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

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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.