Multimorbidity Trajectories, Psychosocial Resilience and Stress, and Risk of Dementia and Poor Cognitive Functioning

项目摘要/摘要 阿尔茨海默病(AD)是美国第六大致死原因，是最常见的 晚年的痴呆症。疾病进展、阿尔茨海默病患病率和 死亡率是由性别和种族决定的。然而，风险因素的分布和相对重要性的变化， 例如多发性疾病，这可能会导致AD风险和认知变化的性别和种族差异 时间并没有被很好地理解。数据驱动的策略捕捉慢性病的动态本质 积累可能通过以下方式提供关于痴呆症风险和认知功能差异的关键洞察 性别和种族。此外，一份强有力的文献假设了心理社会韧性和压力之间的联系。 有痴呆症风险和认知功能。然而，这些因素增强或减弱的程度 痴呆症风险和认知功能低下值得系统研究，并与新的 AD和衰老研究的优先事项。为了解决这些差距，拟议的工作将调查这种联系 多发病轨迹、心理社会复原力/压力、痴呆症风险和认知改变之间的关系 使用健康退休研究(2000-2018)的数据进行运作。我们提出了两个目标：1)评估 心理社会复原力(如领悟到的社会支持、自我效能感和掌握)对关系的影响 多发病轨迹与认知功能改变和偶发性痴呆之间的关系；以及2)评估 心理社会压力(如歧视、慢性压力、社会孤立)对关系的影响 多发病轨迹与认知功能改变和偶发性痴呆之间的关系。指定 不同预测痴呆症风险和认知功能不良的多病轨迹类别 在以下方面做出了宝贵贡献：澄清了在晚年生活中传播性别和种族差异的因素 渐进性认知衰退和痴呆症风险；为干预措施和预防策略的设计提供信息 针对高危人群的心理社会复原力和压力；并提高对 对认知功能低下的风险进行分层，以延缓AD的发展和进展。

PROJECT SUMMARY / ABSTRACT Alzheimer’s Disease (AD), the sixth leading cause of death in the US, is the most common form of dementia in later life. Substantial heterogeneity in the course of disease progression, AD prevalence, and mortality exist by gender and race. Yet, variations in the distribution and the relative importance of risk factors, such as multimorbidity, that may inform gender and racial differences in AD risk and cognitive change over time are not well understood. Data-driven strategies capturing the dynamic nature of chronic disease accumulation may offer critical insight regarding differences in dementia risk and cognitive functioning by gender and race. Further, a robust literature hypothesizes linkages between psychosocial resilience and stress with dementia risk and cognitive functioning. However, the extent to which these factors enhance or attenuate dementia risk and poor cognitive functioning merits systematic investigation and is in alignment with new priorities for AD and aging research. To address these gaps the proposed work will investigate the association between multimorbidity trajectories, psychosocial resilience/stress, dementia risk and changes in cognitive functioning using data from the Health Retirement Study (2000-2018). We propose two aims: 1) assess the effect of psychosocial resilience (e.g., perceived social support, self-efficacy, and mastery) on the relationship between multimorbidity trajectories and change in cognitive functioning and incident dementia; and 2) assess the effect of psychosocial stress (e.g., discrimination, chronic stress, social isolation) on the relationship between multimorbidity trajectories and change in cognitive functioning and incident dementia. Specifying multimorbidity trajectory classes that differentially predict dementia risk and poor cognitive functioning represents a valuable contribution in: clarifying factors that propagate gender and racial disparities in late life progressive cognitive decline and dementia risk; informing the design of interventions and preventive strategies targeting psychosocial resilience and stress among populations at greatest risk; and improving precision in stratifying risk for poor cognitive function to delay the development and progression of AD.