One of the Center’s major goals is to enhance the diversity of the aging research workforce by identifying and mentoring scientists from and/or with interest in underrepresented groups who can advance research on AD and related dementias (ADRD).
Elizabeth Muñoz, PhD
Department of Human Development and Family Sciences
University of Texas at Austin
Abstract: The primary goal of this research is to develop a comprehensive multi-domain profile of psychosocial stress in a racially and ethnically diverse sample of adults and investigate how these are related to cognitive status and variability. Guided by propositions from the life span (Glymour & Manly, 2008) and epidemiology literature (Martikainen et al., 2002), I propose that psychosocial stress across domains clusters in distinct profiles that are linked with cognitive health through biological and behavioral mechanisms. Further, because cognitive decline may begin before old age, during midlife (Hughes et al., 2018), I propose an analysis in a diverse sample from midlife to older adults that incorporates multi-domain assessments of psychosocial stress to address the following aims:
Aim 1. To evaluate the hypothesis that there will be distinct psychosocial stress profiles that will distinguish racial and ethnic minorities from their counterparts.
Aim 2: To test the hypothesis that high-risk psychosocial stress profiles will be associated with lower cognitive function, and with greater cognitive variability. 2a: Test the hypothesis that high-risk psychosocial stress profiles will be associated with greater variability of cognitive performance within and across measurement bursts.
Aim 3: Test the hypothesis that the observed associations between stress profiles and cognitive status and variability are mediated by daily experiences and biological correlates of stress.
Tiffany Kindratt, PhD
Public Health Program
College of Nursing and Health Innovation
University of Texas at Arlington
Abstract: The increasing incidence and prevalence of ADRD and comorbid diabetes, in addition to the cognitive challenges that ADRD presents to appropriate diabetes monitoring and treatment, represents a serious barrier for patients to adhere to recommended standards of care. Adults with ADRD and comorbid diabetes may be less able to adhere to monitoring and treatment recommendations and less confident in their abilities to take care of their diabetes. Adults with ADRD and comorbid diabetes place a greater burden on caregivers than adults with ADRD alone. This presents a greater challenge for clinicians to provide recommended treatment and monitoring plans in collaboration with patients and caregivers. By identifying the prevalence of and adherence to standards of care on a national level, we can begin to examine ways to create policies and design interventions to reduce these challenges. Two innovative features of this study include: 1) a focus on diabetes care management among adults with ADRD and comorbid diabetes 2) a unique methodology designed to unmask Arab American health disparities using linked National Health Interview Survey (NHIS) and Medical Expenditure Panel Survey (MEPS) data. First, there is a gap in the literature on studies evaluating diabetes care treatment, monitoring, and self-efficacy among adults with ADRD and comorbid diabetes using nationally representative samples. This gap in the literature represents a significant barrier in our ability to provide patient- and family-centered care from providers, based on patient and caregiver perspectives. Second, by linking these two data sources, we can determine nationally representative estimates of ADRD and comorbid diabetes and adherence to standards of care among Arab American. This new method represents an innovative approach to uncover Arab American health disparities.
Sandra P. Arévalo, PhD
College of Liberal Arts
California State University, Long Beach
Abstract: The main objective of this study is to assess the needs and stressors affecting young adult Latino caregivers. This is an important research undertaking because young adults are at a critical developmental stage and most caregiver research, designed for the older caregiver population, may not capture the specific needs of this group. Using Pearlin’s Alzheimer’s caregivers’ stress framework, this study will model the multifactorial components promoting young adult Latino caregiver burdens that may contribute to the increase in stress, interfere with normal development, and ultimately increase mental and physical health disparities in Latinos. To reach young Latino caregivers, we will collect survey data from undergraduates attending, a large, public, urban university. This study goes beyond existing caregiver research focused on older predominantly NLW caregivers by collecting data from younger caregivers, i.e., 18-34 years of age, from an ethnically diverse public urban university, i.e., CSULB student population: 42.9% Latino, 22.3% Asian, 16.7% white, 4.78% two or more races, 3.6% Black, 6.2% non-resident aliens. Specific aims are to:
Aim 1: Characterize the prevalence and features of university undergraduates with current or previous caregiving responsibilities of a person with ADRD. Randomly selected instructors will be invited to share 5-10 minutes of class time to recruit participants; participants will also be recruited across public space on campus.
Aim 2: Examine cross-sectional associations between caregiver burdens and care intensity and young adult’s development and health outcomes in Latino caregivers.
