The Voices of our Elders

研究项目：摘要 到2050年，65岁及以上的美国印第安人的数量将增加两倍，达到162.4万人，而这些人的数量 85岁及以上的人将增加7倍，达到30万人。这些人口趋势引起了人们对人口的担忧 阿尔茨海默病和相关痴呆(ADRD)及其前驱症状、轻度认知障碍、 以及ADRD对医疗保健的需求。美国印第安人也经历了不成比例的ADRD负担 危险因素，如高血压和2型糖尿病。关于认知障碍和ADRD的现有数据 美国印第安人长老的数量仍然有限。此外，现有的少数关于美洲印第安人痴呆症的研究 仅限于美国中西部和西部。存在着对能够估计、跟踪、 预防并最终治疗ADRD。我们还需要权衡适当的公共卫生的经济成本 对美国东半部的美洲印第安人的干预。因此，我们建议第一个人口-- 一项旨在系统描述东部美洲印第安人社区ADRD特征的研究 我们。这一努力将是华盛顿州立大学、迈阿密大学和瓦巴纳基之间的合作伙伴关系 公共卫生，一个部落创建并指导的公共卫生区，为联邦承认的所有4个部落提供服务 缅因州，统称为瓦巴纳基部落。大约有875名55岁及以上的美国印第安人居住在这里 在4个部落的服务提供区域，对他们的认知功能或临床情况一无所知 患病率ADRD或多重认知功能障碍。我们将用部落名单邀请所有55岁的美国印第安人 年龄较大的人参加以人群为基础的流行病学研究(n=650，假设参与率为75% 根据先前的Wabanaki应答率)来评估认知功能和ADRD风险因素，并确定 可能有认知障碍或ADRD的人。我们还将进行一项病例对照验证研究， 一组参与者(n=260)，以对照临床结果验证我们的认知筛查结果 诊断性访谈，ADRD的黄金标准。最后，我们将对当前的卫生经济学进行分析 以及与ADRD相关的未来成本。我们的具体目标是：1)开展健康流行病学研究 ADRD和认知功能下降的生活方式风险因素，筛查流行的ADRD和轻度认知障碍 55岁及以上Wabanaki部落成员的损害；2)进行病例对照验证研究 将来自目标1的筛查结果与临床诊断访谈进行比较；以及3)使用来自目标1和目标2的数据 估计与ADRD和轻度认知障碍相关的当前和未来直接和间接成本 发病率和治疗。我们的研究将为和巴纳基公共卫生部门提供宝贵的公共卫生数据 美国印第安人，并为制定与ADRD相关的卫生干预措施做出贡献 瓦巴纳基社区和其他美洲印第安人的需求。

RESEARCH PROJECT: ABSTRACT The number of American Indians aged 65 and older will triple to 1,624,000 by 2050, while the number of those aged 85 and older will increase 7-fold to 300,000. These demographic trends raise concerns about the population prevalence of Alzheimer’s disease and related dementias (ADRD) and its prodrome, mild cognitive impairment, and the need for health care for ADRD. American Indians also experience a disproportionate burden of ADRD risk factors, such as hypertension and type 2 diabetes. Available data on cognitive impairment and ADRD among American Indian elders remain limited. Furthermore, the few existing studies on dementia in American Indians have been limited to the midwestern and western US. There exists a need for studies that can estimate, track, prevent, and, eventually treat ADRD. We also need to weigh the economic costs of appropriate public health interventions for American Indians in the eastern half of the US. Accordingly, we propose the first population- based study designed to systematically characterize ADRD among American Indian communities in the eastern US. This effort will be a partnership between Washington State University, the University of Miami, and Wabanaki Public Health, a tribally founded and directed public health district serving all 4 federally recognized tribes in Maine, collectively known as the Wabanaki tribes. Approximately 875 American Indians aged 55 and older reside in the service delivery areas of the 4 tribes, yet nothing is known about their cognitive function or clinical prevalence ADRD or multiple cognitive impairment. We will use tribal rolls to invite all American Indians aged 55 and older to participate in a population-based epidemiologic study (n = 650, assuming 75% participation based on prior Wabanaki response rates) to assess cognitive function and ADRD risk factors, and to identify people with probable cognitive impairment or ADRD. We will also conduct a case-control validation study with a subset of participants (n = 260) to validate our cognitive screening results against the results of a clinical diagnostic interview, the gold standard in ADRD. Finally, we will conduct a health economics analysis of current and future costs associated with ADRD. Our Specific Aims are to: 1) Conduct an epidemiologic study of health and lifestyle risk factors for ADRD and cognitive decline, and screen for prevalent ADRD and mild cognitive impairment among Wabanaki tribal members aged 55 and older; 2) Conduct a case-control validation study comparing screening results from Aim 1 to a clinical diagnostic interview; and 3) Use data from Aims 1 and 2 to estimate current and future direct and indirect costs associated with ADRD and mild cognitive impairment morbidity and treatment. Our study will contribute invaluable public health data for Wabanaki Public Health and American Indians nationally, and contribute to the development of ADRD-related health interventions tailored to the needs of Wabanaki communities and other American Indian populations.