Explaining racial and ethnic Alzheimer’s disease disparities with joint estimation of life course social inequities and measurement bias in verbal memory assessment

通过生命历程社会不平等和言语记忆评估中测量偏差的联合估计来解释种族和民族阿尔茨海默病差异

• 批准号: 10728325
• 负责人: William Goette
• 金额: $ 3.83万
• 依托单位: UT SOUTHWESTERN MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-01 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10728325
• 关键词: Adult; Affect; Aging; Alzheimer disease detection; Alzheimer' s Disease; Alzheimer' s disease diagnosis; Alzheimer' s disease related dementia; Alzheimer' s disease risk; Behavioral; Cessation of life; Childhood; Clinical; Cognitive; Cognitive aging; Complex; Data Set; Dementia; Detection; Development; Diagnosis; Disease; Disparate; Disparity; Early Diagnosis; Education; Equation; Equity; Ethnic Origin; Ethnic Population; Face; Fellowship; Food; Funding; Goals; Grant; Growth; Health; Health Disparities Research; Health Services Accessibility; Health and Retirement Study; Impaired cognition; Impairment; Individual; Inequity; Institutional Racism; Joints; Learning; Life Cycle Stages; Life Experience; Link; Longevity; Measurement; Measures; Mediating; Memory; Mentors; Methods; Minority Groups; Modeling; National Institute on Aging; Neuropsychological Tests; Neuropsychology; Occupational; Pathway interactions; Persons; Production; Property; Protocols documentation; Psychometrics; Race; Registries; Research; Research Personnel; Risk; Risk Reduction; Role; Sampling; Social Class; Social Justice; Social Mobility; Socioeconomic Status; Statistical Methods; Stress; Structural Racism; Sum; Telephone Interviews; Test Result; Testing; Time; Training; Training Support; United States; accurate diagnosis; aging population; brain health; caregiving; cognitive interview; cognitive testing; data harmonization; dementia risk; diagnostic accuracy; disease disparity; ethnic difference; ethnic disparity; ethnic minority; health care availability; health data; health disparity; improved; marginalization; marginalized population; mental state; novel; perceived discrimination; performance tests; psychosocial; racial bias; racial difference; racial disparity; racial minority; racial population; response; screening; segregation; social; social culture; social determinants; social factors; social stress; statistics; stressor; theories; verbal

Project Summary/Abstract Marginalized populations have both greater rates of Alzheimer’s disease (AD) and greater risk of misdiagnosis, which can delay access to treatment and caregiving. These differences reflect a life course cascade of social inequity in the United States that disproportionately impacts historically marginalized racial and ethnic groups and results in a host of physical and cognitive health disparities. Racial and ethnic differences in neuropsychological test performance, which is commonly used to diagnose AD, are well- documented and may contribute to racial/ethnic differences in the detection and diagnosis of AD. The effects of this structural racism begin in early life experiences and extend to educational and occupational opportunities, social mobility, wealth accumulation, and stress. Differences in social classes of origin (SCO) often persist across the lifespan and develop into differences in adult socioeconomic status (SES). Associated with adult SES are additional contextual SES factors that can mediate health risks like food scarcity and access to healthcare. Beyond SES and associated financial stressors, racial and ethnic minorities also face greater social stress from experiences of discrimination, which have been linked to greater cognitive risk. These differences in risk compound measurement biases in neuropsychological testing, making accurate diagnosis of impairment more difficult and contributing to the observed racial/ethnic differences in scores. The proposed study will examine these complex life course factors to better understand why racial and ethnic disparities arise in AD and how clinicians can reduce the risk of misdiagnosis. In order to study each of these factors in the necessary complexity, the Health and Retirement Study and Harmonized Cognitive Assessment Protocol datasets will be used to study the effects of SCO, adult SES, contextual SES factors, stress, and test bias on verbal memory, which robustly declines early in the AD disease course. The first two study aims utilize Bayesian explanatory item response theory to separate group-level racial/ethnic differences attributable to measurement bias in the tests themselves from the effects of life course social inequities as a cause of the group-level differences. The final aim will test the resulting models’ ability to improve diagnostic accuracy for AD among minority populations. In line with the National Institute of Aging’s Health Disparities Research Framework, these models leverage environmental, sociocultural, and behavioral factors to understand the interactions and pathways that life course differences have in normal and abnormal aging, dementia risk, and measurement bias. The fellowship will support training and mentoring in the complexities of normal and abnormal cognitive aging, sophisticated statistical methods, and role of social equity in AD assessment to support my growth as a researcher in AD disparities and the development of new methods to improve detection of AD among the increasingly diverse aging population.

项目概要/摘要 边缘化人群患阿尔茨海默氏病 (AD) 的比例较高，患阿尔茨海默病的风险也较高 误诊，可能会延误治疗和护理。这些差异反映了生命历程 美国一系列的社会不平等现象对历史上边缘化的种族产生了不成比例的影响 和种族群体，并导致一系列身体和认知健康差异。种族和民族 通常用于诊断 AD 的神经心理学测试表现的差异是显而易见的 记录并可能导致 AD 检测和诊断中的种族/民族差异。 这种结构性种族主义的影响始于早期的生活经历，并延伸到教育和教育领域。 职业机会、社会流动性、财富积累和压力。社会阶层的差异 起源（SCO）通常会在一生中持续存在，并发展成成人社会经济地位的差异 （SES）。与成人 SES 相关的是其他 SES 背景因素，可以调节食物等健康风险 稀缺性和获得医疗保健的机会。除了社会经济地位和相关的财务压力因素之外，种族和族裔也如此 还面临着来自歧视经历的更大社会压力，这与认知能力的提高有关 风险。神经心理学测试中风险复合测量偏差的这些差异使得准确 损伤的诊断更加困难，并导致观察到的种族/民族分数差异。 拟议的研究将检查这些复杂的生命历程因素，以更好地理解为什么种族和 AD 中存在种族差异以及临床医生如何降低误诊风险。为了研究每一个 这些因素具有必要的复杂性，健康与退休研究和协调认知 评估协议数据集将用于研究 SCO、成人 SES、背景 SES 因素、 压力和言语记忆测试偏差，在 AD 病程早期，言语记忆力急剧下降。前两个 研究目的利用贝叶斯解释性项目反应理论来区分群体层面的种族/民族差异 归因于测试本身的测量偏差，这是由于生命历程中社会不平等的影响 造成群体层面差异的原因。最终目标将测试所得模型改善诊断的能力 少数群体中 AD 的准确性。符合国家老龄化研究所的健康差异 研究框架，这些模型利用环境、社会文化和行为因素来 了解生命历程差异在正常和异常衰老中的相互作用和途径， 痴呆风险和测量偏差。该奖学金将支持复杂的培训和指导 正常和异常的认知衰老、复杂的统计方法以及社会公平在 AD 中的作用 评估以支持我作为 AD 差异研究人员的成长以及新方法的开发 提高对日益多样化的老龄化人口中 AD 的检测。

项目成果

Impact of word properties on list learning: An explanatory item analysis.

单词属性对列表学习的影响：解释性项目分析。

• DOI: 10.1037/neu0000810
• 发表时间: 2023
• 期刊: Neuropsychology
• 影响因子: 2.4
• 作者: Goette,WilliamF;Schaffert,Jeff;Carlew,Anne;Rossetti,Heidi;Lacritz,LauraH;DeBoeck,Paul;Cullum,CMunro
• 通讯作者: Cullum,CMunro