Perceived racism, cardiovascular disease risk, and neurocognitive aging

越来越多的人认识到种族主义让我们生病。美国黑人是白色美国人的两倍， 阿尔茨海默病（AD）与遗传风险无关。尽管有这些知识， 关于种族主义的慢性经历是否以及如何有助于内侧颞海马（MTH）， 前额叶执行系统的完整性，在AD中表现出深刻的神经退行性变的系统。虽然comor- 尽管疾病和社会经济地位对AD健康差异有贡献，但差异仍然存在。这凸显 一个关键的未满足的需求，了解社会和社会因素的差距，在大脑健康。一个主要 在美国，健康不平等的一个原因是由于种族主义对生活的累积影响而造成的慢性压力， 时间虽然慢性压力对MTH和前额系统的负面影响是众所周知的， 理解的是长期的人际和体制/结构性种族主义的影响，独特和突出的形式， 美国黑人的慢性压力，对这些大脑系统的神经认知完整性。自从种族歧视 导致心血管疾病（CVD）风险因素的健康差异，这也是AD的风险因素， 种族主义也会对AD健康差异产生重大影响。为此，我们的预... 初步数据显示，年长黑人女性感知到的种族主义预示着未来的主观记忆力下降， 这部分是由抑郁症状介导的，更大的社会歧视预测 老年人的记忆力更差，杏仁核和海马体体积更小。尽管有这些知识， 种族主义对黑人老年人神经认知完整性的累积影响仍然未知。的目标 本研究旨在探讨种族主义对神经认知的MTH记忆和前额叶执行功能的影响 系统的完整性，并检查潜在的生物学机制。我们的中央卫生- 假设是，认知健康的黑人老年人谁经历了更高水平的慢性种族主义将 显示出更大的CVD风险（目标1）和更差的MTH和前额叶完整性（目标2）比那些有经验的人， 在一生中，种族主义的例子越来越少。我们进一步假设心血管疾病风险和心理健康将 介导（即，解释）感知种族主义和神经认知完整性之间的关系（探索性 Aim）。将通过结构化访谈和机构/结构性评估被认为的人际种族主义。 基于种族居住隔离的种族主义。将使用2013年动脉粥样硬化量表评估10年CVD风险- 红细胞性CVD（ASCVD）风险算法，脂质和其他生物标志物从空腹血液检查和血液 动态血压监测的压力。神经认知MTH和前额叶系统的完整性将 分别使用情景记忆和执行功能的认知评估进行检查，并构建 常规MRI。此外，我们将使用结构方程模型来研究种族主义，心血管疾病， 风险、心理健康和神经认知完整性。解决这一知识差距对于开发新的 健康老龄化的卫生政策以及生物行为和社会干预措施。

There is increasing knowledge that racism makes us sick. Black Americans are twice as likely as White Ameri- cans to have Alzheimer’s disease (AD) independent of genetic risk. Despite this knowledge, little is known about whether and how chronic experiences of racism contribute to medial temporal hippocampal (MTH) and prefrontal-executive system integrity, systems that exhibit profound neurodegeneration in AD. Although comor- bid illnesses and socioeconomic status contribute to the AD health disparity, disparities remain. This highlights a critical unmet need for understanding social and societal contributors to disparities in brain health. A major contributor to health inequities in the U.S. is chronic stress due to the cumulative effects of racism over the life- time. Although the negative impact of chronic stress on the MTH and prefrontal systems is well known, less understood is the impact of chronic interpersonal and institutional/structural racism, unique and salient forms of chronic stress in Black Americans, on neurocognitive integrity of these brain systems. Since perceived racism contributes to health disparities in cardiovascular disease (CVD) risk factors, which are also risk factors for AD, perceived racism should have a significant impact also on the AD health disparity. In support of this, our pre- liminary data show that perceived racism in older Black women predicts future subjective memory decline, which was in part mediated by depressive symptoms, and that greater perceived social discrimination predicts poorer memory and lower amygdala and hippocampal head volumes in older adults. Despite this knowledge, the cumulative impact of racism on neurocognitive integrity in Black seniors remains unknown. The objective of this application is to investigate the impact of racism on neurocognitive MTH-memory and prefrontal-executive system integrity in Black seniors and to examine potentially underlying biological mechanisms. Our central hy- pothesis is that cognitively healthy Black seniors who have experienced higher levels of chronic racism will show greater CVD risk (Aim 1) and poorer MTH and prefrontal integrity (Aim 2) than those who have experi- enced fewer instances of racism over the lifetime. We further hypothesize that CVD risk and mental health will mediate (i.e., explain) the relationship between perceived racism and neurocognitive integrity (Exploratory Aim). Perceived interpersonal racism will be assessed with a structured interview and institutional/structural racism based on racial residential segregation. Ten-year CVD risk will be assessed using the 2013 Atheroscle- rotic CVD (ASCVD) risk algorithm, with lipid and other biomarkers obtained from a fasting blood test and blood pressure from ambulatory blood pressure monitoring. Neurocognitive MTH and prefrontal system integrity will be examined using a cognitive assessment of episodic memory and executive function, respectively, and struc- tural MRI. Further, we will use structural equation modeling to examine interrelationships between racism, CVD risk, mental health, and neurocognitive integrity. Addressing this knowledge gap is critical for developing new health policies and biobehavioral and social interventions for healthy aging.