Bilingualism as a protective factor of ADRD in American Indian adults: the Strong Heart Study

项目摘要/摘要 美国印第安人患脑血管疾病和阿尔茨海默病及相关疾病的负担较大 痴呆症(ADRD)与非西班牙裔美国白人人群的共病比较，也可能 认知衰退和痴呆症的负担更大。双语--在美国印第安人社区中很常见-- 可能会增强工作记忆能力、注意力控制和认知储备，从而降低认知风险。 然而，双语是一种高度个人化的体验，使用的语境可以改变其认知效果。 可能影响这种联系的因素包括年龄、性别、词汇量、身体和精神状况、 社会经济地位、文化和社会活动。全面评估两国关系 双语和认知表现可能是充分理解美国印第安人成年人ADRD的关键。 尽管双语能力和认知储备之间的联系已经在许多人群中进行了研究， 在美洲印第安人群体中的双语研究一直是有限的，部分原因是相关的关键辅助因素 他们的经验、观点和标准化评估。不公正的美国(美国)联邦政策 影响美国印第安人的因素包括被迫上英语寄宿学校，在那里使用 土著语言的同化受到了惩罚，文化同化优先于教育质量。作为一名 因此，在这样的学校就读的美国印第安人成年人的双语能力可能与其他人不同 人口。事实上，NIA(RFA-AG-23-001)将双语定义为“精通两种或两种以上语言”， 然而，对于美国本土语言或美国人来说，还没有经过验证的、详细的熟练程度评估 说这些语言的印度人。我们提议的研究将是第一个从文化上适应一种语言使用和 在一个庞大的、不同种族的美国印第安人群体中，历史是一种工具。为回应RFA-AG-23-001，我们 将利用强大的心脏研究，这是一个大型的，纵向的，不同的，基于人群的老龄化研究 3个地理区域(N=2,500)以上的美国印第安人。在这项拟议的工作中，我们将在这项研究的基础上， 以及我们之前的工作，从文化上评估美洲印第安人双语的连续性 改编语言史问卷，评估多族裔美国印第安人的双语能力 与详细的认知表现组合相关联的代数，并构建概念模型以 通过结晶认知评估变量间的关系，包括效果修正和调节。这 该项目将阐明在仍然脆弱的人群中具有公共卫生意义的问题 在ADRD研究中代表性不足，可能对未来的预防和治疗战略产生影响。

PROJECT SUMMARY/ABSTRACT American Indian populations have greater burden of cerebrovascular and Alzheimer’s disease and Related Dementias (ADRD) comorbidities compared with non-Hispanic White U.S. populations and may also have greater burden of cognitive decline and dementia. Bilingualism—common in American Indian communities— may enhance working memory capacity, attentional control, and cognitive reserve, thus reducing cognitive risk. However, bilingualism is a highly individual experience, and the context of use can modify its cognitive effects. Factors that may influence this association include age, sex, vocabulary, physical and mental status, socioeconomic status, culture, and social activity. Comprehensively assessing the relationship between bilingualism and cognitive performance may be critical to fully understanding ADRD in American Indian adults. Although the link between bilingualism and cognitive reserve has been studied in many populations, bilingualism research in American Indian populations has been limited, due in part to critical cofactors related to their experiences, perspectives, and standardized assessments. Unjust United States (U.S.) federal policies affecting American Indian people included forced attendance at English-speaking boarding schools where use of Native languages was punished, and cultural assimilation was prioritized over quality of education. As a result, bilingualism in American Indian adults who attended such schools may present differently than for other populations. Indeed, NIA (RFA-AG-23-001) defines bilingualism as “proficiency in two or more languages”, however no validated, detailed assessment of proficiency exists for U.S. Native languages, or for American Indian speakers of those languages. Our proposed study will be the first to culturally adapt a language use and history instrument in a large, heterogeneous American Indian population. In response to RFA-AG-23-001, we will leverage the Strong Heart Study, a large, longitudinal, heterogeneous, population-based study of aging in American Indian adults over 3 geographic regions (N=2,500). In this proposed work, we will build on this study, as well as our prior work, to assess the continuum of bilingualism in American Indian peoples by culturally adapting the Language History Questionnaire, evaluate bilingualism in American Indians of multiple generations in association with a detailed cognitive performance battery, and construct conceptual models to assess intervariable relationships including effect modification and moderation by crystallized cognition. This project will illuminate questions of public health significance in a vulnerable population that remains underrepresented in ADRD research, with potential implications for future prevention and treatment strategies.