Socioeconomic and Cardiovascular Sources of Cross-National Variation in Cognitive Health Among Older Adults

项目总结 尽管全球近75%的阿尔茨海默病和相关痴呆(ADRD)病例将发生在较低和 到2050年，中等收入国家(LMIC)的ADRD研究很少包括这些地区的数据。这是一名少校 错过了确定个人水平和背景对以后生活认知功能的影响的机会。证据 来自高收入国家的研究表明，ADRD在一定程度上可归因于社会经济因素，如教育， 以及心血管因素，如高血压。这些因素是否有助于认知健康 在人口迅速老龄化的LMICs中，类似程度的结果尚不清楚。跨领域比较研究 小岛屿发展中国家和高收入国家可以帮助解锁ADRD的重要驱动因素，并找出关键差异 各国之间的合作，可用于制定预防战略，以减轻全球抗灾救灾负担。这个 NIA资助的协调认知评估协议(HCAP)最近被引入美国健康和 退休研究(HRS)及其国际合作伙伴研究(IPS)作为一种可比的跨国认知 评估。关键的是，没有任何工作表明来自各国的HCAP数据实际上是直接的 具有可比性。因此，对国家一级差异的任何观察都可能是实际差异的未知混合物 在认知功能的分布和偏向上归因于无公度测量。我们最重要的是 目的是评估关键的社会经济和心血管ADRD风险因素对晚年生活的贡献 个人之间和国家之间的认知功能美国HRS和IPS中的南非，墨西哥， 印度和英国。我们收集了HCAP和主要HRS/IPS调查数据，其中N=10,642名老年人来自 这五个国家。为了实现我们的目标，我们的目标是：1)在统计上协调HCAP衡量标准 HRS/IPS国家/地区使用现代心理测量学，使我们能够识别和解决任何不同的项目 碳排放上限措施在各国的运作情况，以促进有效的跨国比较；2) 调查和量化生活过程中社会经济因素对晚年认知变化的贡献 个人之间和国家之间的作用；以及，3)调查和量化 心血管因素对个体之间和国家之间晚年认知功能的差异。钥匙 创新之处在于：1)采用复杂的心理测量方法，以协调不同地区的HCAP数据 经济、社会和文化多样化的国家背景；2)纳入跨国家数据，以使 扩大全球人口在ADRD证据库中的代表性；以及，3)使用多层次模型来 将晚年认知功能的差异划分为个体之间和个体之间的差异 国家。我们将通过已建立的全球老龄化数据网关提供我们的协调数据 网站。我们的结果将为确定高危个体以及整体的干预目标奠定基础 从全球的角度来看，最终目标是预防和(或)延缓ADRD的发生。

PROJECT SUMMARY Although nearly 75% of global Alzheimer’s disease and related dementias (ADRD) cases will occur in lower- and middle-income countries (LMICs) by 2050, little ADRD research includes data from these regions. This is a major missed opportunity to identify individual-level and contextual influences on later-life cognitive function. Evidence from high-income countries suggests ADRD is partly attributable to socioeconomic factors, such as education, and cardiovascular factors, such as hypertension. Whether these same factors contribute to cognitive health outcomes to a similar degree in LMICs with rapidly aging populations is unknown. Comparative research across LMICs and high-income countries could help to unlock important drivers of ADRD and identify key differences between countries that could be leveraged for prevention strategies to reduce the global ADRD burden. The NIA-funded Harmonized Cognitive Assessment Protocol (HCAP) was recently introduced into the US Health and Retirement Study (HRS) and its International Partner Studies (IPS) as a comparable cross-national cognitive assessment. Critically, no work has demonstrated that HCAP data from the various countries are in fact directly comparable. Any observation of country-level differences may thus be an unknown mixture of actual differences in the distribution of cognitive function and bias attributable to incommensurate measurement. Our overarching goal is to estimate the contributions of key socioeconomic and cardiovascular ADRD risk factors to later-life cognitive function between individuals and between countries in the US HRS and IPS in South Africa, Mexico, India, and England. We have assembled HCAP and main HRS/IPS survey data on N=10,642 older adults from these five countries. To accomplish our goal, we aim to: 1) statistically harmonize HCAP measures across HRS/IPS countries using modern psychometrics to enable us to identify and address any differential item functioning of HCAP measures across countries in order to facilitate valid cross-national comparisons; 2) investigate and quantify the contributions of life course socioeconomic factors to variation in later-life cognitive function between individuals and between countries; and, 3) investigate and quantify the contributions of cardiovascular factors to variation in later-life cognitive function between individuals and between countries. Key innovations are: 1) adaptation of sophisticated psychometric methods to harmonize HCAP data across economically, socially, and culturally diverse country contexts; 2) inclusion of cross-national data to diversify and expand representation of global populations in the ADRD evidence base; and, 3) use of multi-level models to partition variance in later-life cognitive function to differences between individuals and differences between countries. We will make our harmonized data available through the established Gateway to Global Aging Data website. Our results will set the stage to identify intervention targets for high-risk individuals as well as whole populations, with the ultimate goal of preventing and/or delaying the onset of ADRD from a global perspective.