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

项目概要/摘要 阿尔茨海默病（AD）是美国第六大死亡原因，是阿尔茨海默病最常见的形式。 老年痴呆症后期疾病进展过程、AD患病率和 死亡率是按性别和种族划分的。然而，风险因素的分布和相对重要性的变化， 如多Morphism，这可能会告知AD风险和认知变化的性别和种族差异， 时间不太了解。数据驱动的战略捕捉慢性病的动态本质 累积可能提供关于痴呆风险和认知功能差异的重要见解， 性别和种族。此外，一个强大的文献假设之间的联系心理社会弹性和压力 有痴呆风险和认知功能。然而，这些因素增强或减弱的程度 痴呆风险和认知功能差值得系统研究，并与新的 AD和老龄化研究的优先事项。为了解决这些差距，拟议的工作将调查协会 多发病轨迹，心理社会弹性/压力，痴呆风险和认知变化之间的关系 使用健康退休研究（2000-2018）的数据。我们提出两个目标：1）评估 心理社会复原力的影响（例如，知觉社会支持、自我效能和掌握）对关系的影响 多项运动轨迹与认知功能变化和痴呆事件之间的关系;以及2）评估 心理社会压力的影响（例如，歧视、长期压力、社会孤立）对关系的影响 在认知功能改变和痴呆事件之间的联系。指定 不同的预测痴呆风险和认知功能差的多项运动轨迹分类 代表了一个宝贵的贡献：澄清因素，传播性别和种族差异在晚年生活 进行性认知能力下降和痴呆风险;为干预措施和预防战略的设计提供信息 针对风险最大人群的心理社会复原力和压力; 对认知功能差的风险进行分层，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.