Incident Vascular Brain Injury, Probable Alzheimer's Disease, and Cognitive Change in Elderly American Indians

项目摘要/摘要 2013年由国家老龄研究所和国家神经疾病研究所举办的研讨会 而卒中优先研究认知障碍的多种病因，对脑血管病的贡献 损伤(VBI)到神经退行性变和阿尔茨海默病(AD)，以及涉及种族、民族、 社会经济学和乡村住宅。VBI是加速大脑老化的主要原因和主要风险因素 适用于中风、认知衰退、抑郁症和可能的阿尔茨海默病(AD)。然而，很少有研究表明 评估美国印第安人(AIS)的VBI、认知障碍和AD，他们承担着沉重的危险因素负担 在这些情况下。这种排除是不幸的，因为独特的历史、风险概况、环境 人工智能的压力源、社会环境和医疗保健系统可能导致不同的疾病模式。 很大程度上来自其他种群。我们的研究团队已经进行了迄今为止唯一一项关于隐蔽的队列研究 人工智能中的VBI。2010-2013年，美国印第安人脑血管疾病及其后果研究完成 1000多名老年人的标准化临床检查、神经心理测试和头颅磁共振成像 -95岁，来自3个州的10个部落。2016年，我们开始重新检查幸存的参与者，使用相同的 协议，通过评估可能的AD来增强。然而，来自 为这项后续检查提供资金的国家老龄研究所仅限于数据收集， 没有分配用于分析的资源。在这项建议中，我们将利用积累的纵向数据 为了应用复杂的成像和分析方法来量化和评估事件VBI的关联， 这一老年少数民族人群的神经退行性变和认知状态的变化。我们的具体目标是 为：(1)为老年人的轻度认知障碍和痴呆症建立规范和诊断标准， 并评估发生VBI、脑萎缩、认知能力下降和可能的 AD；(2)进行聚类分析，以确定预测老年AAI亚群的新的神经成像特征 脑萎缩、认知衰退和可能的阿尔茨海默病的风险最高；以及(3)完成严格的职业生涯 将申请者定位为创新领域的独立调查者和领导者的发展计划 少数民族人群的神经流行病学研究。这项建议利用了一个及时的机会来产生 第一个基于人群的对VBI和认知障碍的新科学问题的估计和解决 在人工智能中，健康差距普遍存在的少数群体。

PROJECT SUMMARY / ABSTRACT A workshop convened in 2013 by National Institute of Aging and the National Institute of Neurological Diseases and Stroke prioritized research on cognitive impairment of multiple etiologies, contributions of vascular brain injury (VBI) to neurodegeneration and Alzheimer's Disease (AD), and disparities involving race, ethnicity, socioeconomics, and rural residence. VBI is a leading cause of accelerated brain aging and a major risk factor for stroke, cognitive decline, depression, and probable Alzheimer's disease (AD). However, few studies have evaluated VBI, cognitive impairment, and AD in American Indians (AIs), who bear a heavy burden of risk factors for these conditions. This exclusion is unfortunate, since the distinctive history, risk profiles, environmental stressors, social environments, and healthcare systems of AIs likely result in patterns of disease that differ substantially from other populations. Our research team has conducted the only cohort study to date of covert VBI in AIs. In 2010-2013, Cerebrovascular Disease and its Consequences in American Indians study completed standardized clinical examinations, neuropsychological testing, and cranial MRI on more than 1,000 AIs aged 64-95 years from 10 tribes in 3 states. In 2016, we began re-examination of surviving participants using the same protocols, augmented by assessment for probable AD. However, the particular grant mechanism from the National Institute on Aging that provides funding for this follow-up examination is limited to data collection, with no resources allocated for analysis. In this proposal, we will capitalize on the accumulated longitudinal data to apply sophisticated imaging and analysis methods to quantify and evaluate associations for incident VBI, neurodegeneration, and changes in cognitive status in this elderly minority population. Our Specific Aims are to: (1) establish normative and diagnostic standards for mild cognitive impairment and dementia in elderly AIs, and evaluate associations and determinants for incident VBI, cerebral atrophy, cognitive decline, and probable AD; (2) conduct cluster analyses to identify novel neuroimaging profiles that predict subgroups of elderly AIs at highest risk for cerebral atrophy, cognitive decline, and probable AD; and (3) complete a rigorous career development plan that will position the applicant as an independent investigator and leader in innovative neuroepidemiology research with minority populations. This proposal leverages a timely opportunity to generate the first population-based estimates of and address novel scientific questions on VBI and cognitive impairment in AIs, a minority population with pervasive health disparities.