Aim 3: Characterize qualitatively the influence of culture and community context on knowledge, beliefs, and behaviors on caregiving practices and quality of life of both Latino care- givers and -recipients.
Erica Diminich, PhD
Research Assistant Professor
Program in Public Health
Stony Brook University School of Medicine
Study Title: Identifying Risk Factors for Cognitive Impairment in Latinos: A Population Based Pilot Study of Biomarkers, Emotion and Stress
This pilot study will address a critical need to characterize plasma biomarkers of neuropathological change and pre-clinical AD-plasma biomarkers in a non-clinical sample of Latinos at mid-life. This work will also provide 1) preliminary evidence to assess the acceptability, feasibility and potential limitations in recruiting, engaging and retaining Latino participants in AD research involving venipuncture, and computer based assessments; 2) advance understanding of how chronic stress and risk factors identified in this application potentially influence neuropathological changes; 3) examine potential moderating effects of emotion and psychosocial functioning.
Marc A. Garcia, PhD
Sociology & Institute for Ethnic Studies
University of Nebraska – Lincoln
Study Title: Age of Migration and Cognition: The Importance of Contextual Factors in Cognitive Aging Among Older Latinos in the United States.
The goal of this research is to identify potential mechanisms and multifactorial processes underlying the pathways that create and sustain cognitive health disparities among older Latino populations. Currently, there are no available empirical studies that use a nationally representative sample to identify cognitive decline, cognitive impairment, and Alzheimer’s dementias among Latinos by age of migration and contextual factors. Prior research investigating cognitive outcomes have examined older Latinos as a monolithic group or have been limited to regional studies which focused on specific Latino populations. Thus, there is a critical need to examine the demographic diversity within the older Latino population to identify cognitive risk profiles by nativity status, age of migration, and environmental risk factors. This project will examine these disparities to better understand how underlying factors (i.e. gender and race/ethnicity), nativity status (i.e. foreign-born, age of migration), socioeconomic factors (i.e. education, income, and occupation), psychosocial factors (i.e. social support and depressive symptoms), behavioral factors (i.e. obesity, physical inactivity, smoking, alcohol consumption), physical factors (i.e. morbidity, physical functioning, and disability), and environmental factors (i.e. social/physical environment) contribute to heterogeneous cognitive health disparities among older Latinos. I will accomplish this through three aims: Aim 1: Investigate population-level trends in cognitively unimpaired, cognitive impairment no dementia (CIND), and dementia life expectancies among older Latinos by nativity and age of migration to the US. Aim 2: Evaluate population-level trends in cognitive decline among older Latinos by nativity and age of migration to the US. Aim 3: Investigate population-levels in the prevalence of CIND and dementia among older Latinos by nativity and age of migration to the US.
Salim Hayek, MD
Assistant Professor, Medicine Cardiology
University of Michigan
Study Title: Using a “SuPAR” Biomarker to Evaluate the Burden of Inflammation and Its Impact on the Ethnoracial Differences in Cognitive Decline.
Inflammation is increasingly recognized as a major component of the pathogenesis of Alzheimer’s disease (AD). While numerous epidemiological studies suggest that use of anti-inflammatory drugs is associated with a lower incidence of AD, clinical trials have been largely disappointing. Peripheral biomarkers of inflammation may identify a subgroup of AD patients that could benefit from anti-inflammatory therapy. Moreover, differences in inflammatory burden may account for ethnoracial differences in the prevalence and progression of AD. Characterizing the burden of inflammation in AD is however challenging, and the association of traditional blood-based measures of inflammation with AD and cognitive decline has been inconsistent. We propose characterizing levels of soluble urokinase plasminogen activator receptor (suPAR) – a novel marker of chronic immune activation – in patients with AD, determine whether levels can predict declining cognitive function, and assess whether differences in the burden of inflammation accounts for ethnoracial differences in cognitive decline.
