American Indians are a minority population in the U.S., numbering only about 4.1 million according to year 2000 census figures.1 While most Indians live in cities, a substantial number live in rural settings and earn marginal wages. Although health care is free for Indians, the services tend to be basic and do not include specialized dementia diagnosis and care. Indians are of special interest to the UTSW ADC because of their increasingly high prevalence of obesity, diabetes, hypertension, and cardiovascular disease.2 We have a long-standing relationship with the Choctaw Nation, which covers 15,000 square miles in southeastern Oklahoma, and comprises 80,000 persons. Given our theme of investigating the impact of vascular and inflammatory factors on the onset and course of AD, this is an ideal study population. Over many years, we have developed a strong positive working relationship with these underserved rural minority individuals by providing clinical sen/ices as a quid pro quo for performing research.
The Specific Aims of the Native American Satellite Diagnostic and Treatment Core are: 1. To provide dementia diagnosis and treatment to the Choctaw Nation through in-person visits to Oklahoma and monthly telemedicine clinics staffed by ADC faculty in Dallas and our nurse and clinical educator in Talihina, Oklahoma. 2. To support UT Southwestern investigator-initiated dementia research. We have enabled the conduct of an Alzheimer Association-sponsored investigation of cardiovascular risk factor in Indians with AD. 3. To support telemedicine-based research. We have established the feasibility of telemedicine based clinical care and neuropsychological testing. 4. To support multi-institutional observational studies and clinical trials. We have contributed 40% of the American Indians in the NACC database and have used the NACC database to compare the clinical course of AD in American Indians with that in Caucasians and African Americans.
The development of successful therapies for Alzheimer's disease (AD) will require a thorough understanding of the pathologic mechanisms that contribute to neurodegeneration. Data from epidemiologic and observational studies indicates that vascular and inflammatory pathology contributes to AD. The goal of the UTSW ADC is to identify biomarkers of vascular and inflammatory pathology that will be useful for selection
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