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)影响着数百万美国人。生活在农村地区的人面临着 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 健康后果包括：贫穷；教育程度低；健康素养差；营养不良；烟、酒和毒品 虐待；获得护理的机会有限(专家、诊断测试)；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。非裔美国人是2倍 西班牙裔患ADRD的可能性是白人的1.5倍，这可能是由于不同的风险造成的 个人资料，特别是血管风险。这些社会、生物和遗传决定因素增加了患多发性慢性病的风险 与认知障碍和痴呆症(VCID)的血管因素相关的疾病。我们建议 研究与ADRD相关的健康差异，更具体地说，研究不同文化背景的老年人中VCID的健康差异 与居住在城市/郊区的老年人相比，老年人生活在农村环境中。比较种群 居住在(A)佛罗里达州棕榈滩县的西部农村地区(当地称为“林地”)或(B) 棕榈滩县的大都会和富裕的沿海地区(当地人称之为“海岸”)。整体而言 假设是乡村，结合低SES，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了ADRD，特别是VCID的风险。这些是相同的 与类似的老年人群体相比，农村人口的健康结果存在差异的因素 来自城市/郊区社区。我们提出这些具体目标：(1)进行横断面、人口- 根据参与者的表型和基因型对沼泽地进行研究，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，并与年龄进行比较-和 招募郊区/城市老年人进行纵向随访的种族/民族匹配样本；(3)评估 在基线、18mo和36mo时，临床、功能、心理社会、遗传、 以及生物标志物变量和认知表现，作为一个整体，并按相关生物学分层 变量；和(4)模型基线和纵向临床、功能、心理社会、行为、遗传和 预测认知损害的生物标志物变量和从正常认知到MCI的进展率 MCI到ADRD/VCID，作为一个整体，并按相关生物变量分层。我们的短期计划 目标是确定农村人口从正常老龄化向ADRD/VCID转变的患病率和概况 与城市/郊区环境进行比较；识别和表征独特的遗传和生物标记特征；并探索 大脑健康的社会和生物决定因素。我们的长期目标是缩小健康差距。

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.