Leveraging the Electronic Health Record and Integrating Social and Biological Data to Expand Dementia Research in Understudied Populations in Los Angeles County

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PROJECT SUMMARY This proposal requests UH2/UH3 funding to build a collaborative research program to study Alzheimer’s disease (AD) and AD related dementias (ADRD) in diverse populations through the UCLA Health System in Los Angeles County. This program is led by a multi-disciplinary team with expertise in AD/ADRD clinical and neurobiological (PI Vossel, Co-I Chang); social and environmental (PI Mayeda); sociocultural (Co-I Díaz-Santos, Adrissi); and genomic (Co-I Chang, Deters) research. The program is based in the Mary S. Easton Center for Alzheimer’s Research and Care (Director Vossel), which has robust ties with greater L.A. communities and ongoing education and outreach activities. AD and ADRD comprise syndromes with a spectrum of environmental, social, genomic, and clinical mechanisms. To improve our understanding of the heterogeneity of AD/ADRD, individuals from all groups, including traditionally understudied groups, must be studied. The UCLA Health System serves one of the largest Hispanic/Latinx (HL), Black, and Asian American/Pacific Islander (AAPI) populations in the United States. Traditional AD/ADRD recruitment of these understudied populations has been challenging. Leveraging electronic health records (EHR) tools to recruit understudied populations and analyzing routinely collected EHR data would lower the barrier to entry. Our objective is to recruit HL, Black, and AAPI AD/ADRD cohorts via EHR tools and partnerships with primary care clinics and communities. Next, we will evaluate recruitment efficiency of EHR tools and partnerships, followed by augmentation of EHR with social determinants of health (SDOH), genetic, blood biomarker, neuroimaging, and neurophysiology data to study mechanisms of AD/ADRD in these understudied populations. Our long-term goal is to develop and scale an EHR-linked AD/ADRD research infrastructure in L.A. County through UCLA Health’s network sites, allowing integration of SDOH, neurobiological and genomic data. We will improve recruitment and retention of understudied ADRD populations in research by enrolling 160 HL, 160 Black, and 100 AAPI AD/ADRD individuals and controls. In preliminary work, our team has integrated dementia screening in the EHR to improve AD and ADRD diagnosis in primary care and studied genomic, social, and environmental risk factors of AD and ADRD from the EHR. During the UH2 phase we will 1) utilize EHR tools in HL, Black, and AAPI AD/ADRD participant recruitment, 2) engage HL, Black, and AAPI community partners to improve study recruitment and design, and 3) share clinical, social, and genomic data on NIA-supported infrastructures. During the UH3 phase we will 4) evaluate dementia screening and EHR tools on AD and ADRD recruitment in HL, Black, and AAPI individuals, 5) identify AD endophenotypes from social determinants of health, blood biomarker, neurophysiologic, and comorbidity factors in HL, Black and AAPI individuals, and 6) predict AD among HL, Black, and AAPI individuals using polygenic risk, SDOH, and comorbidities. This innovative program will support our goal is to discover personalized risk factors that will yield early behavioral interventions and precise therapies.