Epidemiology of Age-related Dementia, Mild Cognitive Impairment and Brain Pathology in a Multiethnic Cohort of Oldest-Old

多种族老年人群体中年龄相关性痴呆、轻度认知障碍和脑病理学的流行病学

• 批准号: 9828946
• 负责人: Maria Corrada
• 金额: $ 1217.31万
• 依托单位: UNIVERSITY OF CALIFORNIA AT DAVIS
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-15 至 2022-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9828946
• 关键词: Epidemiology; Age; related; Dementia; Mild

Abstract Though life expectancy in the US has steadily increased and many people live to age 90 and beyond, health and quality of life is extremely poor for most. While Alzheimer's disease and related dementias (ADRD) affect 15% of those age 65+, by age 90+, this number increases to a startling 40-50%. The oldest-old (OO), people aged 90+, are the fastest growing segment of the elderly population in the US, currently comprising 4.7% and expected to increase to 11.5% by 2060. Yet there's an enormous dearth of information on the epidemiology of mild cognitive impairment (MCI) and ADRD in the OO, particularly in non-whites and those from lower socioeconomic classes. This is highly problematic as the proportion of non-white minorities is rapidly increasing and by 2060 will represent 36% of the OO. Dementia and MCI rates highly vary between ethnic groups at younger ages yet it is completely unknown if patterns are the same in the OO. Brain imaging and neuropathology studies so far in OO suggest that vascular pathologies, rather than AD, play a larger role in dementia, yet this hasn't been examined in non-Whites. Beyond the lack of demographic diversity in 90+ studies of OO, there is a paucity of information on early and midlife risk and protective factors for ADRD and brain pathology in OO. Lifecourse studies in the OO are imperative; yet very costly and logistically challenging since studies encompassing multiple decades are needed. Thus, careful investigation of lifecourse health and protective mechanisms is strongly needed in this high risk population to tease apart which factors, at what point in time, may protect an individual. We propose an unprecedented epidemiologic study of MCI and Dementia in the OO whom we have 30-50 years of prospectively collected life history and health data. Kaiser Permanente has an unparalleled cohort of almost 7121 individuals currently aged 90+ (36% Non-White) who participated in the Multiphasic Health Study (MHC) with baseline exams from 1964-1973, and follow-ups to 1991. These data, joined with granular electronic medical records from 1996–present provide an exceptional and comprehensive resource. Eight hundred MHC members aged 90+ (300 Black, 300 Asian, and 200 White) without dementia will enroll in a study of incident dementia and MCI. Structural MRI and Amyloid PET will be obtained on a random subsample of 200 individuals (75 Black, 75 Asian, 50 White) to characterize cerebral amyloid burden, vascular lesions, and atrophy. Brain donation for postmortem pathology will be sought from all 800 participants. Our overall objectives are to estimate incidence of dementia/MCI in a diverse cohort of OO, identify midlife and late-life risk and protective factors, and understand the pattern of cerebral and brain pathologies in this diverse OO population.

摘要 尽管美国的预期寿命稳步增长，许多人活到90岁及以上，但健康和 大多数人的生活质量极差。虽然阿尔茨海默病和相关痴呆症（ADRD）影响15% 在65岁以上的人中，到90岁以上，这个数字增加到惊人的40- 50%。The oldest old（OO），老年人 90岁以上是美国老年人口增长最快的部分，目前占4.7%， 预计到2060年将增加到11.5%。然而，关于流行病学的信息非常缺乏， OO中的轻度认知障碍（MCI）和ADRD，特别是在非白人和来自较低水平的人中， 社会经济阶层。这是一个很大的问题，因为非白人少数民族的比例正在迅速增加。 到2060年将占OO的36%。不同种族的痴呆症和MCI发病率差异很大 然而，我们完全不知道OO中的模式是否相同。脑成像和 到目前为止，OO中的神经病理学研究表明，血管病理学而不是AD在 痴呆症，但这还没有在非白人中进行过研究。除了90+人口缺乏多样性之外 OO的研究，缺乏关于ADRD的早期和中年风险和保护因素的信息， 脑病理学在OO中进行生命过程研究是必要的，但成本非常高，在后勤方面具有挑战性 因为需要进行几十年的研究。因此，仔细调查生命周期的健康状况， 在这一高风险人群中，强烈需要保护机制来区分哪些因素， 时间点，可以保护一个人。我们建议对MCI进行一项前所未有的流行病学研究， 我们前瞻性地收集了OO中的痴呆症患者30-50年的生活史和健康数据。Kaiser Permanente拥有无与伦比的近7121名年龄在90岁以上的人（36%非白人），他们 1964-1973年参加了多相健康研究（MHC），进行了基线检查， 1991.这些数据与1996年至今的详细电子医疗记录相结合，提供了出色的 综合资源。800名90岁以上的MHC成员（300名黑人，300名亚洲人和200名白色人） 没有痴呆症的人将参加痴呆症和MCI的研究。结构MRI和淀粉样蛋白PET将 从200名个体（75名黑人、75名亚洲人、50名白色人）的随机子样本中获得，以表征大脑特征 淀粉样蛋白负荷、血管病变和萎缩。死后病理学的大脑捐赠将从 800名参与者我们的总体目标是估计痴呆/MCI在不同人群中的发病率， OO，识别中年和晚年的风险和保护因素，并了解大脑和大脑的模式 在这个不同的OO人群中的病理学。