Contribution of Longitudinal Neighborhood Determinants to Cognitive Health and Dementia Disparities within a Multi-Ethnic Cohort

项目摘要/摘要 除了个人因素(如年龄、种族、性别和社会经济地位)在 阿尔茨海默病和相关痴呆的进展(ADRD)、邻里因素(例如，社会因素和建筑因素 环境)可能会影响认知健康。关键是，尽管非洲裔美国人和西班牙裔美国人面临着 作为ADRD最高和最不成比例的风险，研究传统上将不同人群排除在外。 考虑到种族和社会经济方面的健康邻里因素的历史和现状 这些特征可能部分解释了观察到的ADRD风险差异。到目前为止，已经有 没有关于邻里环境在ADRD风险差异中的作用的研究。 在这项研究中，我们建议利用和扩展来自多种族研究的广泛的纵向数据 动脉粥样硬化(MESA)，以解决ADRD社区和差异研究中的主要空白。我们 建议在以下范围内大规模收集、处理和分发新邻域数据 梅萨。我们的主要目标是确定与疾病原因相关的社区变化的独特模式 认知衰退和痴呆症的患病率和差异。我们将通过(目标1)实现我们的主要目标 表征动态的、纵向的社区社会和已建成环境变量(基于调查和 与台地居民地址认知相关)；(目标2)考察 邻里环境特征与认知和临床相关的ADRD结果；(目标3) 调查按社会经济地位和种族/族裔划分的ADRD结果差异的决定因素 评估邻里环境的贡献。 该项目准备为邻里之间的路径和联系提供强有力的新证据 环境和认知结果，对建筑环境科学具有重要影响 进展研究，以及支持健康老龄化的政策。目标1将创建最全面的 不同样本的纵向邻里数据集，包括详细的认知和ADRD结果 广泛传播到研究人员网络。目标2中的分析将有助于开发 社区在ADRD进程中的作用的实质性理论，并为城市规划者提供指导 设计支持健康老龄化的社区。目标3考察了种族因素的贡献 认知上的差异和ADRD。通过这一点，我们希望确定可行的、社区的和临床的 处理和补救因不平等而产生的种族和社会经济不平等的干预措施 健康老龄化的环境支持分布。我们期望这一证据能够支持和加强这方面的努力。 以缩小差距。

PROJECT SUMMARY/ABSTRACT Beyond the role that individual factors (e.g. age, race, gender, and socioeconomic status) play in the progression of Alzheimer's Disease and related dementias (ADRD), neighborhood factors (e.g. social and built environments) may affect cognitive health. Critically, although African American and Hispanic individuals face the highest and most disproportionate risk for ADRD, research has traditionally excluded diverse populations. Given historic and current patterning of healthy neighborhood factors by racial and socioeconomic characteristics, these features may partially explain observed disparities in ADRD risk. To date there has been no research on the role of neighborhood environments in disparities in ADRD risk. In this study, we propose to leverage and extend extensive longitudinal data from the Multi-Ethnic Study of Atherosclerosis (MESA) to address major gaps in research on neighborhoods and disparities in ADRD. We propose to undertake large-scale collection, processing, and distribution of new neighborhood data within MESA. Our main objective is to identify unique patterns of neighborhood change related to the causes of prevalence and disparities in cognitive decline and dementia. We will attain our main objective by (Aim 1) characterizing dynamic, longitudinal neighborhood social and built environment variables (survey-based and GIS-derived) relevant to cognition for residential addresses of a MESA; (Aim 2) examining associations of neighborhood environmental characteristics with cognition and clinically relevant ADRD outcomes; (Aim 3) investigate determinants of disparities in ADRD outcomes by socioeconomic position and race/ethnicity and assess the contribution of neighborhood environments. This project is poised to provide robust new evidence about pathways and links between neighborhood environments and cognitive outcomes, with important implications for built environment science, ADRD progression research, and policies to support healthy aging. Aim 1 will create the most comprehensive longitudinal neighborhood dataset on a diverse sample with detailed cognitive and ADRD outcomes for widespread dissemination to a network of researchers. Analyses in Aim 2 will contribute to developing substantive theory on the role of neighborhoods in ADRD progression and provide guidance for urban planners to design neighborhoods that support healthy aging. Aim 3 examines component contributions to racial disparities in cognition and ADRD. Through this, we expect to identify actionable, community and clinical interventions to address and remediate racial and socioeconomic inequalities derived from the unequal distribution of environmental supports for healthy aging. We expect this evidence to support and amplify efforts to reduce disparities.