Elucidating Factors Contributing to Disparities in Neurobiological Vulnerabilities and Alzheimers Disease and Related Dementias Risk

项目总结/摘要 代表性不足的族裔/种族群体的阿尔茨海默病发病率高得不成比例， 相关痴呆症（ADRD），预计到2060年将增加一倍。许多健康状况会增加风险 包括慢性疼痛。尽管大量研究表明，代表性不足的族裔/种族 这些群体比非西班牙裔白色（NHW）成年人面临更大的风险， 有证据表明，社会环境因素造成了这些差异。社会环境因素 影响身体和大脑的功能，并与认知能力下降和ADRD有关。我们有 研究结果表明，在慢性疼痛严重程度较高的个体中，非西班牙裔黑人（NHB）成年人的疼痛程度较低， 与非西班牙裔白色人相比， (NHW)拥有更多社会环境资源的成年人。另外，性格特征是神经生物学上的- 有基础和强有力的证据表明某些特征与ADRD发作风险有关。我们已经表明 性格特征不仅与疼痛和心理压力有关，而且与一种衡量 大脑年龄和社会环境因素的影响。拟议的项目将扩大的科学价值， 通过利用现有数据进行的联合治疗缓解骨关节炎疼痛（PROACT）研究 并扩大研究范围，以阐明以前未调查的慢性疼痛， 社会环境因素，性格特征，大脑结构和功能的措施，有助于 神经生物学脆弱性的差异和ADRD风险的增加。PROACT研究（ClinicalTrials.gov 标识符：NCT 03884374）是一项数据收集第四年的临床试验（R37，PI：R。Fillingim）进行 在佛罗里达大学（UF）和伯明翰的亚拉巴马大学（UAB）。PROACT将招募360名 研究参与者中，NHB和NHW成年人的代表性相同，膝关节疼痛与 骨关节炎参与者被随机分为四组：经颅直流电刺激（tDCS）， 或假tDCS与呼吸和注意力训练（BAT）或假BAT。参与者将参加五次会议 并将完成基线和干预后的脑部MRI。除了调查 大脑结构和大脑年龄，前/后功能成像数据将提供独特的机会， 确定慢性疼痛的严重程度、社会环境状况和性格特征是否能预测个体 治疗反应的差异。这项研究的长期目标是改善临床护理， 识别有助于确定哪些个体面临ADRD和其他健康风险最大的因素 条件并加强个性化治疗干预措施，以改善所有人的健康。

Project Summary/Abstract Underrepresented ethnic/race groups have a disproportionately higher incidence of Alzheimer’s disease and related dementias (ADRD) with numbers expected to double by 2060. Numerous health conditions increase risk of ADRD including chronic pain. Although an extensive body of research indicates underrepresented ethnic/race groups are at greater risk for these health conditions than non-Hispanic white (NHW) adults, a growing body of evidence indicates socioenvironmental factors contribute to these disparities. Socioenvironmental factors influence functioning in both the body and the brain and are linked with cognitive decline and ADRD. We have findings indicating that in individuals with high chronic pain severity, non-Hispanic black (NHB) adults with fewer socioenvironmental resources had significantly thinner temporal cortical gray matter than non-Hispanic white (NHW) adults with greater socioenvironmental resources. Additionally, dispositional traits are neurobiologically- based and a strong body of evidence has linked certain traits with risk of ADRD onset. We have shown dispositional traits are not only associated with pain and psychosocial stress but also related to a measure of brain age and influenced by socioenvironmental factors. The proposed project will extend the scientific merit of the Pain Relief for OsteoArthritis through Combined Treatment (PROACT) study by leveraging available data and broadening the scope of research to elucidate previously uninvestigated relationships between chronic pain, socioenvironmental factors, dispositional traits, and brain structural and functional measures contributing to disparities in neurobiological vulnerabilities and increased ADRD risk. The PROACT study (ClinicalTrials.gov Identifier: NCT03884374) is a clinical trial in the fourth year of data collection (R37, PI: R. Fillingim) conducted at the University of Florida (UF) and the University of Alabama at Birmingham (UAB). PROACT will recruit 360 study participants with equal representation of NHB and NHW adults with knee pain associated with osteoarthritis. Participants are randomized to one of four groups: transcranial direct current stimulation (tDCS), or Sham tDCS with breathing and attention training (BAT) or Sham BAT. Participants are seen for five sessions over a period of a week and will complete baseline and post-intervention brain MRIs. In addition to investigating brain structure and brain age, the pre/post functional imaging data will provide the unique opportunity to determine if chronic pain severity, socioenvironmental status, and dispositional traits predict individual differences in treatment response. The long-term goals of this line of investigation are to improve clinical care by identifying factors to assist in determining which individuals are at greatest risk for ADRD and other health conditions and to enhance individualized treatment interventions to improve health for all.