HANDLS Scan Substudy: Race, Socioeconomic status, and the Brain

描述（由申请人提供）：注意到与种族和社会经济地位（SES）相关的明显健康差异的脑健康终点包括中风（特别是在年轻时）、痴呆、磁共振成像（MRI）上的脑结构、认知下降和功能障碍。需要努力解开种族和社会经济地位对大脑健康的各自影响，特别是预测未来中风和痴呆的早期和微妙的病理标志。灰质（GM）和白色（WM）体积的MRI评估测量值以及WM微观结构的扩散张量成像测量值提供了此类已证实的相关性。同样重要的是识别种族和SES与微妙的大脑病理学关系的多层次介质。生物医学，行为，心理，社会和环境因素已被牵连的种族和SES的关系，许多身体健康结果的潜在调解人，但很少有人知道这些途径与大脑健康。微妙的脑病理MRI指标也可能介导种族和SES的认知和身体功能的关系。在这里，我们提出了一个跨学科的，辅助研究的健康老龄化在整个生命周期的多样性社区（手）。HANDLS研究是一项新的20年流行病学调查，由国家老龄化研究所的校内研究计划进行，重点是了解生活在马里兰州巴尔的摩的4,000名社会经济多样化的非洲裔美国人（AA）和白人之间的健康差异。HANDLS的独特设计是为了解开种族和社会经济地位对健康结果的各自关系。在HANDLS SCAN中，我们建议从500例患者中获得定量MRI数据，（250名AA，250名白色;年龄30-64岁）无卒中和痴呆的HANDLS参与者，具有全方位的SES：（1）检查GM和WM体积以及WM微观结构中与种族和SES相关的差异（2）检查多水平介质-生物医学，行为，心理，社会，（3）研究GM和WM是否是种族和SES与认知和身体功能关系的近端介质。结构方程模型将用于构建日益复杂的模型，以解决这些相互关联的目标。公共卫生相关性：了解种族和SES与脑病理学早期和微妙标志物的关系以及脑病理学与认知和身体功能的关系的多水平介质，有助于制定适当的预防和干预策略，这些策略对减少和最终消除中风、痴呆、认知和功能下降方面的健康差异至关重要。

DESCRIPTION (provided by applicant): Pronounced health disparities associated with race and socioeconomic status (SES) are noted for brain health endpoints including stroke (particularly at younger ages), dementia, brain structure on magnetic resonance imaging (MRI), cognitive decline, and functional disability. Efforts are needed to disentangle respective influences of race and SES on brain health, particularly early and subtle markers of pathology predictive of future stroke and dementia. MRI- assessed measures of gray matter (GM) and white matter (WM) volume and diffusion tensor imaging measures of WM microstructure offer such proven associations. Also critical is identification of multi-level mediators of the relations of race and SES to subtle brain pathology. Biomedical, behavioral, psychological, social and environmental factors have been implicated as potential mediators of the relations of race and SES to many physical health outcomes, but exceedingly little is known about these pathways with respect to brain health. MRI indices of subtle brain pathology may also mediate relations of race and SES to cognitive and physical function. Here we propose an interdisciplinary, ancillary study to the Healthy Aging In Neighborhoods of Diversity Across the Life Span (HANDLS). HANDLS study is a new 20-year epidemiological investigation conducted by the National Institute on Aging's Intramural Research Program focused on understanding health disparities among 4,000 socioeconomically diverse African-Americans (AA) and Whites living in Baltimore, MD. HANDLS is uniquely designed to disentangle the respective relations of race and SES to health outcomes. In HANDLS SCAN we propose to obtain quantitative MRI data from 500 (250 AA, 250 White; ages 30-64) stroke- and dementia-free HANDLS participants with a full range of SES to: (1) Examine race- and SES-related disparities in GM and WM volume, and WM microstructure (2) Examine multi-level mediators - biomedical, behavioral, psychological, social, and environmental - of the relations of race and SES to GM and WM; and (3) Examine whether GM and WM are proximal mediators of the relations of race and SES to cognitive and physical function. Structural equation modeling will be used to construct increasingly complex models to address these interrelated aims. PUBLIC HEALTH RELEVANCE: An understanding of multi-level mediators of the relations of race and SES to early and subtle markers of brain pathology, and the relation of brain pathology to cognitive and physical function, is needed to facilitate appropriate strategies in prevention and intervention critical to the reduction and ultimate elimination of health disparities in stroke, dementia, and cognitive and functional decline.