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

家长资助金摘要 尽管美国人的预期寿命稳步增长，许多人活到了90岁以上， 对大多数人来说，健康和生活质量都非常差。而阿尔茨海默病和相关痴呆(ADRD) 65岁以上的人中有15%受到影响，到90岁以上，这个数字增加到惊人的40%-50%。最年长的，人们 90岁以上的老年人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，关于流行性感冒的流行病学信息非常匮乏。 轻度认知障碍(MCI)和ADRD在年龄最大的老年人中，特别是在非白人和低年龄人群中 社会经济阶层。这是非常有问题的，因为非白人少数民族的比例很快 不断增加，到2060年将占最年长老年人的36%。痴呆症和MCI的发病率在以下情况下差异很大 年龄较小的种族群体，但最年长的人是否也是如此，这是完全未知的。脑区 到目前为止，对老年患者的影像和神经病理学研究表明，血管病理而不是阿尔茨海默病起作用 在痴呆症中起到更大的作用，但这还没有在非白人身上进行研究。超越人口统计的缺失 在90多项关于高龄老年人的研究中，关于早年和中年风险和保护的信息很少 高龄老年人ADRD和脑病理的影响因素。对年龄最大的人进行终身学习是势在必行的；但 由于需要进行长达数十年的研究，因此成本高昂且在后勤方面具有挑战性。因此，要小心 在这一高危人群中，迫切需要对生命周期健康和保护机制进行调查 梳理出哪些因素，在什么时间点，可以保护一个人。我们提出一个史无前例的 30-50岁高龄人群MCI与痴呆的流行病学研究 收集生活史和健康数据。Kaiser Permanente拥有无与伦比的近7121人队伍 目前年龄90岁以上(36%非白人)，参与了多相健康研究(MHC)，并有基线 从1964年到1973年的考试，以及1991年的后续调查。这些数据与细粒度的电子病历相结合 从1996年至今提供了一种特殊和全面的资源。800名MHC成员年迈 90+(600名非白人和200名白人)没有痴呆症的人将参加一项关于痴呆症和MCI的研究。 结构磁共振成像和淀粉样蛋白PET将在200人(非白人150人)的随机亚样本中进行 和50白色)，以表征大脑淀粉样蛋白负荷、血管病变和萎缩。将大脑捐赠给 将对所有800名参与者进行尸检。我们的总体目标是估计发病率 在不同的高龄老年人队列中进行痴呆症/MCI的研究，确定中老年风险和保护因素，以及 了解这一多样化的老年人群中大脑和大脑病理的模式。

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.