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

项目总结/摘要 结构性种族主义和歧视造成的不公平的社会和环境背景， 阿尔茨海默病和相关痴呆症以及心血管疾病的患病率更高， 黑人/非裔美国老年人。目前的建议（1）探讨了隔离作为一种 10年认知和功能老化轨迹中种族差异的社区层面驱动因素，以及（2） 确定血管风险是否部分解释了隔离如何成为生物学嵌入， 在参加高级认知训练的黑人老年人中， 活力老年人（ACTIVE）研究。研究小组在以前的人口普查数据联系工作的基础上， 通过描述多个隔离指标（暴露、隔离、聚类）来估计SRD;采用 通过检查社会（隔离）和生物（血管风险）偶然性的多维研究方法 晚年认知和日常功能下降的途径;并描绘了隔离的影响 主观认知问题，客观神经心理学表现，以及生态有效性 日常运作的绩效衡量标准。这项工作符合NIA的PAS-19的直接目标- 391通过具体澄清造成和维持AD差异的重要途径;采取多方面的措施， 三维方法，以改善对纵向结果的环境/建筑风险因素的估计; 利用现有的大规模数据集来增强我们对转型背后因素的理解 从正常到病态这项提案的发现有望推动对可改变的 干预和预防途径，促进黑人老年人更公平的老龄化结果。

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.