2018 MCCFAD AD-RCMAR Scientists
Danielle L. Beatty Moody, PhD
Department of Psychology
University of Maryland, Baltimore County
Study Title: Early Life Adversity and Cognitive Decline in Middle-Aged to Older African Americans in HANDLS
This project will be the first to comprehensively investigate early life adversity (ELA; e.g., childhood socioeconomic status [CSES], MIDUS childhood context indicators, & Adverse Childhood Experiences [ACEs]) in relation to cognitive decline in middle-aged to older urban-dwelling, African American adults, without neurological disease. Use of prospective data on multiple cognitive outcomes among African Americans in this age range represents a major advantage of the NIH-funded Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study in comparison to other studies, allowing us to detail these associations more extensively. This pilot project will allow for initial exploration of these linkages, in preparation for a R01 that will aim to elucidate biopsychosocial mechanisms underlying the relation of ELA to cognitive decline among African Americans. The Specific Aims of this project are, Aim 1: Determine whether greater ELA is associated with decline in cognitive functioning among African Americans. ELA in childhood will be assessed by CSES, MIDUS indicators, and ACEs. Cognitive functioning will be assessed by neurocognitive tests of verbal and nonverbal learning and memory, attention, working memory, visuospatial skills, psychomotor speed, and executive function. We hypothesize that greater ELA in childhood will be associated with greater decline in these endpoints over follow-up, independent of adult SES and key sociodemographic, psychosocial, and behavioral adjustment variables. Aim 2: Determine whether cardiometabolic risk factors serve as mediators of the relation of ELA in childhood to decline in cognitive functioning among African Americans. A cardiometabolic risk factor composite will be comprised of blood pressure, body mass index, total cholesterol, glucose, insulin, and CRP. We hypothesize that greater cardiometabolic risk will partially account for the relation of ELA in childhood to cognitive endpoints in adulthood (outlined in Aim #1). Overall, this project may promote greater understanding of the role ELA plays in the earlier onset of poorer cognitive functioning among African Americans.
Laura Y. Cabrera, PhD
Assistant Professor, Neuroethics
Michigan State University
Study Title: Latinos Perceptions and Concerns about Alzheimer’s Disease
Increasing evidence highlights the role of individual and cultural values in the experience of caregiving challenges (Sherman, Webster and Antonucci, 2013; Nápoles et al., 2010). As such, are the expectations and burdens of caregivers the same across Latino groups? It is recognized that beliefs surrounding memory loss and AD caregiving vary across racial/ethnic groups; such variability affects the level and type of interaction between patients, families, and the healthcare system (Janevic & Connell, 2001; Roberts et al., 2003). However, are there ethnically distinct interactions among Latino groups? How might the acceptability of AD intervention and related efficacy vary across Latino groups? As part of the MCCFAD, we will explore, in a systematic and culturally sensitive fashion, levels of familiarity with symptoms associated with AD, diagnosis and care, and perceptions and concerns about AD, as well as barriers to care among Mexican and Puerto Rican, the predominant -Latino groups in the Grand Rapids, Michigan region.
Specific Aim 1: Examine perceptions and concerns about AD symptoms, diagnosis, and care among Mexicans and Puerto Ricans in the Grand Rapids region.
Our main objective is to identify and assess perceptions and concerns regarding AD symptoms, diagnosis and care in the two identified Latino groups.
We held five Focus Groups (three with Mexicans, and two with Puerto Ricans), as well as two interviews with Puerto Ricans participants employing open-ended questions about AD, predictive testing, diagnosis, progression of disease and care. Focus Group interview guide was first discussed with a community advisory board, composed of Latino community leaders, to develop a cultural sensitive interview process that takes in consideration social context.
Chair and Associate Professor, Department of Public and Environmental Wellness
School of Health Sciences
Study Title: The Epidemiology of Alzheimer’s Disease and Related Dementias (ADRD) among Arab Americans Compared to non-Hispanic whites (NHW), non-Hispanic blacks (NHB), Hispanics, and Asian Americans in the US and Michigan
Study Purpose: The overall goal of the study is to understand the epidemiology, specifically prevalence
and risk factors for and mortality related to ADRD among Arab Americans ages 45 and older compared
to non-Hispanic whites, non-Hispanic blacks, Hispanic and Asian Americans. The three specific aims are
to: 1) Estimate the national prevalence of and risk factors for ADRD using US Census and National Health
Interview Survey data; and 2) Estimate ADRD-specific mortality rates using data from the Michigan
Department of Health and Human Services using a surname list.
Methods: For aim 1, percents and odds ratios were calculated. For aim 2, we will use an Arab name
algorithm that uses first, last, and maiden name, along with standard race and ethnicity variables to
identify Arab Americans use state data. We will calculate death rates. The data base will be de-identified
prior to data analysis.
Summary of Results to Date: Arab Americans are more likely to have ADRD compared to other groups (10.3% for Arab Americans; ~ 7.5% for US-born non-Hispanic whites, blacks and Asians; and 8.6% for Hispanics). Also, Arab Americans are 1.4 times more likely to have ADRD compared to US-born non-Hispanic whites when controlling for other factors.