The Voices of our Elders

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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.