The impact of segregation and the mediating effects of vascular risk on 10-year cognitive and functional outcomes in Black/African American older adults enrolled in the ACTIVE study

项目摘要/摘要 结构性种族主义和歧视(SRD)造成的不公平的社会和环境背景导致 阿尔茨海默氏症和相关痴呆症以及心血管疾病的更高患病率， 黑人/非裔美国老年人。目前的提案(1)探讨了种族隔离作为一种 10年认知和功能老龄化轨迹中种族差异的社区一级驱动因素，以及(2) 确定血管风险是否部分解释了隔离如何在生物上根深蒂固，并最终 在参加高级认知培训的黑人老年人中导致不良老龄化结果的因素 用于重要的老年人(积极)研究。研究小组在以前人口普查数据联系的基础上努力改进 通过表征隔离的多个指数(暴露、隔离、聚集)来估计SRD；采用 通过考察社会(隔离)和生物(血管风险)偶然的多维研究方法 晚年认知和日常功能衰退的途径；并描绘了种族隔离的影响 论主观认知关切、客观神经心理表现与生态有效性 以绩效为基础的日常运作衡量标准。这项工作符合NIA PAS-19的直接目标- 391通过具体阐明造成和维持AD差异的重要途径；采取多个 改进环境/建筑风险因素对纵向结果的估计的量纲方法； 并利用大规模的现有数据集来增强我们对潜在过渡因素的理解 从正常到病态。这项提案的发现有望推动对可修改的 在黑人老年人中促进更公平老龄化结果的干预和预防途径。

PROJECT SUMMARY/ABSTRACT Inequitable social and environmental contexts produced by structural racism and discrimination (SRD) have led to greater prevalence of Alzheimer’s disease and related dementias, as well as cardiovascular disease, among Black/African American older adults. The current proposal (1) explores the impact of segregation as a community-level driver of racial disparities in 10-year cognitive and functional aging trajectories, and (2) determines if vascular risk partially explains how segregation becomes biologically embedded and ultimately contributes to adverse aging outcomes among of Black older adults enrolled in Advanced Cognitive Training for Vital Elderly (ACTIVE) study. The study team builds upon previous census data linkage efforts to improve estimation of SRD by characterizing multiple indices of segregation (exposures, isolation, clustering); employs a multi-dimensional research approach by examining social (segregation) and biological (vascular risk) casual pathways of late-life declines in cognition and everyday functioning; and delineates the effects of segregation on subjective cognitive concerns, objective neuropsychological performance, and ecologically valid performance-based measures of everyday functioning. This work meets the direct goals of the NIA’s PAS-19- 391 by specifically clarifying important pathways that create and sustain AD disparities; taking a multi- dimensional approach to improve the estimation of environmental/built risk factors on longitudinal outcomes; and leveraging large scale existing datasets to enhance our understanding of factors underlying transitions from normal to pathological. Findings from this proposal are expected to advance research on modifiable intervention and prevention pathways that promote more equitable aging outcomes among Black older adults.