Aging Research Characterizing Health Equity via Social determinants (ARCHES)

项目摘要/摘要 我们的长期目标是利用以社区为基础的创新参与性研究来建立 社区咨询委员会，与我们的社区合作伙伴合作，招募、登记和保留一批 黑人参与者，然后检查增加阿尔茨海默病(AD)风险的因果机制 在社区队列中。阿尔茨海默病漫长的临床前阶段，正如成年人的生物标志物所反映的那样，是一种 症状性AD的关键危险因素。然而，尽管黑人患AD的风险更高，但最近 研究表明，在认知正常的样本中，他们的生物标记物的异常水平低于白人。 本研究旨在探讨认知功能减退和AD的其他危险因素，如抑郁、压力和 具有代表性的黑人参与者样本中的健康社会决定因素(SDOH)。 这项研究意义重大，因为有近4600万美国黑人，占美国黑人人口的13% 美国的人口。黑人老年人口预计将从440万增加到 到2060年，成年人将从2016年的1210万增加到1210万。尽管有这些人口预测，黑人在很大程度上 在AD研究中代表性不足。对白人的几乎独家关注造成了知识鸿沟 了解SDOH机制如何影响不同的人群。尽快弥合这一知识鸿沟至关重要 因为流行病学研究表明，与白人相比，黑人患AD的风险是白人的两倍。 我们的具体目标将(1)建立一个中老年黑人成年人队列(N=300)，使用社区- 基于参与性研究，以了解与以下方面相关的独特的社会、环境和经济障碍 AD风险，(2)确定抑郁、压力和一种新的、基于理论的SDOH综合指数(CI)的影响 认知功能正常的AD患者和非AD患者的认知功能研究 脑白质高信号(WMH)和海马体积(HV)与SDOH-CI的关系 在具有磁共振成像(MRI)数据的参与者子集(N=150)中。 为了测试我们的目标，我们组建了一支拥有AD、SDOH、社区专业知识的多学科团队- 基于参与性研究和系统动力学、社区动员、压力和抑郁、血浆 生物标志物、遗传学、神经成像、神经心理学和生物统计学方法。参赛者将接受 一次性抽血进行AD生物标记物分析，使用神经心理学电池进行认知评估，以及 参加一次MRI扫描。参与者还将参加研讨会，完成全面的 一系列SDOH指标映射到国家老龄研究所的健康研究差异 框架，每年进行临床、神经和神经心理测试，最长可达五年。 一旦获得，这种认知功能和AD风险的组内异质性是如何 受SDOH影响可能更好地支持对美国黑人的有效AD干预和治疗。

PROJECT SUMMARY/ABSTRACT Our long-term goal is to employ innovative community based participatory research to establish a community advisory board, to collaborate with our community partners to recruit, enroll, and retain a cohort of Black participants and, then, to examine causal mechanisms that increase the risk of Alzheimer disease (AD) within the community cohort. The long preclinical stage of AD, as reflected in biomarkers among adults, is a key risk factor of symptomatic AD. However, despite Blacks having a higher risk of developing AD, recent studies suggest that they have less abnormal levels of biomarkers than Whites in cognitively normal samples. This study aims to examine other risk factors of cognitive decline and AD such as depression, stress, and social determinants of health (SDOH) in a representative sample of Black participants. This research is significant because there are nearly 46 million Black Americans, comprising 13% of the population in the United States. The Black older adult population is expected to increase, from 4.4 million older adults in 2016 to 12.1 million by 2060. Despite these demographic projections, Blacks are significantly underrepresented in AD research. An almost exclusive focus on Whites has created a knowledge gap in understanding how SDOH mechanisms affect diverse populations. Closing this knowledge gap soon is critical since epidemiological studies suggest that Blacks are at twice the risk of AD compared to Whites. Our Specific Aims will (1) Establish a cohort of middle-to-older age Black adults (N=300) using community- based participatory research to understand the unique social, environmental, and economic barriers related to AD risk, (2) Determine the impact of depression, stress, and a novel, theory-based SDOH composite index (CI) on cognitive functioning in participants who are cognitively normal with and without preclinical AD, and (3) Test the association between white matter hyperintensities (WMH) and hippocampal volume (HV) with the SDOH-CI in a subset of participants (N=150) with magnetic resonance imaging (MRI) data. To test our Aims, we have assembled a multidisciplinary team with expertise in AD, SDOH, community- based participatory research and system dynamics, community mobilization, stress and depression, plasma biomarkers, genetics, neuroimaging, neuropsychology, and biostatistical methods. Participants will undergo a one-time blood draw for AD biomarker profiling, cognitive assessment using a neuropsychological battery, and participate in one MRI scan session. Participants will also participate in workshops, complete a comprehensive battery of SDOH measures mapped onto the National Institute of Aging’s Health Research Disparities Framework, and clinical, neurological, and neuropsychological tests annually for up to five years. Once obtained, this knowledge of how within-group heterogeneity in cognitive functioning and AD risk is impacted by SDOH may better support effective AD intervention and treatment for Black Americans.