Cerebrovascular Disease and Cognitive Performance in African Americans

描述(申请人提供)：脑血管疾病(CBVD)及其相关认知障碍的发病率在全球范围内迅速上升。非裔美国人(AA)和糖尿病患者的CBVD和相关认知功能障碍的发生率更高。然而，通过脑部磁共振成像(MRI)和认知测试来评估种族对CBVD发展的影响仍缺乏研究。与欧洲美国人(EA)相比，AA患者脑部小血管疾病的严重程度存在争议。小血管病变在脑MRI上表现为“白质高信号”(WMH)。一些研究已经报道，相对于EA，AA的WMH更多，一些WMH更少。现有研究未能考虑到影响WMH发展的潜在可改变的环境风险因素的影响，如获得医疗保健、社会经济地位、血压和血糖控制。这项应用旨在确定600名2型糖尿病AA患者大脑结构和功能变化背后的环境和遗传因素。我们计划在正在进行的AA-糖尿病心脏研究(AA-DHS)中用脑MRI和一系列认知测试重新评估600名AA；这些人以前曾接受过沉默(亚临床)心脏病的存在测试，并且都有DNA可用于基因测试。我们计划在这些AA受试者中测试大脑结构(包括WMH)的变化和大脑功能与认知表现之间的关系。为了确定CBVD和认知表现之间的关系是否存在种族差异，AA的结果将与相关糖尿病心脏研究(DHS-Mind)中患有T2D的EA的类似数据进行对比。这项建议将试图检测导致再生障碍性贫血对CBVD易感性的遗传和环境因素。我们预计，可改变的环境风险因素可能解释了现有AA研究中报告的CBVD发生率较高的原因。此外，注意这些可改变的危险因素可能会降低再生障碍性贫血高危人群中CBVD和认知功能障碍的发生率。 公共卫生相关性：非裔美国人(AA)和糖尿病患者有较高的脑血管疾病(CBVD)和相关认知功能障碍的发生率。该项目建议使用脑部磁共振成像(MRI)来评估CBVD，并对患有2型糖尿病的AA患者进行一系列认知测试。结果将与一组患有2型糖尿病的欧洲美国人的现有MRI和认知数据进行比较，以确定CBVD与认知表现之间的关系是否存在种族差异，并确定在高风险和研究不足的AA社区中导致CBVD的环境和遗传原因。

DESCRIPTION (provided by applicant): The incidence rates of cerebral vascular disease (CBVD) and its associated cognitive impairment are rapidly increasing around the world. African Americans (AA) and patients with diabetes have higher rates of CBVD and associated cognitive dysfunction. However, the impact of race on the development of CBVD assessed by Magnetic Resonance Imaging (MRI) of the brain and cognitive testing remains poorly studied. Controversy exists regarding the severity of cerebral small blood vessel disease in AA, relative to European Americans (EA). Small blood vessel disease appears as "white mater hyperintensities" (WMH) on brain MRI. Several studies have reported more WMH, and some less WMH, in AA relative to EA. Existing studies failed to account for the effects of potentially modifiable environmental risk factors that impact development of WMH, such as access to healthcare, socioeconomic status, blood pressure and blood sugar control. This application proposes to determine the environmental and genetic factors that underlie cerebral structural and functional changes in 600 AA with type 2 diabetes. We plan to re-evaluate 600 AA in the ongoing AA-Diabetes Heart Study (AA-DHS) with cerebral MRI and a battery of cognitive tests; these individuals have previously been tested for the presence of silent (sub-clinical) heart disease and all have DNA available for genetic testing. We plan to test for relationships between alterations in brain structure (including WMH) and brain function with cognitive performance in these AA subjects. To determine whether racial differences in the relationships between CBVD and cognitive performance are present, results in AA would be contrasted with similar data in EA who have T2D from the related Diabetes Heart Study (DHS-MIND). This proposal will attempt to detect the inherited and environmental factors that produce susceptibility to CBVD in AA. We expect that modifiable environmental risk factors may explain the higher rates of CBVD reported in existing studies of AA. Furthermore, attention to these modifiable risk factors may reduce the rates of CBVD and cognitive dysfunction in the high risk AA population. PUBLIC HEALTH RELEVANCE: African Americans (AA) and individuals with diabetes have higher rates of cerebrovascular disease (CBVD) and associated impairment in cognitive function. This project proposes to evaluate CBVD using Magnetic Resonance Imaging (MRI) of the brain and performing a battery of cognitive tests in AA with type 2 diabetes. Results would be compared to existing MRI and cognitive data in a cohort of European Americans with type 2 diabetes to determine whether racial differences exist in the relationship between CBVD and cognitive performance and to identify the environmental and inherited causes of CBVD in the high risk and understudied AA community.