The Contribution of Repetitive Head Impacts and Social Determinants of Health to Alzheimer's Disease and Related Dementia in Older Adult Black Men

抽象的。美国黑人罹患阿尔茨海默病(AD)及其相关疾病的风险几乎翻了一番 与白人相比。美国黑人男性患老年神经系统疾病的风险可能会增加 接触运动导致的重复头部撞击(RHI)和创伤性脑损伤(TBI) 以及其他风险因素。暴露于RHI/TBI与老年认知障碍、神经精神障碍有关 紊乱和结构性的大脑变化。黑人的种族认同和接触RHI/TBI已被证明 对萎缩和脑脊液神经退行性疾病蛋白的MRI指标有相加的影响。 这些神经上的差异可以用健康的社会决定因素(SDOH)(例如，教育)来解释 可获得性和质量、卫生保健可获得性和质量、社区环境)，这可能影响抵抗力 以及对RHI/TBI的其他神经疾病的恢复能力。SDOH因素可能确实有助于 成年黑人男性的神经学结果与RHI/TBI无关。然而，持续存在的- 黑人在生物医学和健康研究中的代表性，包括在后期效应研究中 来自美式橄榄球比赛的RHI。这项研究的主要目标是检查RHI/TBI的影响 从美式足球到早年SDOH对晚年认知功能的贡献，神经精神病学 黑人男性前美式足球运动员的症状、结构MRI特征和血浆生物标志物 非RHI/TBI暴露了黑人男性。我们将招募100名黑人男性前美式橄榄球运动员(所有 游戏和认知连续体的水平，50岁以上)和100名年龄匹配的没有RHI/TBI的黑人男性。 参与者将注册完成协调的认知和神经精神测试、核磁共振成像和抽血以 评估神经退行性疾病蛋白。一系列调查问卷(例如，不良童年经历， 儿童-经验调查，分享生活调查)将被用来评估SDOH。在目标1中，我们将 研究RHI/TBI与黑人晚年认知和神经精神症状的关系 男性前美式橄榄球运动员。目标2将调查RHI/TBI与晚年生活的关系 黑人男性前美式橄榄球运动员Aü、p-tau和神经退变结果的生物标记物。目标 3将研究SDOH对晚年认知和神经精神症状以及晚年生活的贡献。 Aü、p-tau和神经退行性变结果的生物标志物。我们的假设是(1)RHI/TBI将是 与认知和神经精神功能较差以及结构灰质/白质受损有关 黑人前足球运动员；(2)贫困的SDOH会增加风险，降低对晚年的适应能力 RHI/TBI的影响；(3)贫穷的SDOH将中介RHI对晚年神经结局的影响。 这本R01将发现RHI/TBI和SDOH在老年黑人男性中的作用。我们将解决种族差距问题 出现在RHI/TBI的晚年神经学结果数据中，以促进准确的疾病检测和 个人层面的诊断。

ABSTRACT. Black Americans face nearly double the risk of Alzheimer’s disease (AD) and related compared to Whites. Black American men may be at increased risk for late-life neurological disorders associated with exposure to repetitive head impacts (RHI) and traumatic brain injury (TBI) from contact sports participation and other risk factors. Exposure to RHI/TBI is linked with late-life cognitive impairment, neuropsychiatric disturbances, and structural brain changes. Black racial identity and exposure to RHI/TBI has been shown to have an additive effect on MRI metrics of atrophy and cerebrospinal fluid neurodegenerative disease proteins. These neurological disparities might be explained by social determinants of health (SDOH) (e.g., education access and quality, health care access and quality, neighborhood environment), which might affect resistance and resilience to other neurological disorders from RHI/TBI. SDOH factors might indeed contribute to neurological outcomes in adult Black men irrespective of RHI/TBI. Yet, there has been persistent under- representation of Blacks in biomedical and health research, including among studies of the late effects of RHI from American football play. The overarching goal of this study is to examine the impact of RHI/TBI from American football and the contribution of early-life SDOH to later-life cognitive function, neuropsychiatric symptoms, structural MRI features, and plasma biomarkers in Black male former American football athletes and non-RHI/TBI exposed Black men. We will recruit 100 Black male former American football athletes (across all levels of play and cognitive continuum, 50+ years) and 100 age-matched Black males without RHI/TBI. Participants will enroll to complete harmonized cognitive and neuropsychiatric tests, MRI, and blood draw to assess neurodegenerative disease proteins. A battery of questionnaires (e.g., Adverse Childhood Experiences, Childhood-Experiences Survey, SHARELIFE survey) will be administered to assess SDOH. In Aim 1, we will investigate the association between RHI/TBI and later-life cognitive and neuropsychiatric symptoms in Black male former American football athletes. Aim 2 will investigate the association between RHI/TBI and later-life biomarkers of Aß, p-tau, and neurodegeneration outcomes in Black male former American football athletes. Aim 3 will examine the contribution of SDOH to later-life cognitive and neuropsychiatric symptoms and later-life biomarkers of Aß, p-tau, and neurodegeneration outcomes. Our hypotheses are that (1) RHI/TBI will be associated with worse cognitive and neuropsychiatric function and compromised structural gray/white matter in Black former football players; (2) impoverished SDOH will increase risk and reduce resilience to the late-life effects of RHI/TBI; and (3) impoverished SDOH will mediate the effects of RHI on late-life neurological outcomes. This R01 will discover the role of RHI/TBI and SDOH in older Black men. We will address racial disparities present in data on late life neurological outcomes from RHI/TBI to facilitate accurate disease detection and diagnosis at the individual-level.