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

这项申请的总体目标是为以人口为基础的可持续方案奠定基础 尼泊尔阿尔茨海默病及相关痴呆症研究。为此，该项目寻求 启动一系列研究能力建设活动，制定新的、以人口为基础的、纵向的 该人群中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)越来越普遍。因此，这些 各国面临着包括ADRD在内的常见与年龄相关的慢性病日益沉重的负担。尼泊尔是一个 目前人口老龄化的低收入中等收入国家，使越来越多的成年人面临患上 发展ADRD。在尼泊尔几乎没有研究能力来调查范围和初级 目前缺乏ADRD的决定因素，甚至缺乏关于ADRD的最基本信息。这样的信息是 迫切需要指导制定预防战略，减轻反兴奋剂机构在这方面的负担 国家。能力建设活动的重点是调查数据收集方法方面的培训，重点是 纵向面板复杂数据分析中ADRD的确定及统计方法 调查。活动将包括在设计和管理方面具有实践经验的讲习班 认知评估，以确定一般人群中的ADRD，并在统计分析方法中 来自复杂调查的纵向数据。该项目还将开始对ADRD进行一项新的纵向队列研究 旨在填补尼泊尔关于ADRD及其主要风险因素的信息空白。它将专注于 两个新的风险因素具有特别突出的意义，以了解尼泊尔的ADRD负担。第一个问题涉及 国际劳工移徙的作用：相当一部分尼泊尔成年人长时间地 成年后在其他国家工作以赚取家庭收入，往往是在具有挑战性的情况下。这个 第二个风险因素涉及暴露在武装冲突中的长期影响，而武装冲突已影响到这一人口 为期10年(1996-2006年)。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特万山谷家族开发的数据收集基础设施 这项研究始于1996年，对10,000名年龄在15-59岁之间的参与者进行了人口调查。这群人现在正在老龄化， 提供了一个独特的机会，开始对ADRD和其他慢性健康状况进行新的人口研究。 这项研究将包括大约4000名幸存的参与者，他们现在已经达到了年龄(&>50) 这项研究。该样本将被邀请进行基线访谈，包括详细的认知评估，以及 两年后的后续采访。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一起，向当地提供预防艾滋病的解决方案和政策 在这一人群中进行ADRD的治疗。我们预计，这些工作中的大部分将与其他 与尼泊尔面临类似情况和挑战的低资源、低收入国家。

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.