Reducing Disparities in Dementia and VCID Outcomes in a Multicultural Rural Population

摘要 阿尔茨海默病和相关痴呆症（ADRD）影响数百万美国人。生活在农村地区的人面临 与城市/郊区居民相比，ADRD的患病率（OR=1.1）和发病率（OR=1.2）增加， 影响健康结果的差距扩大。可能增加ADRD风险的潜在因素和 健康结果包括：贫穷;教育程度低;卫生知识普及程度低;营养不良;烟草、酒精和药物 虐待;获得护理（专家、诊断测试）的机会有限;移民或边缘移民身份;以及 保险不足除了农村，种族和民族可能在ADRD中发挥作用。非洲裔美国人是2倍 西班牙裔可能是白人的1.5倍，可能是由于不同的风险， 特别是血管风险。这些社会、生物和遗传决定因素增加了多种慢性疾病的风险。 与血管对认知障碍和痴呆（VCID）的贡献相关的病症。我们建议 研究与ADRD相关的健康差异，更具体地说，在文化异质性老年人中研究VCID 生活在农村环境中的老年人与生活在城市/郊区环境中的老年人相比。比较人群 居住在（a）佛罗里达州棕榈海滩县的西部农村地区（当地称为“林中空地”）或（B） 棕榈海滩县（当地称为“海岸”）更大的都市和富裕的沿海部分。整体 假设是农村，结合低社会经济地位，文化特征，血管危险因素，环境 生活方式因素和遗传特征协同增加ADRD的风险，特别是VCID。这些相同 因素导致农村人口与类似老年人群体相比健康结果的差异 从城市/郊区社区。我们提出这些具体目标：（1）进行一次跨部门的人口- 基于Glades研究的参与者的表型和基因型，以确定ADRD/VCID的患病率; (2)对从目标1中随机选择的个人进行纵向研究，并与年龄和 种族/民族匹配的郊区/城市老年人样本，招募进行纵向随访;（3）评估 基线、18个月和36个月时，临床、功能、心理社会、遗传 和生物标志物变量和整个队列的认知表现，并按相关生物学指标分层。 变量;和（4）模型基线和纵向临床，功能，心理，行为，遗传， 预测认知障碍和从正常认知进展到MCI的速率的生物标志物变量，以及 整个队列的MCI至ADRD/VCID，并按相关生物学变量分层。我们的短期 目标是确定农村人群中从正常老龄化向ADRD/VCID转变的患病率和概况 与城市/郊区环境相比;识别和表征独特的遗传和生物标志物特征;并探索 大脑健康的社会和生物决定因素。我们的长期目标是减少健康差距。

ABSTRACT Alzheimer's disease and related dementias (ADRD) affect millions of Americans. Persons living in rural areas face increased prevalence (OR=1.1) and incidence (OR=1.2) of ADRD compared to urban/suburban dwellers with increased disparities affecting health outcomes. Underlying factors that may increase ADRD risk and disparities in health outcomes include: poverty; low education; poor health literacy; poor nutrition; tobacco, alcohol and substance abuse; limited access to care (specialists, diagnostic testing); migrant or marginal immigration status; and non- and underinsurance. In addition to rurality, race and ethnicity may play a role in ADRD. African Americans are 2 times as likely and Hispanics are 1.5 times more likely than Whites to develop ADRD that may be due to different risk profiles, particularly vascular risks. These social, biologic, and genetic determinants increase risk for multiple chronic conditions associated with vascular contributions to cognitive impairment and dementia (VCID). We propose to study health disparities associated with ADRD and more specifically VCID in culturally heterogeneous older adults living in a rural setting compared with older adults living in an urban/suburban setting. Comparison populations reside either in the (a) western rural portion of Palm Beach County, FL (locally referred to as “the Glades”) or (b) the more metropolitan and affluent coastal portion of Palm Beach County (locally referred to as “the Coast”). The overall HYPOTHESIS is that rurality, combined with low SES, cultural characteristics, vascular risk factors, environment and lifestyle factors, and genetic traits synergistically increase the risk for ADRD and in particular VCID. These same factors contribute to disparities in health outcomes for rural populations compared to similar groups of older adults from urban/suburban communities. We propose these SPECIFIC AIMS: (1) Conduct a cross-sectional, population- based study of the Glades with phenotype and genotype of participants to determine the prevalence of ADRD/VCID; (2) Conduct a longitudinal study of individuals randomly selected from Aim 1 and compare to an age- and racial/ethnicity-matched sample of suburban/urban older adults recruited for longitudinal follow-up; (3) Evaluate cross-sectional relationships at baseline, 18mos, and 36mos between clinical, functional, psychosocial, genetic, and biomarker variables and cognitive performance for the cohort as a whole, and stratified by relevant biological variables; and (4) Model baseline and longitudinal clinical, functional, psychosocial, behavioral, genetic, and biomarker variables to predict cognitive impairment and rate of progression from normal cognition to MCI, and MCI to ADRD/VCID for the cohort as a whole, and stratified by relevant biological variables. Our short-term goals are to determine prevalence and profile of transition from normal aging to ADRD/VCID, in a rural population compared to urban/suburban settings; identify and characterize unique genetic and biomarker features; and explore social and biologic determinants of brain health. Our long-term goal is to reduce health disparities.