Associations of Adverse Childhood Experiences with Midlife Neighborhood Deprivation and Cognitive Trajectories and Dementia Outcomes in Later Life

项目摘要 预计到2060年，阿尔茨海默病和相关痴呆症(ADRD)的负担将增加150% 影响了1400万美国人，预计黑人和西班牙裔/拉美裔老年人的人数将增加四到七倍 成年人。为了更好地了解风险在整个生命过程中的积累以及ADRD中存在的差异， 强调研究健康的社会和结构决定因素，并采用生命历程的观点。 关于早期生活压力源和逆境在ADRD中的作用的研究正在兴起，但仍然有限。年纪较大的人 在三个国际老年队列中，经历更多童年逆境的人发生痴呆症的可能性更大； 以美国为基础的研究在设计上基本上是横断面的，结果喜忧参半，只有一项 考察了种族/民族差异。然而，更好地了解这些因素所起的作用是必要的，如果我们 目的从卫生公平的角度降低ADRD的风险。识别ADRD和原发疾病的早期生命危险因素 童年逆境发生的途径将允许采取更有针对性的干预措施，以降低 为我们人口中最脆弱的人在晚年生活中的ADRD。 此外，邻里关系剥夺在这些关系中的作用仍未得到充分的研究，尽管已知 环境因素对健康行为和结果的影响。了解的结构决定因素 健康及其对ADRD风险的影响将为识别最脆弱的社区提供宝贵的见解 针对有效的预防战略和结构变化的动机以及旨在改善这些问题的政策 环境和处于最大风险的个人的整体健康。以最大的影响减少 对于ADRD的风险，必须考虑环境的作用。 在这项拟议研究的F99阶段，Adrienne Lee将对这些复杂的联系进行三项新的研究。 具体地说，Adrienne将使用健康和退休研究来评估童年逆境与 社区剥夺、认知轨迹和种族/民族亚组内的痴呆症结果。她会链接到 本研究以中年地区剥夺指数为研究样本，进一步了解环境和结构性因素的作用 关于这些关联的健康决定因素，并确定我们可以用来定制的特定于人群的机制 在整个生命过程中进行干预。 在这项拟议研究的K00阶段，Adrienne将在她的论文研究的基础上确定早期生命 促进健康认知老化并可能抵消ACE暴露的弹性因素，她将研究 血管紧张素转换酶暴露，结合社区剥夺与其他老龄化特征的关系。这 研究将为公平干预提供信息。

Project Summary The burden of Alzheimer’s Disease and Related Dementias (ADRD) is projected to increase by 150% by the year 2060 to affect 14 million Americans, with four- and seven-fold increases anticipated among Black and Hispanic/Latino older adults. To better understand the accumulation of risk throughout the life course and the disparities that exist in ADRD, studying social and structural determinants of health and employing a life course perspective have been emphasized. Research on the role of early life stressors and adversity on ADRD is emerging, but still limited. Older adults who experienced more childhood adversities had greater likelihood of incident dementia in three international aging cohorts; U.S.-based studies have been largely cross-sectional in design, mixed results have been observed, and only one examined racial/ethnic differences. However, greater understanding of the role these factors play is imperative if we aim to mitigate the risk of ADRD with a health equity lens. Identifying early life risk factors for ADRD and the primary pathways through which childhood adversity is operating will allow for more targeted interventions to reduce risk of ADRD in later life for the most vulnerable in our population. In addition, the role of neighborhood deprivation in these relationships remains understudied, despite known ramifications of environmental factors on health behaviors and outcomes. Understanding structural determinants of health and how they impact risk of ADRD will provide valuable insight for identifying the most vulnerable communities for targeting effective prevention strategies and motive for structural changes and policies that aim to improve these environments and the overall health of those individuals at greatest risk. To have the greatest impact on reducing the risk of ADRD, the role of the environment must be considered. In the F99-phase of this proposed research, Adrienne Lee will conduct three novel studies of these complex associations. Specifically, Adrienne will use the Health and Retirement Study to evaluate the associations of childhood adversity with neighborhood deprivation, cognitive trajectories, and dementia outcomes within racial/ethnic subgroups. She will link the study sample to the area deprivation index in midlife to further understand the role of environment and structural determinants of health on these associations, and to identify population-specific mechanisms by which we can tailor interventions throughout the life course. In the K00-phase of this proposed research, Adrienne will build off her dissertation research to identify early life resilience factors that promote healthy cognitive aging and that may counteract ACE exposure, and she will examine the associations of ACE exposure, in combination with neighborhood deprivation in relation to other hallmarks of aging. This research will inform equitable interventions.