The Role of Mid-life Psychosocial Stressors, Social Resources and Physiological Dysregulation in Understanding Race Differences in Cognitive Decline

摘要 随着个人年龄的增长，记忆、学习和决策的逐渐变化自然会发生；然而， 认知功能减退的速度加快可能是即将出现的损伤和痴呆症的迹象。种族和民族 少数族裔比白人痴呆症负担更重，患病率和发病率约为2-3 黑人的比例是白人的三倍。这些差异通常被归因于社会经济差异。 身份、生活方式因素、慢性病和儿童状况。在考虑到这些因素的同时， 为了缩小这些差异，黑人和白人的差异经常存在，需要检查其他 这种不平等的决定因素，特别是在生命过程的早期阶段。最近的研究表明 黑人的认知能力衰退始于中年。这一早些时候的下降速度可能是由于差异 暴露于中年的急性和慢性应激源。年龄较大的种族和少数民族通常报告说 与白人相比，他们暴露在压力之下，这使得他们健康状况不佳的风险更大。这些应激源可能 加速关键生理系统的失调，包括心血管、代谢和免疫 系统，这与认知结果有关。因此，种族差异的压力暴露导致 生理功能的差异可能是应激源通过不同途径影响 黑人和白人的认知功能。此外，社会资源，如社会支持、参与度和 融合与积极的认知结果相关，并可能防止 急性和慢性应激源对认知功能的影响。这项提案的首要目标是评估 急、慢性应激源、社会资源和生理失调对黑白人群的影响 认知功能变化的差异。我们将：确定急性和慢性应激源是否在中期 生活与认知衰退有关，以及它们是否解释了认知衰退中的黑人和白人的差异 (目标1)：检查生理失调的变化是否调节中年之间的关系 压力和认知衰退(目标2)；以及，确定中年社会资源的可获得性是否影响 压力与认知衰退之间的关系(目标3)。最后，我们将测试一个概念模型 包括急性和慢性应激源、社会资源和生理因素在内的认知衰退 种族和性别特定群体的失调(目标4)。为了实现这些目标，我们将使用来自 健康与退休研究和包含随机截获和随机的线性混合效应模型 坡度。这项研究的发现将提高我们对影响衰老的中年因素的理解 和认知功能的差异，从而与国家老龄研究所的目标B和F一致 战略规划。这项研究还将有助于确定干预点以及可修改的风险和保护措施 认知衰退的因素，这与PA-18-850的目标一致。

ABSTRACT As individuals age, gradual changes in memory, learning and decision-making naturally occur; however, accelerated rates of cognitive decline may be signs of impending impairment and dementia. Racial and ethnic minorities carry a greater dementia burden than whites with a prevalence and incidence rate approximately 2-3 times higher among blacks than whites. These disparities are often attributed to differences in socioeconomic status, lifestyle factors, chronic conditions and childhood conditions. While accounting for these factors tends to reduce these disparities, the black-white difference often persists, warranting examination of other determinants of this inequity, particularly at earlier stages of the life course. Recent research suggest that cognitive decline among blacks begins during mid-life. This earlier rate of decline may be due to differential exposure to mid-life acute and chronic stressors. Older racial and ethnic minorities generally report greater exposure to stress compared to whites, which puts them at greater risk for poor health. These stressors can accelerate dysregulation of key physiological systems, including the cardiovascular, metabolic and immune systems, which are associated with cognitive outcomes. Thus, race differences in stress exposure that lead to differences in physiological functioning may be one pathway through which stressors differentially affect the cognitive function of blacks and whites. Additionally, social resources, such as social support, engagement and integration are associated with positive cognitive outcomes and may protect against the negative effects of acute and chronic stressors on change in cognitive function. The overarching goal of this proposal is to assess the role of acute and chronic stressors, social resources and physiological dysregulation on black-white differences in change in cognitive function. We will: determine whether acute and chronic stressors during mid- life are associated with cognitive decline and whether they explain black-white differences in cognitive decline (Aim 1); examine whether change in physiological dysregulation mediates the relationship between mid-life stress and cognitive decline (Aim 2); and, determine whether mid-life availability of social resources influences the relationship between stress and cognitive decline (Aim 3). Finally, we will test a conceptual model for cognitive decline that incorporates acute and chronic stressors, social resources and physiological dysregulation across race- and sex-specific groups (Aim 4). To achieve these aims, we will use data from the Health and Retirement Study and linear mixed effects models that include random intercepts and random slopes. The findings from this research will improve our understanding of mid-life factors that influence aging and disparities in cognitive function, thus aligning with Goal B and F of the National Institute on Aging’s Strategic Plan. This research will also help identify points of intervention and modifiable risk and protective factors for cognitive decline, which aligns with the objectives of PA-18-850.