Epidemiology of Age-related Dementia, Mild Cognitive Impairment and Brain Pathology in a Multiethnic Cohort of Oldest-Old - Administrative Supplement

多种族老年人群体中年龄相关性痴呆、轻度认知障碍和脑病理学的流行病学 - 行政补充

• 批准号: 10075066
• 负责人: Maria Corrada
• 金额: $ 33.5万
• 依托单位: UNIVERSITY OF CALIFORNIA AT DAVIS
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-15 至 2022-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10075066
• 关键词: Acids; Administrative Supplement; Affect; African; Age; Alzheimer' s disease related dementia; Amyloid; Amyloid beta-Protein; Apolipoprotein E; Asians; Atrophic; Autopsy; Biological Markers; Blood; Blood Vessels; Brain; Brain Pathology; Brain imaging; California; Cerebrum; Cessation of life; Cognitive; Collection; Computerized Medical Record; DNA; Data; Dementia; Elderly; Enrollment; Ensure; Epidemiology; Equipment and supply inventories; Ethnic group; Etiology; Evaluation; Exhibits; Filament; Future; Goals; Health; Healthcare Systems; Image; Impaired cognition; Incidence; Individual; Investigation; Knowledge; Latino; Lesion; Life; Life Expectancy; Life Style; Light; Logistics; Longitudinal cohort study; Magnetic Resonance Imaging; Measures; Minority; Not Hispanic or Latino; Participant; Pathologic; Pathology; Pattern; Plasma; Play; Population; Population Heterogeneity; Positron-Emission Tomography; Prevention; Proteins; Quality of life; Recruitment Activity; Research; Research Design; Resources; Risk; Risk Factors; Role; SNP genotyping; Sampling; Serum; Specimen; Structure; Time; Ubiquitin; Value of Life; Whole Blood; age related; aged; aging brain; blood-based biomarker; cohort; cost; epidemiology study; ethnic diversity; ethnic minority population; health data; high risk population; imaging biomarker; insight; life history; member; middle age; mild cognitive impairment; mortality; neurofilament; neuroimaging; neuropathology; parent grant; prospective; protective factors; racial diversity; recruit; socioeconomics; tau Proteins; β-amyloid burden

ABSTRACT OF PARENT GRANT Though life expectancy in the US has steadily increased and many people live to age 90 and beyond, health and quality of life is extremely poor for most. While Alzheimer's disease and related dementias (ADRD) affect 15% of those age 65+, by age 90+, this number increases to a startling 40-50%. The oldest-old, people aged 90+, are the fastest growing segment of the elderly population in the US, currently comprising 4.7% and expected to increase to 11.5% by 2060. Yet there's an enormous dearth of information on the epidemiology of mild cognitive impairment (MCI) and ADRD in the oldest-old, particularly in non-whites and those from lower socioeconomic classes. This is highly problematic as the proportion of non-white minorities is rapidly increasing and by 2060 will represent 36% of the oldest-old. Dementia and MCI rates highly vary between ethnic groups at younger ages yet it is completely unknown if patterns are the same in the oldest-old. Brain imaging and neuropathology studies so far in oldest-old suggest that vascular pathologies, rather than AD, play a larger role in dementia, yet this hasn't been examined in non-Whites. Beyond the lack of demographic diversity in 90+ studies of oldest-old, there is a paucity of information on early and midlife risk and protective factors for ADRD and brain pathology in oldest-old. Lifecourse studies in the oldest-old are imperative; yet very costly and logistically challenging since studies encompassing multiple decades are needed. Thus, careful investigation of lifecourse health and protective mechanisms is strongly needed in this high risk population to tease apart which factors, at what point in time, may protect an individual. We propose an unprecedented epidemiologic study of MCI and Dementia in the oldest-old whom we have 30-50 years of prospectively collected life history and health data. Kaiser Permanente has an unparalleled cohort of almost 7121 individuals currently aged 90+ (36% Non-White) who participated in the Multiphasic Health Study (MHC) with baseline exams from 1964-1973, and follow-ups to 1991. These data, joined with granular electronic medical records from 1996–present provide an exceptional and comprehensive resource. Eight hundred MHC members aged 90+ (600 Non-White and 200 White) without dementia will enroll in a study of incident dementia and MCI. Structural MRI and Amyloid PET will be obtained on a random subsample of 200 individuals (150 Non White and 50 White) to characterize cerebral amyloid burden, vascular lesions, and atrophy. Brain donation for postmortem pathology will be sought from all 800 participants. Our overall objectives are to estimate incidence of dementia/MCI in a diverse cohort of oldest-old, identify midlife and late-life risk and protective factors, and understand the pattern of cerebral and brain pathologies in this diverse oldest-old population.

家长补助金摘要 尽管美国人的预期寿命稳步增长，许多人活到 90 岁甚至更久， 大多数人的健康和生活质量极差。而阿尔茨海默病和相关痴呆症 (ADRD) 影响 65 岁以上人群的 15%，到 90 岁以上，这个数字增加到惊人的 40-50%。最年长的人， 90 岁以上老年人口是美国老年人口中增长最快的部分，目前占 4.7% 预计到 2060 年将增加到 11.5%。然而，有关流行病学的信息却非常缺乏 老年人中的轻度认知障碍 (MCI) 和 ADRD，尤其是非白人和低收入群体 社会经济阶层。这是一个很大的问题，因为非白人少数族裔的比例正在迅速上升 到 2060 年，这一比例将持续上升，占最年长老年人的 36%。痴呆症和 MCI 的发病率差异很大 年龄较小的种族群体中存在这种现象，但完全不知道最年长的老年人的模式是否相同。脑 迄今为止，对最年长老年人的影像学和神经病理学研究表明，血管病理学而不是 AD 发挥着作用。 在痴呆症中发挥更大的作用，但尚未在非白人中进行研究。除了缺乏人口外 90 多项针对高龄老人的研究存在多样性，缺乏有关早年和中年风险和保护的信息 老年人 ADRD 和脑病理学的因素。对老年人的生命历程研究势在必行；却又非常 成本高昂且在后勤方面具有挑战性，因为需要进行数十年的研究。因此，小心 迫切需要对这一高危人群进行生命全程健康和保护机制的调查，以 梳理哪些因素、在什么时间点可以保护个人。我们提出前所未有的 我们前瞻性地进行了 30-50 岁老年人 MCI 和痴呆的流行病学研究 收集生活史和健康数据。 Kaiser Permanente 拥有一支由近 7121 名员工组成的无与伦比的团队 目前年龄超过 90 岁（36% 非白人），参加了多相健康研究 (MHC)，基线为 1964-1973 年的检查以及 1991 年的后续检查。这些数据与详细的电子病历相结合 从 1996 年至今提供了特殊且全面的资源。八百名年老的MHC会员 90 岁以上（600 名非白人和 200 名白人）没有痴呆症的人将参加一项关于突发性痴呆和 MCI 的研究。 结构 MRI 和淀粉样蛋白 PET 将在 200 名个体（150 名非白人）的随机子样本中获得 和50 White）来表征脑淀粉样蛋白负荷、血管病变和萎缩。大脑捐赠 将对所有 800 名参与者进行尸检病理检查。我们的总体目标是估计发病率 在不同的老年人群体中了解痴呆/MCI的情况，确定中年和晚年的风险和保护因素，以及 了解这个多样化的老年人群的大脑和大脑病理模式。