International Labor Migration, Armed Conflict and Dementia Risk in Nepal: A Population Study

这项申请的总体目标是为一个以人口为基础的可持续方案奠定基础。 在尼泊尔进行阿尔茨海默病和相关痴呆症（ADRD）的研究。为此，该项目力求 启动一系列研究能力建设活动，并制定一个新的、以人口为基础的、纵向的 ADRD和相关年龄相关慢性健康状况的队列研究。人口老龄化 在许多低收入和中等收入国家（LMIC），这种情况越来越普遍。结果这些 这些国家面临着日益沉重的与年龄相关的常见慢性病负担，包括ADRD。尼泊尔是一个 中低收入国家，人口正在老龄化，使越来越多的成年人面临失业的风险。 发展ADRD。尼泊尔实际上没有研究能力调查这一现象的范围和主要原因， ADRD的决定因素，甚至最基本的信息ADRD目前缺乏。该等资料不 迫切需要指导预防战略的制定，并减少ADRD的负担， 国家能力建设活动将侧重于调查数据收集方法方面的培训， 关于ADRD的确定和纵向面板复杂数据分析的统计方法 调查。这些活动将包括举办讲习班， 认知评估，以确定ADRD在一般人群中，并在统计分析方法， 复杂调查的纵向数据。该项目还将开始一项新的ADRD纵向队列研究 旨在填补尼泊尔有关ADRD及其主要风险因素的信息方面的巨大空白。将重点 两个新的风险因素对于了解尼泊尔ADRD的负担特别重要。第一个涉及 国际劳动力迁移的作用：尼泊尔成年人的很大一部分花了很长一段时间， 成年人在其他国家工作，为家庭赚取收入，往往是在具有挑战性的情况下。的 第二个风险因素涉及武装冲突的长期影响， 10年（1996-2006）。劳动力迁移和武装冲突对ADRD风险的影响目前尚不清楚。 这项研究将利用为奇旺谷家庭开发的数据收集基础设施 这项研究是一项始于1996年的人口调查，有10 000多名15-59岁的参与者。这群人现在正在老龄化， 为开始ADRD和其他慢性健康状况的新人群研究提供了独特的机会。 这项研究将包括估计4,000名幸存的参与者，他们现在已经达到年龄（> 50岁）， 本研究该样本将被邀请进行基线访谈，包括详细的认知评估， 两年后的采访。将分享能力建设和研究活动的成果 与尼泊尔的相关利益攸关方和组织合作，为当地的预防解决方案和政策提供信息， 和ADRD的治疗。我们预计，这项工作的大部分将与其他 这些国家都是低资源、低收入国家，面临着与尼泊尔类似的情况和挑战。

The overall objective of this application is to lay the foundation for a sustainable program of population-based research into Alzheimer’s disease and related dementias (ADRD) in Nepal. To that end, the project seeks to initiate a series of research capacity building activities and develop a new, population-based, longitudinal cohort study of ADRD and related age-associated chronic health conditions in this population. Population aging is becoming increasingly more common in many low- and middle-income countries (LMIC). As a result, these countries face the growing burden of common age-associated chronic illnesses, including ADRD. Nepal is a low middle-income country where the population is now aging, putting a rising number of adults at risk of developing ADRD. There is virtually no research capacity in Nepal to investigate the scope and primary determinants of ADRD, and even the most basic information on ADRD is currently lacking. Such information is urgently needed to guide the development of prevention strategies and reduce the burden of ADRD in this country. Capacity building activities will focus on training in survey data collection methods with a primary focus on ascertainment of ADRD and statistical methods for the analysis of complex data from longitudinal panel surveys. The activities will consist of workshops with hands-on experience in the design and administration of cognitive assessments to identify ADRD in the general population, and in statistical analysis methods for longitudinal data from complex surveys. The project will also begin a new, longitudinal cohort study of ADRD designed to fill substantial gaps in information on ADRD and its primary risk factors in Nepal. It will focus on two novel risk factors with particular salience to understand the burden of ADRD in Nepal. The first involves the role of international labor migration: a substantial portion of Nepali adults spend prolonged periods of adulthood working in other countries to earn income for their families, often in challenging situations. The second risk factor involves the long-term effects of exposure to armed conflict that has affected this population for 10 years (1996-2006). The impact of labor migration and armed conflict on ADRD risk is currently unknown. The study will leverage the data collection infrastructure that has been developed for the Chitwan Valley Family Study, a population survey of >10,000 participants aged 15-59 that started in 1996. The cohort is now aging, providing a unique opportunity to begin a new population study of ADRD and other chronic health conditions. The study will include the estimated 4,000 surviving participants who have now become age-eligible (> 50) for this study. This sample will be invited for a baseline interview, including a detailed cognitive assessment, and a follow-up interview two years later. Outcomes from the capacity building and research activities will be shared with relevant stakeholders and organizations in Nepal to inform local solutions and policies for the prevention and treatment of ADRD in this population. We anticipate that much of this work will have relevance for other low-resource, low-income countries that face similar circumstances and challenges as Nepal.