Mechanisms of Cognitive Decline Across Socioeconomic and Clinical Contexts

项目摘要/摘要 与美国人的社会经济地位(SEP)相关的健康结果不平等正在加剧，尽管最近 有证据表明，美国黑人和白人之间的预期寿命差距可能正在缩小。贫富差距 职业生涯顶层和底层之间的预期寿命(考虑到50岁的寿命) 在过去的20年里，收入几乎翻了一番。2新的研究表明，这些不平等 在对认知衰退的研究中也观察到了这一点，种族和少数民族以及低收入者 在多项研究中表现出较早发病或认知功能下降较快的社会经济状况。一个 对健康与退休研究的分析进一步发现，社区的社会经济地位 (SEP)和心血管危险因素会增加老年人认知功能低下的几率。 我们目前由NIA资助的研究《动脉粥样硬化风险的建模和预测：复杂系统方法》 (R01AG055480)正在利用电子健康记录(EHR)数据，这是首个以人口为基础的区域数据 登记，以了解社区社会环境如何影响整个生命过程的心血管风险。 NeOCARE学习健康登记处包括从1999年到2019年收集的310多万人的数据 独特的个体，在俄亥俄州东北部因种族和民族而多样化。在本补充资料中，我们将实施 多方面的、基于系统的方法，用于联合建模认知和心血管疾病的风险。我们的 工作将评估社区条件对阿尔茨海默氏症发病率和患病率的影响 相关痴呆症。我们还将描述高血压和认知功能之间的关系 社会经济谱，特别关注抗高血压治疗的中介影响。 最后，我们的目标是调查和比较免疫血液学功能、肥胖和 心血管疾病和体感诱发电位对认知功能的影响。我们的研究结果有望改善 通过以下方式提高初级保健服务的效力和提供：(I)促进更深入地了解 而涉及患者社会和身体环境的长期背景因素会导致患者在 阿尔茨海默病的发病和结局；以及(2)确定和量化可改变风险的重要性 跨异质人群的因素，可用于制定针对人群的干预措施 预防或延缓阿尔茨海默氏症和痴呆症的发病。这项研究有望产生新的机理。 在未来的研究应用中用于测试的洞察力和假设，更准确和具有代表性的模型 预测阿尔茨海默病和痴呆症，并为多个战略和决策提供信息基础 程序化水平。

PROJECT SUMMARY/ABSTRACT Inequality in health outcomes in relation to Americans’ socioeconomic position (SEP) is rising, despite recent evidence that the life expectancy gap between black and white Americans may be decreasing1. The disparity in life expectancy (given survival to age 50) between individuals in the top and bottom deciles of career earnings has nearly doubled over the last 20 years.2 Emerging research has indicated that these inequalities are also observed in studies of cognitive decline, with racial and ethnic minorities and persons of low socioeconomic status demonstrating earlier onset or more rapid cognitive decline in multiple studies. An analysis of the Health and Retirement Study has further found that neighborhood socioeconomic position (SEP) and cardiovascular risk factors increase the odds of poor cognitive function among older adults. Our current NIA-funded study, “Modeling and Forecasting Atherosclerotic Risk: A Complex Systems Approach” (R01AG055480) is utilizing electronic health record (EHR) data in a first-of-its-kind regional, population-derived registry to understand how neighborhood social contexts influence cardiovascular risk across the life course. The NEOCARE Learning Health Registry includes data collected from 1999 to 2019 on more than 3.1 million unique individuals, diverse by race and ethnicity in Northeast Ohio. In this supplement we will implement a multifaceted, systems-based approach for jointly modeling risk of cognitive and cardiovascular disorders. Our work will evaluate the influence of neighborhood conditions on incidence and prevalence of Alzheimer’s and related dementias. We will also describe the relationship between hypertension and cognitive function across the socioeconomic spectrum, with a special focus on the mediating influence of antihypertensive therapies. Lastly, we aim to investigate and compare the influence of immuno-hematologic function, obesity and cardiovascular disease and SEP on cognitive function. The results of our study are expected to improve the effectiveness and delivery of primary care services by (i) promoting a deeper understanding about how short and long-term contextual factors involving patients’ social and physical environments lead to variation in Alzheimer’s disease onset and outcomes; and (ii) identifying and quantifying the importance of modifiable risk factors across heterogeneous populations that can be used to develop population-specific interventions to prevent or delay the onset of Alzheimer’s and dementia. This research is anticipated to yield new mechanistic insights, hypotheses for testing in future research applications, more accurate and representative models for predicting Alzheimer’s disease and dementia, and a basis for informing decisions at multiple strategic and programmatic levels.