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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)

基本信息

批准号：
10615888
负责人：
MONICA G. RIVERA-MINDT
金额：
$ 82.45万
依托单位：
FORDHAM UNIVERSITY
依托单位国家：
美国
项目类别：
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/10615888
关键词：
Acculturation Address Adult Affect African American population Age Aging Alzheimer&apos s Disease Alzheimer&apos s disease related dementia Attention Biological Biological Factors Biological Markers Biological Models Brain Cardiovascular system Chronic Cognition Cognitive Cognitive aging Country Data Dementia Disparate Disparity Elderly Equation Ethnic Origin Goals HIV HIV Infections HIV-associated neurocognitive disorder Health High Prevalence Hippocampus Impaired cognition Impairment Inflammation Interleukin-6 Intervention Laboratories Latin American Latina Latina Population Latino Population 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 Predisposition Public Health Puerto Rican Research Risk Risk Factors Sampling Scientist Severities Severity of illness Stress Structure Temporal Lobe Testing Variant Work advanced dementia age related aged aging population brain health brain magnetic resonance imaging cerebrovascular cognitive change cognitive function comorbidity cytokine design ethnic disparity executive function gray matter health disparity health equity high risk improved indexing lens multidisciplinary multimodal neuroimaging neural neuroimaging neuroinflammation personalized approach poor health outcome processing speed risk mitigation social adversity social culture sociocultural determinant white matter

项目摘要

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，特别是对于拉丁裔/非裔人口而言。居住在美国的拉丁裔/os 是与非西班牙裔白人相比，他们感染艾滋病毒的风险更高，并且承受着不成比例的负担 HIV 相关神经认知障碍 (HAND) 可能会随着年龄的增长而加剧。 HIV 感染者 (HIV+) 在美国所有群体中，波多黎各裔拉丁裔/其他群体的 HAND 患病率最高（约 78%）（HIV+ 墨西哥裔美国人：44%；非裔美国人：~40%，非西班牙裔白人：~40%）。年长的 HIV+ 拉丁裔/os （50±岁）似乎比非西班牙裔白人面临更大的手部疾病和认知能力下降的风险 HAND 中的认知障碍模式似乎因种族而异。在一般艾滋病毒人群中，HAND 的特点是处理速度、注意力和执行功能受损与额纹状体回路的参与一致。 HIV+ 波多黎各拉丁裔/os 表现出非典型遗忘记忆特征与内侧颞叶（MTL）受累更加一致。尽管有这些重要的差异、不同的认知特征以及受影响的神经结构可能存在的差异，有关拉丁裔/其他地区 HAND 的文献几乎完全是横截面的，不包括未感染 HIV 的 (HIV-) 控制，缺乏针对该人群大脑完整性的研究，并且尚未检查其机制这些差异的背后。本研究的目标是利用针对文化的方法进行调查波多黎各血统的老年艾滋病病毒感染拉丁裔/其他人是否表现出更严重的认知能力下降模式与其他种族/艾滋病毒状况群体相比，了解其功能和大脑完整性，并揭示生物学特征（例如，神经炎症生物标志物 [sTREM2、sCD14、sTNFR-II 和 IL-6]、心血管负担）和社会文化（例如，文化适应、社会逆境、压力）导致神经退行性和认知风险的机制这个人口的变化。为此，这项多学科研究将部署纵向观察设计有 90 名 HIV+ 和 90 名 HIV 匹配的对照成年人（两组均包括：70% 拉丁裔和 30% 非非裔）西班牙裔白人；年龄60-80岁）超过36个月。所有参与者将完成实验室、神经医学、多模式神经影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、艾滋病毒以及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 大脑指数（白质病变和 MTL）灰质体积； MTL 内在活动和海马内网络连接）。解决差异拉丁裔/后裔的认知和大脑健康结果为阐明 HAND 提供了重要机会神经发病机制，通过视角理清认知衰老的生物学和社会文化方面 HIV 感染，并确定可改变的因素以减轻认知能力下降的风险。由于这个人口是美国老龄化人口中增长最快的部分，确定与文化相关的干预目标以降低拉丁裔/外科医生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。