Population demographic trends suggest an expected dramatic increase in age-associated dementias and a looming public health crisis. Current emphasis is on disease prevention, with a focus on older adults who express early cognitive impairment. The SMART (Statistical Modeling of Aging and Risk of Transitions) has successfully harmonized data from nine different longitudinal studies on aging involving records on 5,032 subjects, with 1,657 having autopsy information. We propose to identify authoritatively the roles of diabetes and hypertension on the occurrence and duration of pre-dementia states, as well as mixed pathology. The project has shown that self-reported diabetes is not a risk for Alzheimer pathology but is a risk for cerebrovascular pathology, that subjective memory complaints are a risk for a future cognitive impairment, and that transitioning to a subjective complaint or even to mild cognitive impairment is no guarantee of future dementia. The SMART renewal proposes to obtain Medicare claims data on its participants to determine the severity of diabetes, hypertension and other comorbidities that have not been investigated, such as renal disease, with a focus on improving the prediction of who is at risk for a transition to an impaired cognitive state and mixed dementia pathology. This will be accomplished through the following specific aims:
Aim 1. Update and extensively revise the existing SMART project database with additional participant data; obtain and integrate linked Medicare claims data; assess agreement between self-reported medical history and claims data.
Aim 2. Investigate the relationship of HTN, T2DM, and multimorbidity in advanced old age with AD and non-AD neuropathologies.
Aim 3. Investigate the relationship of HTN, T2DM, and multimorbidity in advanced old age with cognitive states including subjective memory complaints, mild cognitive impairment, and dementia.

Public Health Relevance

With the graying of America, the cost of caring for older adults with dementia will rise substantially over the next few decades. Current emphasis in the field is on primary and secondary prevention. This project will study diabetes and hypertension as risk factors for various forms of dementia inducing pathology, as well as the impaired clinical states that precede diagnosed dementia.

Agency
National Institute of Health (NIH)
Institute
National Institute on Aging (NIA)
Type
Research Project (R01)
Project #
2R01AG038651-06A1
Application #
9738650
Study Section
Neurological, Aging and Musculoskeletal Epidemiology (NAME)
Program Officer
Anderson, Dallas
Project Start
2011-09-01
Project End
2024-01-31
Budget Start
2019-04-01
Budget End
2020-01-31
Support Year
6
Fiscal Year
2019
Total Cost
Indirect Cost
Name
University of Kentucky
Department
Biostatistics & Other Math Sci
Type
Schools of Arts and Sciences
DUNS #
939017877
City
Lexington
State
KY
Country
United States
Zip Code
40526
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