HANDLS Scan Substudy: Race, Socioeconomic status, and the Brain

描述（由申请人提供）：与种族和社会经济地位（SES）相关的明显健康差异在脑健康终点中被注意到，包括中风（特别是在年轻时）、痴呆、磁共振成像（MRI）的脑结构、认知能力下降和功能性残疾。需要努力理清种族和社会经济地位对大脑健康的各自影响，特别是预测未来中风和痴呆的早期和微妙的病理标记。MRI评估灰质（GM）和白质（WM）体积的测量和WM微观结构的扩散张量成像测量提供了这种证实的关联。同样重要的是确定种族和社会经济地位与微妙脑病理关系的多层次中介。生物医学、行为、心理、社会和环境因素已被认为是种族和社会地位与许多身体健康结果之间关系的潜在中介，但对这些途径与大脑健康的关系知之甚少。细微脑病理的MRI指标也可能介导种族和社会经济地位与认知和身体功能的关系。在此，我们提出了一项跨学科的辅助研究，以健康老龄化的多样性社区在整个生命周期（HANDLS）。HANDLS研究是一项新的为期20年的流行病学调查，由国家老龄研究所的内部研究项目进行，重点是了解生活在马里兰州巴尔的摩的4000名社会经济不同的非洲裔美国人（AA）和白人之间的健康差异。HANDLS的独特设计是为了弄清种族和SES对健康结果的各自关系。在HANDLS扫描中，我们建议获得500名（250名AA， 250名白人，年龄30-64岁）无中风和痴呆的HANDLS参与者的定量MRI数据，这些参与者具有全方位的SES:(1)检查种族和SES相关的GM和WM体积差异，以及WM微观结构(2)检查种族和SES与GM和WM关系的多层次中介-生物医学，行为，心理，社会和环境；(3)检验GM和WM是否是种族和SES对认知和身体功能关系的近端中介。结构方程建模将用于构建越来越复杂的模型来解决这些相互关联的目标。公共卫生相关性：需要了解种族和社会地位与早期和微妙的脑病理学标志物之间关系的多层次中介，以及脑病理学与认知和身体功能之间的关系，以促进适当的预防和干预策略，这对于减少和最终消除卒中、痴呆、认知和功能衰退的健康差异至关重要。

DESCRIPTION (provided by applicant): Pronounced health disparities associated with race and socioeconomic status (SES) are noted for brain health endpoints including stroke (particularly at younger ages), dementia, brain structure on magnetic resonance imaging (MRI), cognitive decline, and functional disability. Efforts are needed to disentangle respective influences of race and SES on brain health, particularly early and subtle markers of pathology predictive of future stroke and dementia. MRI- assessed measures of gray matter (GM) and white matter (WM) volume and diffusion tensor imaging measures of WM microstructure offer such proven associations. Also critical is identification of multi-level mediators of the relations of race and SES to subtle brain pathology. Biomedical, behavioral, psychological, social and environmental factors have been implicated as potential mediators of the relations of race and SES to many physical health outcomes, but exceedingly little is known about these pathways with respect to brain health. MRI indices of subtle brain pathology may also mediate relations of race and SES to cognitive and physical function. Here we propose an interdisciplinary, ancillary study to the Healthy Aging In Neighborhoods of Diversity Across the Life Span (HANDLS). HANDLS study is a new 20-year epidemiological investigation conducted by the National Institute on Aging's Intramural Research Program focused on understanding health disparities among 4,000 socioeconomically diverse African-Americans (AA) and Whites living in Baltimore, MD. HANDLS is uniquely designed to disentangle the respective relations of race and SES to health outcomes. In HANDLS SCAN we propose to obtain quantitative MRI data from 500 (250 AA, 250 White; ages 30-64) stroke- and dementia-free HANDLS participants with a full range of SES to: (1) Examine race- and SES-related disparities in GM and WM volume, and WM microstructure (2) Examine multi-level mediators - biomedical, behavioral, psychological, social, and environmental - of the relations of race and SES to GM and WM; and (3) Examine whether GM and WM are proximal mediators of the relations of race and SES to cognitive and physical function. Structural equation modeling will be used to construct increasingly complex models to address these interrelated aims. PUBLIC HEALTH RELEVANCE: An understanding of multi-level mediators of the relations of race and SES to early and subtle markers of brain pathology, and the relation of brain pathology to cognitive and physical function, is needed to facilitate appropriate strategies in prevention and intervention critical to the reduction and ultimate elimination of health disparities in stroke, dementia, and cognitive and functional decline.