Cerebrovascular Disease and Cognitive Performance in African Americans

描述（由申请方提供）：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增加。非裔美国人（AA）和糖尿病患者的CBVD和相关认知功能障碍发生率较高。然而，通过大脑磁共振成像（MRI）和认知测试评估的种族对CBVD发展的影响仍然研究不足。相对于欧洲裔美国人（EA），AA中脑小血管疾病的严重程度存在争议。小血管病在脑MRI上表现为“白色脑膜高信号”（WMH）。几项研究报告了更多的WMH，和一些较少的WMH，在AA相对于EA。现有的研究未能解释影响WMH发展的潜在可改变的环境风险因素的影响，例如获得医疗保健，社会经济地位，血压和血糖控制。本申请旨在确定600例2型糖尿病AA患者大脑结构和功能变化的环境和遗传因素。我们计划在正在进行的AA-糖尿病心脏研究（AA-DHS）中使用脑MRI和一系列认知测试重新评估600例AA;这些个体先前已接受过无症状（亚临床）心脏病的检测，并且所有人都有DNA可用于基因检测。我们计划测试大脑结构（包括WMH）和大脑功能的改变与这些AA受试者的认知表现之间的关系。为了确定CBVD和认知能力之间的关系是否存在种族差异，将AA的结果与相关糖尿病心脏研究（DHS-MIND）中患有T2 D的EA的类似数据进行对比。本提案将尝试检测在AA中产生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研究中报告的较高CBVD率。此外，关注这些可改变的风险因素可能会降低高危AA人群中CBVD和认知功能障碍的发生率。

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.