Alzheimer's Disease and Related Dementias and Cognitive Impairment

项目1 年龄相关性痴呆，包括阿尔茨海默病和相关痴呆（ADRD）， 在非洲大部分地区，对这一问题的研究仍然不足，只有少数几个值得注意的例外。 全球将有100万痴呆症患者居住在低收入和中等收入国家。 这些国家，如南非，预期寿命预计将大幅上升。 几乎在所有国家，认知能力下降都显示出与家庭收入的巨大差异， 10、11南非也不例外，教育水平低的协会和 终身的不利条件是巨大的。我们的长期目标是了解流行病学模式， 南非ADRD的预计公共卫生负担，以及确定减少 或增加ADRD风险。非洲健康与老龄化：纵向研究 在INDEPTH社区（HAALSI）计划中，我们建议通过以下方式向这一目标迈出重要一步： 在HAALSI中进行纵向认知和痴呆相关评估， 年龄≥40岁的成人社区队列。项目1与项目2（心脏代谢疾病）相结合 和3（艾滋病毒），以优化目标。我们的认知测量与健康和退休研究相协调 在HAALSI队列（5，059例≥40岁的成人）中进行的姐妹研究。我们提出以下目标： 目的1：获得ADRD的发病率和患病率以及轻度认知障碍的信息。 损害（MCI）。到2005年，我们将在三个阶段进行三次认知评估， 关于认知功能、死亡率随访以及临床和知情人评估的纵向信息。 这些数据将使我们能够（1A）确定全因痴呆和MCI的发病率;（1B）评估 血管疾病和艾滋病毒对全因痴呆和轻度认知障碍的影响，并计算归因风险。为了实现这一点， 我们将利用我们的神经心理电池、临床检查和风险生物标志物中的信息， 与艾滋病毒、抗逆转录病毒治疗（ART）和血管疾病有关。 目的2：确定影响认知下降和ADRD的社会和经济风险和弹性因素。 我们假设，教育程度和社交网络有助于老年人保持高认知能力， 随着年龄的增长而发挥作用（认知储备）。12 -16我们确定社会参与是否来自网络 结构防止下降。12，17-24我们研究了与性别和年龄有关的调节条件。 目的3：评估载脂蛋白E（APOE）和生物衰老相关标志物的相关性， 端粒与认知能力下降和ADRD的关系。在2,000个子样本中，我们将研究这些因素的作用。 遗传标记和ADRD，并确定风险和教育程度和ADRD的相互作用。

Project 1 Abstract The burden of age-related dementias, including Alzheimer’s disease and related dementias (ADRD), remains understudied in much of Africa, with a few notable exceptions.1-4 By 2040, an estimated 70% of the 80 million people with dementia globally will reside in low and middle income countries.5 Dementia is a particular issue for these countries, such as South Africa, where life expectancies are expected to rise dramatically.6-9 7-9 Within virtually all countries, cognitive decline has shown strong disparities with household income and educational attainment.10, 11 South Africa is no exception and the associations with low levels of education and lifelong disadvantage are substantial. Our long-term goal is to understand the epidemiologic patterns and projected public health burden of ADRD in South Africa, as well as to identify factors that either reduce or increase ADRD risk. With this renewal application for the Health and Aging in Africa: Longitudinal Studies of an INDEPTH Community (HAALSI) Program, we propose to take a major step towards this goal by conducting longitudinal cognitive and dementia-related assessments in HAALSI , a population-based community cohort of adults ≥40 years of age. Project 1 is integrated with Projects 2 (Cardiometabolic Disease) and 3 (HIV) to optimize goals. We have cognitive measures harmonized with the Health and Retirement Study and sister studies for the HAALSI cohort of 5,059 adults ≥40 years of age. We propose the following aims: AIM 1: Obtain information on the incidence and prevalence of ADRD as well as mild cognitive impairment (MCI). By year 05, we will have three cognitive assessments over three waves with six years of longitudinal information on cognitive function, mortality follow-up and clinical and informant assessments. These data will permit us to (1A) identify rates of all-cause dementia and MCI; and (1B) evaluate impacts of vascular conditions and HIV on all-cause dementia and MCI and calculate attributable risk. To accomplish this, we will use information from our neuropsychological batteries, clinical examination, and biomarkers of risk related to HIV, antiretroviral therapy (ART), and vascular disorders. AIM 2: Identify social and economic risk and resilience factors affecting cognitive decline and ADRD. We hypothesize that educational attainment and social networks help older adults maintain high cognitive functioning as they age (cognitive reserve).12-16 We determine whether social engagement drawn from network structures protects against decline.12, 17-24 We examine moderating conditions related to gender and age. AIM 3: Evaluate associations of Apoliprotein E (APOE) and markers of biological aging related to telomeres with cognitive decline and ADRD. In a subsample of 2,000 we will investigate the role of these genetic markers and ADRD and identify risks and interactions with educational attainment and ADRD.