Risk and Resilience Factors in Memory Aging Among Older Cancer Survivors: A Cross Country Comparison of the US and England

记忆丧失是阿尔茨海默病和相关痴呆症（ADRD）的标志性症状。通过识别其 在早期阶段，可以制定干预措施来预防或减缓ADRD的进展。虽然之前的研究 研究了一般人群的记忆老化，老年癌症的长期记忆老化， 幸存者正在研究中。这是一个关键的证据差距，因为美国有2600万人， 到2040年，英国将有超过500万人成为癌症幸存者，超过70%的癌症幸存者 将超过65岁。美国和英国有不同的医疗保健系统，政府的社会安全网政策， 以及收入不平等的程度。因此，老年癌症幸存者在不同的社会，政治和 这两个高收入国家的经济环境。美国和英国的跨国比较 是一个机会，以确定驱动因素的个人水平的变化和人口水平的差异， 老年癌症幸存者的记忆老化。了解老年癌症幸存者的长期记忆老化 在一个跨国的框架将提高我们的知识，什么因素最重要的记忆老化， 老年癌症幸存者，可能是干预的目标。此K99/R 00提案利用纵向预处理， 以及来自两个全国代表性队列的癌症诊断后数据，美国健康和退休研究， (HRS)和英国老龄化纵向研究（艾尔莎），调查长期记忆轨迹， 2002年至2018年，N= 2，500名老年癌症幸存者。具体目的是：（1）识别和比较记忆 HRS和艾尔莎中癌症幸存者的总体和按年龄和性别（K99期）的轨迹;（2）识别和 比较癌症记忆老化中的个人、邻里和宏观社会经济不平等 HRS和艾尔莎（R 00阶段）中的幸存者;（3）确定可改变的风险和弹性因素的作用 （高血压，糖尿病，肥胖，抑郁症，体育活动，社会支持），因为这些可能 作为干预目标，以促进老年癌症幸存者（R 00期）的健康记忆老化。培训 该计划将建立在申请人在社会和癌症流行病学方面的先前培训的基础上，包括：（1）ADRD研究 （2）测量和分析多层次的社会经济暴露;（3）和 在跨国框架内进行复杂的纵向数据分析。这一综合培训将使 申请人成功的独立研究生涯，专注于健康老龄化的社会决定因素 在老年癌症幸存者中。申请人由一个有凝聚力的跨学科导师团队提供支持， 包括HRS和艾尔莎领导层。确定国家一级癌症相关疾病风险和复原力的差异 记忆老化对于告知人群水平的干预措施很重要，并将支持政策的探索， 未来研究中的相关决定因素。这项拟议中的研究将联合癌症生存和 ADRD研究通过使用跨国的、基于人群的方法来识别老年癌症的高危人群 幸存者加速记忆衰退，以及确定可改变的风险因素作为干预目标。

Memory loss is a hallmark symptom of Alzheimer’s disease and related dementias (ADRD). By identifying its early stages, interventions could be developed to prevent or slow ADRD progression. While previous research has examined memory aging among the general population, the long-term memory aging of older cancer survivors is under-studied. This is a critical evidence gap, as >26 million people in the United States (US) and >5 million people in the United Kingdom (UK) will be cancer survivors by 2040, and >70% of cancer survivors will be over age 65. The US and UK have different health care systems, government social safety net policies, and magnitudes of income inequality. Hence, older cancer survivors are aging in different social, political, and economic environments across these two high-income countries. A cross-national comparison of the US and UK is an opportunity to identify drivers of both individual-level variation and population-level differences in the memory aging of older cancer survivors. Understanding the long-term memory aging of older cancer survivors in a cross-national framework will enhance our knowledge of what factors matter most for the memory aging of older cancer survivors and could be targets for interventions. This K99/R00 proposal leverages longitudinal pre- and post-cancer diagnosis data from two nationally representative cohorts, the US Health and Retirement Study (HRS) and the English Longitudinal Study of Ageing (ELSA), to investigate long-term memory trajectories of N=2,500 older cancer survivors from 2002 to 2018. The specific aims are to: (1) identify and compare memory trajectories of cancer survivors in the HRS and ELSA, overall and by age and sex (K99 phase); (2) identify and compare individual, neighborhood, and macro-level socioeconomic inequalities in memory aging of cancer survivors in the HRS and ELSA (R00 phase); and, (3) identify the roles of modifiable risk and resilience factors (hypertension, diabetes, obesity, depression, physical activity, social support) across countries, as these may be intervention targets to promote healthy memory aging among older cancer survivors (R00 phase). The training plan will build on the applicant’s prior training in social and cancer epidemiology to include: (1) ADRD research among cancer survivors; (2) the measurement and analysis of multi-level socioeconomic exposures; (3) and complex longitudinal data analyses in a cross-national framework. This integrated training will prepare the applicant for a successful independent research career focused on the social determinants of healthy aging among older cancer survivors. The applicant is supported by a cohesive and interdisciplinary mentorship team, including HRS and ELSA leadership. Identifying country-level differences in risk and resilience for cancer-related memory aging is important for informing population-level interventions and will support the exploration of policy- relevant determinants in future research. The proposed research will unite the fields of cancer survivorship and ADRD research by using a cross-national, population-based approach to identify high-risk groups of older cancer survivors for accelerated memory decline, as well as identify modifiable risk factors as intervention targets.