included NHPIs. We completed a randomized controlled trial of an intervention featuring Hula in 277 NHPIs with uncontrolled hypertension. Over 6 months, the intervention lowered systolic (-5.4 mmHg, p = 0.02) and diastolic (-4.4 mmHg, p = 0.01) blood pressure compared to the control condition. We therefore will partner with 5 community-based organizations in Hawai‘i to adapt our existing Hula intervention and test its effectiveness for improving vascular health and maintaining or improving cognitive function in NHPI elders at high risk of ADRD. The ‘IKE Kupuna (Elder Wisdom) Project will use qualitative methods to revise our existing 12-month Hula curriculum for hypertension with culturally informed dietary education, cognitive exercises, and social engagement strategies. We will then conduct a pragmatic group-randomized trial with 208 NHPIs aged 50-75 years with at least 1 of 4 modifiable vascular risk factors for ADRD (hypertension, hyperglycemia, obesity, or dyslipidemia) and either SCI or MCI using a wait-list control design. The primary outcomes will be vascular risk factors for ADRD and subjective cognitive complaints. Secondary outcomes will include measures of cognitive performance, physical function, and mental health. We will also collect biospecimens from all participants to evaluate the cross-sectional association between APOE genotype, vascular risk factors, and cognitive complaints and function. Our Specific Aims are to: 1) Adapt our existing Hula-based intervention to target vascular risk factors for dementia, improve cognitive symptoms or function, and optimize salience, implementation, and adherence in NHPIs with subjective cognitive impairment or mild cognitive impairment; 2) Conduct a group randomized trial to test the effect of ‘IKE Kupuna on vascular risk factors for ADRD and cognitive complaints and function over 12 months; and 3) Evaluate the cross-sectional association of vascular risk factors and APOE genotype with cognitive complaints and function. The NHPI elder population is increasing and their needs are escalating. This will be the first study to test a novel intervention to address ADRD in NHPIs and to assess the association APOE-ε4 genotype with cognitive function in this group.