Study of Aging Latinas/os for Understanding Dementia in HIV (SALUD HIV)

拉丁裔老龄化研究以了解艾滋病毒痴呆症 (SALUD HIV)

• 批准号: 10261346
• 负责人: MONICA G. RIVERA-MINDT
• 金额: $ 82.86万
• 依托单位: FORDHAM UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-15 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10261346
• 关键词: Acculturation; Address; Adult; Affect; African American; Age; Aging; Alzheimer' s Disease; Alzheimer' s disease related dementia; Attention; Biological; Biological Factors; Biological Markers; Biological Models; Brain; Cardiovascular system; Chronic; Cognition; Cognitive; Cognitive aging; Country; Data; Dementia; Elderly; Equation; Ethnic Origin; Goals; HIV; HIV Infections; HIV-associated neurocognitive disorder; Health; High Prevalence; Hippocampus (Brain); Impaired cognition; Impairment; Infection; Inflammation; Interleukin-6; Intervention; Laboratories; Latin American; Latina; Lead; Learning; Lesion; Literature; Magnetic Resonance Imaging; Medial; Memory; Mexican Americans; Modeling; Morbidity - disease rate; Nerve Degeneration; Neuropathogenesis; Not Hispanic or Latino; Outcome; Participant; Pattern; Population; Public Health; Puerto Rican; Research; Risk; Risk Factors; Sampling; Scientist; Severities; Severity of illness; Stress; Structure; Temporal Lobe; Testing; Ursidae Family; Variant; Work; advanced dementia; age related; aged; aging population; base; brain health; cerebrovascular; cognitive change; cognitive function; comorbidity; cytokine; design; ethnic disparity; executive function; gray matter; health disparity; health equity; high risk; improved; indexing; lens; memory process; multidisciplinary; multimodality; neurocognitive disorder; neuroimaging; neuroinflammation; personalized approach; processing speed; relating to nervous system; social; social culture; virology; white matter

HIV remains a major public health problem, particularly for the Latina/o population. US-dwelling Latinas/os are at increased risk for HIV-infection compared to non-Hispanic whites and suffer a disproportionate burden of HIV-associated neurocognitive disorder (HAND) which may be amplified with age. HIV-infected (HIV+) Latinas/os of Puerto Rican origin have the highest prevalence of HAND (~78%) of any group in the US (HIV+ Mexican Americans: 44%; African Americans: ~40%, & non-Hispanic whites: ~40%). Older HIV+ Latinas/os (50± years) appear to be at even greater risk for HAND and cognitive decline than their non-Hispanic white counterparts, and the pattern of cognitive impairment in HAND appears to differ by ethnicity. In the general HIV population, HAND is characterized by impairments in processing speed, attention, and executive functioning consistent with involvement of the frontostriatal circuitry. HIV+ Puerto Rican Latinas/os present an atypical amnestic memory profile more consistent with medial temporal lobe (MTL) involvement. Despite these important disparities, differing cognitive profiles and possible differences in affected neural structures, the literature on HAND in Latinas/os is almost entirely cross-sectional, does not include HIV-uninfected (HIV-) controls, lacks studies focused on brain integrity in this population, and has yet to examine the mechanisms underlying these disparities. Utilizing a culturally-tailored approach, the goals of this study are to investigate whether older HIV+ Latinas/os of Puerto Rican origin demonstrate worse patterns of decline in cognitive function and brain integrity compared to other ethnic/HIV status groups, and to uncover the biological (e.g., neuroinflammatory biomarkers [sTREM2, sCD14, sTNFR-II, & IL-6], cardiovascular burden) and sociocultural (e.g., acculturation, social adversity, stress) mechanisms conferring risk for neurodegenerative and cognitive changes in this population. To that end, this multidisciplinary study will deploy a longitudinal observational design with 90 HIV+ and 90 HIV-matched control adults (both groups will include: 70% Latina/o and 30% non- Hispanic white; aged 60-80 yrs) over 36-months. All participants will complete laboratory, neuromedical, multimodal neuroimaging, and comprehensive cognitive and sociocultural assessments. Longitudinal structural equation models will test relationships between ethnicity, HIV, and biological and sociocultural factors on cognition (global, learning, memory, & processing speed) and MRI brain indices (white matter lesion & MTL gray matter volumes; MTL intrinsic activity, & hippocampal intra-network connectivity). Addressing disparities in cognitive and brain health outcomes in Latinas/os offers a vital opportunity to elucidate HAND neuropathogenesis, disentangle the biological and sociocultural aspects of cognitive aging through the lens of HIV-infection, and identify modifiable factors to mitigate risk for cognitive decline. As this population is the fastest-growing sector of the US aging population, identifying culturally-relevant intervention targets to lower age-related cognitive morbidity in Latinas/os is key for promoting brain health equity and public health.

