Socioeconomic and Cardiovascular Sources of Cross-National Variation in Cognitive Health Among Older Adults

项目摘要 尽管全球近75%的阿尔茨海默病和相关痴呆症（ADRD）病例将发生在较低年龄段， 由于到2050年中等收入国家（LMICs）的人口减少，几乎没有ADRD研究包括来自这些地区的数据。这是一个重大 错过了机会，以确定个人层面和环境的影响，晚年的认知功能。证据 来自高收入国家的研究表明，ADRD部分归因于社会经济因素，如教育， 和心血管因素，如高血压。这些因素是否有助于认知健康 在人口迅速老龄化的中低收入国家中，类似程度的结局尚不清楚。比较研究 中低收入国家和高收入国家可以帮助释放ADRD的重要驱动因素并找出关键差异 各国之间的合作可以用于预防战略，以减少全球ADRD负担。的 美国国家情报局资助的协调认知评估协议（HCAP）最近被引入美国卫生和 退休研究（HRS）及其国际合作伙伴研究（IPS）作为一个可比的跨国认知 考核重要的是，没有工作表明来自各个国家的HCAP数据实际上直接 可比性因此，任何国家一级的差异都可能是实际差异的未知混合 在认知功能的分布和偏见归因于不相称的测量。我们的总体 我们的目标是估计关键的社会经济和心血管ADRD危险因素对晚年生活的影响 美国HRS和南非IPS，墨西哥， 印度和英国。我们收集了来自N= 10，642名老年人的HCAP和主要HRS/IPS调查数据， 这五个国家。为了实现我们的目标，我们的目标是：1）统计协调HCAP措施， HRS/IPS国家使用现代心理测量学，使我们能够识别和解决任何差异项目 HCAP措施在各国的运作，以促进有效的跨国比较; 2） 调查和量化生命过程中的社会经济因素对晚年认知变化的贡献 个人之间和国家之间的功能;和，3）调查和量化的贡献 心血管因素与个体之间和国家之间晚年认知功能的差异有关。关键 创新是：1）适应复杂的心理测量方法，以协调HCAP数据， 经济、社会和文化多样化的国家背景; 2）纳入跨国数据， 扩大ADRD证据库中全球人群的代表性;以及，3）使用多水平模型， 个体之间的差异和个体之间的差异在晚年认知功能中的分配方差 国家我们将通过已建立的全球老龄化数据门户提供我们的统一数据 网站我们的研究结果将为确定高风险个体以及整体的干预目标奠定基础。 从全球角度来看，最终目标是预防和/或延迟ADRD的发作。

PROJECT SUMMARY Although nearly 75% of global Alzheimer’s disease and related dementias (ADRD) cases will occur in lower- and middle-income countries (LMICs) by 2050, little ADRD research includes data from these regions. This is a major missed opportunity to identify individual-level and contextual influences on later-life cognitive function. Evidence from high-income countries suggests ADRD is partly attributable to socioeconomic factors, such as education, and cardiovascular factors, such as hypertension. Whether these same factors contribute to cognitive health outcomes to a similar degree in LMICs with rapidly aging populations is unknown. Comparative research across LMICs and high-income countries could help to unlock important drivers of ADRD and identify key differences between countries that could be leveraged for prevention strategies to reduce the global ADRD burden. The NIA-funded Harmonized Cognitive Assessment Protocol (HCAP) was recently introduced into the US Health and Retirement Study (HRS) and its International Partner Studies (IPS) as a comparable cross-national cognitive assessment. Critically, no work has demonstrated that HCAP data from the various countries are in fact directly comparable. Any observation of country-level differences may thus be an unknown mixture of actual differences in the distribution of cognitive function and bias attributable to incommensurate measurement. Our overarching goal is to estimate the contributions of key socioeconomic and cardiovascular ADRD risk factors to later-life cognitive function between individuals and between countries in the US HRS and IPS in South Africa, Mexico, India, and England. We have assembled HCAP and main HRS/IPS survey data on N=10,642 older adults from these five countries. To accomplish our goal, we aim to: 1) statistically harmonize HCAP measures across HRS/IPS countries using modern psychometrics to enable us to identify and address any differential item functioning of HCAP measures across countries in order to facilitate valid cross-national comparisons; 2) investigate and quantify the contributions of life course socioeconomic factors to variation in later-life cognitive function between individuals and between countries; and, 3) investigate and quantify the contributions of cardiovascular factors to variation in later-life cognitive function between individuals and between countries. Key innovations are: 1) adaptation of sophisticated psychometric methods to harmonize HCAP data across economically, socially, and culturally diverse country contexts; 2) inclusion of cross-national data to diversify and expand representation of global populations in the ADRD evidence base; and, 3) use of multi-level models to partition variance in later-life cognitive function to differences between individuals and differences between countries. We will make our harmonized data available through the established Gateway to Global Aging Data website. Our results will set the stage to identify intervention targets for high-risk individuals as well as whole populations, with the ultimate goal of preventing and/or delaying the onset of ADRD from a global perspective.