Late Life Learning, Dementia, and Overall Health: An Investigation of The University for Seniors in Beirut.

摘要 随着世界范围内老龄化人口的增长，确定可能保护阿尔茨海默氏症的因素 疾病和相关痴呆症（ADRD）是全球公共卫生优先事项。然而，一些关键的社会决定因素， ADRD，例如教育年限，在生命过程中较早完成，因此不容易改变 在老年。与此同时，越来越多的证据表明，参与认知刺激活动， 生命历程与认知和整体健康的改善有关。这些数据提出了一个令人信服的 假设晚年学习（LLL，正规证书学习之外的非正规教育活动） 可能提供一个机会窗口，在老年人，以减轻ADRD的风险，提供智力的前景， 激励和社会参与。然而，很少有研究评估LLL的益处。长期 我们研究的目标是确定我们如何干预以预防或延迟ADRD，特别是在资源匮乏的地区。 从事老龄化的机会有限的环境，如黎巴嫩，一个中低收入国家 （LMIC）。在阿拉伯区域，黎巴嫩的老年人比例最高， 暴露于许多生命过程中的心理社会逆境（例如，战争压力，财政困难）所有这些 预计会增加ADRD风险。目前的项目朝着我们的长期目标迈进， 这是一项创新研究，我们利用了贝鲁特美国大学正在进行的LLL项目， 老年大学（UfS），评估LLL对认知和整体健康的影响。UFS已经 已经运行了11年，其注册包括1,300名参与者，提供了一个完善的 这是我们开展研究的平台。关于LLL的信息将从UfS记录中提取。评估 在基线和随访访视时，将包括生活史问卷、认知成套测验等 措施这个研究应用程序，它建立在现有的合作调查小组之间， 美国和黎巴嫩（目标1）是一个详细的能力建设计划，旨在加强 在认知老化和ADRD、社会和生命过程等几个需要领域的研究能力 流行病学和定量方法，同时也为研究人员提供网络和支持基础， 黎巴嫩和该区域。对于这个项目，我们建议（目标2）设计一个以社区为基础的研究，3LC (Late生活学习，认知和衰老），包括500名以前登记的UfS参与者，200名新 登记的UfS参与者和700名年龄和性别匹配的非UfS参与社区居民;以及 (Aim 3）应用严格的分析技术来确定LLL与认知的关联强度 和相关结果，检查中介机制，以及LLL是否可以修改先前的影响， 心理社会暴露对认知和其他健康指标的影响。考虑到生理性别在痴呆症中的作用 风险，我们将允许男性和女性的不同模式。该应用程序将建立研究和基础设施 在黎巴嫩和其他资源匮乏的地区，确定痴呆症预防机会的能力。

Abstract As the aging population is growing worldwide, identifying factors that may confer protection for Alzheimer’s disease and related dementias (ADRD) is a global public health priority. Yet, several key social determinants of ADRD, such as years of education, are completed earlier in the lifecourse and are thus unamenable to change in older age. In parallel, growing evidence suggests that engaging in cognitively stimulating activities across the lifecourse is associated with improved cognition and overall health. These data put forward a compelling hypothesis that late life learning (LLL, non-formal educational activities outside formal credentialed learning) may provide a window of opportunity, in older age, to mitigate ADRD risk by providing prospects for intellectual stimulation and social engagement. Yet, very few studies have evaluated the benefits of LLL. The long-term goal of our research is to pinpoint how we can intervene to prevent or delay ADRD, especially in low-resourced settings where opportunities for engaged aging are limited such as in Lebanon, a low to middle income country (LMIC). Lebanon has the largest proportion of older adults in the Arab region, and Lebanese older adults are exposed to a host of lifecourse psychosocial adversities (e.g., war stressors, financial hardship) all of which would be expected to increase ADRD risk. The current project moves towards our long-term goal by proposing an innovative study in which we capitalize on an ongoing LLL program at the American University of Beirut, The University for Seniors (UfS), to evaluate the influence of LLL on cognitive and overall health. The UfS has been running for the last 11 years and its registry includes 1,300 participants, providing a well-established platform from which to launch our study. Information on LLL will be abstracted from UfS records. Assessments at the baseline and follow-up visits will include a life history questionnaire, a cognitive battery, among other measures. This research application, which builds on existing collaborations between investigative teams in the US and Lebanon, (Aim 1) is embedded within a detailed capacity building program aimed at enhancing research capacity in several needed areas such as cognitive aging and ADRD, social and lifecourse epidemiology, and quantitative methods, while also providing a networking and support base for researchers in Lebanon and the region. For this project, we propose to (Aim 2) design a community-based study, the 3LC (Late Life Learning, Cognition and Aging), by including 500 previously enrolled UfS participants, 200 newly enrolled UfS participants, and 700 age- and sex-matched non-UfS-participating community residents; and (Aim 3) apply rigorous analytical techniques to determine the strength of associations of LLL with cognition and related outcomes, examine mediating mechanisms, and whether LLL may modify the influence of prior psychosocial exposures on cognition and other health measures. Given the role of biological sex in dementia risk, we will allow for distinct models for men and women. This application will build research and infrastructure capacities to delineate opportunities for dementia prevention in Lebanon and other low-resourced settings.