VCID and Stroke in a Bi-racial National Cohort

项目总结/摘要 轻度认知障碍（MCI）、痴呆和中风在黑人中的发病率要高得多。 45岁以上，美国东南部地区的居民。的原因 卒中的地理和种族差异（REGARDS）研究是一项国家纵向队列研究 对约30，000名黑人和白人进行的研究，旨在促进对 认知能力下降和中风的流行病学，以及种族和地理因素 这些结果的差异。目前的申请有三个目标： 1.确定种族和地理的社会，心血管和环境机制 血管事件对认知障碍和痴呆（VCID）的贡献存在差异。 通过中年评估和十多年的纵向认知数据，REGARDS是 独特的定位，以确定血管，社会和行为机制， VCID的差异，以及干预措施可以缩小差异的可修改途径 在VCID。完成嵌套校准/确认研究以开发算法后 对于MCI和痴呆的分类，我们将描述种族和地理特征， VCID的差异，并确定对调解人的干预是否会减少或消除 差距。 2.回答中风和脑血管疾病流行病学中尚未回答的问题。 通过在17000例活动队列中继续使用成功的卒中监测方法， 该研究将评估风险因素变化与新型生物标志物的关联 通过完成第二次面对面检查量化中风风险和差异 中风的风险。此外，随着年龄的增长，这一目标将提供急需的 老年人中风流行病学信息。 3.利用事故风险因素数据和生物样本，确定 高血压和糖尿病事件，目的是了解对事件的影响 VCID和中风。我们已经证明，中风风险的种族差异中有30%是由于 由于高血压和糖尿病患病率的种族差异， 将研究导致高血压发病率升高的生物标志物途径 糖尿病在黑人 每个拟议目标都涉及一个具有深远公共卫生影响的主题， 迄今为止取得的进展使这项研究处于独特的地位，可以使用经过验证的方法来实现这些目标 以有效的方式。

PROJECT SUMMARY/ABSTRACT    Mild cognitive impairment (MCI), dementia and stroke are substantially higher among blacks aged 45+, and among residents of the southeastern region of the US. The REasons for Geographic And Racial Differences in Stroke (REGARDS) Study is national, longitudinal cohort study of ~ 30,000 blacks and whites designed to advance the understanding of the epidemiology of cognitive decline and stroke, and the contributors to racial and geographic disparities in these outcomes. The current application has three aims: 1. Identify social, cardiovascular, and environmental mechanisms of racial and geographic disparities in incident vascular contributions to cognitive impairment and dementia (VCID). With assessment in mid-life and over a decade of longitudinal cognitive data, REGARDS is uniquely positioned to identify vascular, social, and behavioral mechanisms underlying disparities in VCID, and modifiable pathways on which interventions may narrow disparities in VCID. After completion of a nested calibration/confirmation study to develop an algorithm for the classification of MCI and dementia, we will characterize racial and geographic disparities in VCID and determine if interventions on mediators would diminish or eliminate disparities. 2. Answer as-yet-unanswered questions in stroke and cerebrovascular disease epidemiology. By continuing the successful approaches for stroke surveillance among 17000 active cohort members, the study will assess the association of risk factor changes and novel biomarkers quantified with the completion of the second in-person exam with stroke risk and disparities in stroke risk. In addition, with the aging of the cohort, this aim will provide greatly needed information on stroke epidemiology in the elderly. 3. Utilize incident risk factor data and biospecimens to identify pathways for development of incident hypertension and diabetes, with the goal of understanding the impact on incident VCID and stroke. We have documented that ≈30% of the racial disparity in stroke risk is attributable to racial disparities in prevalence of hypertension and diabetes, and the study will investigate the biomarker pathways contributing to the higher incidence of hypertension and diabetes in blacks. Each proposed aim addresses a topic of profound public health impact, and REGARDS progress to date uniquely positions the study to address these aims using proven approaches in an efficient manner.