艾滋病毒仍然是一个主要的公共卫生问题，特别是对拉丁美洲人。居住在美国的拉丁美洲人/OS是 与非西班牙裔白人相比，他们感染艾滋病毒的风险增加， HIV相关的神经认知障碍（HAND），可能随着年龄的增长而扩大。艾滋病毒感染者（艾滋病毒+） 在美国，波多黎各裔的拉丁裔/非拉丁裔人群的HAND患病率最高（约78%）（HIV+ 墨西哥裔美国人：44%;非洲裔美国人：~ 40%，非西班牙裔白人：~40%）。老年艾滋病毒阳性拉丁美洲人/os (50±岁）似乎比非西班牙裔白色人患HAND和认知能力下降的风险更大。 HAND的认知障碍模式似乎因种族而异。在一般的艾滋病毒 HAND的特点是在处理速度、注意力和执行功能方面的障碍 与额纹状回路的参与一致。艾滋病毒+波多黎各拉丁裔/os呈现非典型 遗忘的记忆特征与内侧颞叶（MTL）受累更一致。尽管有这些 重要的差异，不同的认知特征和受影响的神经结构的可能差异， 关于拉丁美洲人HAND的文献几乎完全是横断面的，不包括未感染HIV的人（HIV-） 控制，缺乏针对该人群大脑完整性的研究，并且尚未研究其机制 这些差异的根源。本研究的目的是利用文化定制的方法，调查 波多黎各裔的老年HIV+拉丁裔/os是否表现出认知能力下降的更差模式， 功能和大脑完整性与其他种族/艾滋病毒状态组相比，并揭示生物学（例如， 神经炎性生物标志物[sTREM 2，sCD 14，sTNFR-II和IL-6]，心血管负担）和社会文化 (e.g.,文化适应，社会逆境，压力）机制赋予神经退行性和认知风险 这个人口的变化。为此，这项多学科研究将部署纵向观察 设计了90名HIV阳性和90名HIV匹配的对照成年人（两组均包括：70%的拉丁裔/o和30%的非拉丁裔/o）， 西班牙裔白色人;年龄60-80岁）36个月以上。所有参与者将完成实验室，神经医学， 多模式神经成像，以及全面的认知和社会文化评估。纵向结构 方程模型将测试种族、艾滋病毒、生物和社会文化因素之间的关系， 认知（整体、学习、记忆和处理速度）和MRI脑指数（白色物质病变和MTL 灰质体积; MTL内在活性，和海马内网络连接）。解决性别差异问题 拉丁美洲人的认知和大脑健康结果提供了一个重要的机会来阐明手 神经发病机制，通过以下透镜解开认知老化的生物和社会文化方面： 艾滋病毒感染，并确定可改变的因素，以减轻认知能力下降的风险。由于这一人口是 美国老龄化人口增长最快的部门，确定文化相关的干预目标，以降低 拉丁美洲人与年龄相关的认知发病率是促进大脑健康公平和公共卫生的关键。