Perceived racism, cardiovascular disease risk, and neurocognitive aging

感知种族主义、心血管疾病风险和神经认知衰老

• 批准号: 10448789
• 负责人: Karin Schon
• 金额: $ 83.17万
• 依托单位: BOSTON UNIVERSITY MEDICAL CAMPUS
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-01 至 2027-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10448789
• 关键词: Address; Adult; African American population; Age; Aging; Algorithms; Alzheimer' s Disease; Alzheimer' s disease related dementia; Alzheimer' s disease risk; Ambulatory Blood Pressure Monitoring; Ambulatory Monitoring; American; American Heart Association; Amygdaloid structure; Atherosclerosis; Biological; Biological Markers; Biometry; Black American; Black race; Blood Pressure; Blood Tests; Brain; Cardiology; Chronic; Chronic stress; Cognitive; Data; Discrimination; Education; Elderly; Episodic memory; Equation; Exhibits; Family; Family history of; Fasting; Future; Genetic Risk; Goals; Head; Health; Health Policy; Hippocampus (Brain); Human; Hypersensitivity skin testing; Implicit Association Test; Institutional Racism; Interview; Knowledge; Left; Life; Life Stress; Link; Lipids; Magnetic Resonance Imaging; Measures; Medial; Mediating; Mediation; Mediator of activation protein; Memory; Memory Loss; Mental Depression; Mental Health; Methods; Modeling; Nerve Degeneration; Neurobiology; Neurocognitive; Neuropsychology; Outcome; Participant; Population Heterogeneity; Prefrontal Cortex; Proxy; Recording of previous events; Risk; Risk Factors; Social Discrimination; Societal Factors; Socioeconomic Status; Source; Sterile coverings; Structural Racism; Structure; System; Testing; Thick; Time; Tweens; White Matter Hyperintensity; aged; aging brain; base; biobehavior; black women; brain health; cardiovascular disorder risk; cardiovascular health; caucasian American; cognitive neuroscience; cognitive testing; college; community engagement; comorbidity; depressive symptoms; executive function; experience; geriatric mental health; health disparity; health inequalities; healthy aging; indexing; neuropathology; people of color; perceived discrimination; physical conditioning; predictive modeling; racism; recruit; relating to nervous system; residential segregation; sex; social; social factors; social interventions; social stress

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.

人们越来越认识到种族主义会让我们生病。美国黑人的可能性是美国白人的两倍 患有阿尔茨海默病（AD）的可能性与遗传风险无关。尽管有这些知识，但人们知之甚少 关于长期的种族主义经历是否以及如何影响内侧颞海马（MTH）以及 前额叶执行系统完整性，即 AD 中表现出严重神经退行性变的系统。虽然科莫- 尽管疾病和社会经济地位导致 AD 健康差异，但差异仍然存在。这凸显了 了解造成大脑健康差异的社会和社会因素的迫切需求尚未得到满足。一个专业 造成美国健康不平等的一个因素是种族主义在一生中的累积影响造成的慢性压力—— 时间。尽管慢性压力对 MTH 和前额叶系统的负面影响众所周知，但较少 人们理解长期的人际和制度/结构性种族主义的影响、独特而突出的形式 美国黑人的慢性压力对这些大脑系统的神经认知完整性造成影响。自从察觉到种族歧视 导致心血管疾病 (CVD) 危险因素的健康差异，这也是 AD 的危险因素， 感知到的种族主义也会对 AD 健康差异产生重大影响。为了支持这一点，我们的预 初步数据显示，老年黑人女性感知到的种族主义预示着未来主观记忆力下降， 这在一定程度上是由抑郁症状介导的，而更大的社会歧视预示着 老年人的记忆力较差，杏仁核和海马头部体积较小。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 该应用程序旨在研究种族主义对神经认知 MTH 记忆和前额叶执行能力的影响 黑人老年人的系统完整性并检查潜在的潜在生物机制。我们的中央hy- 假设是，经历过较高程度的长期种族主义、认知健康的黑人老年人将 与那些有过相关经验的人相比，他们表现出更大的 CVD 风险（目标 1）以及较差的 MTH 和前额叶完整性（目标 2） 一生中发生的种族主义事件较少。我们进一步假设 CVD 风险和心理健康将 调解（即解释）感知到的种族主义与神经认知完整性之间的关系（探索性 目的）。将通过结构化访谈和制度/结构性评估所感知的人际种族主义 基于种族居住隔离的种族主义。十年 CVD 风险将使用 2013 年动脉粥样硬化指数进行评估 旋转性 CVD (ASCVD) 风险算法，包含从空腹血液测试和血液中获得的脂质和其他生物标志物 来自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 磁共振成像。此外，我们将使用结构方程模型来检查种族主义、CVD 之间的相互关系 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技术至关重要 健康老龄化的卫生政策以及生物行为和社会干预措施。