Mild cognitive impairment (MCI), dementia and stroke are substantially higher among blacks aged 45+, and among residents of the southeastern region of the US. The REasons for Geographic And Racial Differences in Stroke (REGARDS) Study is national, longitudinal cohort study of ~ 30,000 blacks and whites designed to advance the understanding of the epidemiology of cognitive decline and stroke, and the contributors to racial and geographic disparities in these outcomes. The current application has three aims: 1. Identify social, cardiovascular, and environmental mechanisms of racial and geographic disparities in incident vascular contributions to cognitive impairment and dementia (VCID). With assessment in mid-life and over a decade of longitudinal cognitive data, REGARDS is uniquely positioned to identify vascular, social, and behavioral mechanisms underlying disparities in VCID, and modifiable pathways on which interventions may narrow disparities in VCID. After completion of a nested calibration/confirmation study to develop an algorithm for the classification of MCI and dementia, we will characterize racial and geographic disparities in VCID and determine if interventions on mediators would diminish or eliminate disparities. 2. Answer as-yet-unanswered questions in stroke and cerebrovascular disease epidemiology. By continuing the successful approaches for stroke surveillance among 17000 active cohort members, the study will assess the association of risk factor changes and novel biomarkers quantified with the completion of the second in-person exam with stroke risk and disparities in stroke risk. In addition, with the aging of the cohort, this aim will provide greatly needed information on stroke epidemiology in the elderly. 3. Utilize incident risk factor data and biospecimens to identify pathways for development of incident hypertension and diabetes, with the goal of understanding the impact on incident VCID and stroke. We have documented that ?30% of the racial disparity in stroke risk is attributable to racial disparities in prevalence of hypertension and diabetes, and the study will investigate the biomarker pathways contributing to the higher incidence of hypertension and diabetes in blacks. Each proposed aim addresses a topic of profound public health impact, and REGARDS progress to date uniquely positions the study to address these aims using proven approaches in an efficient manner.

Public Health Relevance

Mild cognitive impairment (MCI), dementia and stroke are substantially higher among blacks aged 45 and older, and among persons who live in the southeastern region of the US. The reasons for these higher rates are poorly understood. Analyses of vascular contributions to cognitive impairment and stroke from a national US cohort including persons with and without MCI, dementia, and stroke will help guide interventions to reduce these disparities.

Agency
National Institute of Health (NIH)
Institute
National Institute of Neurological Disorders and Stroke (NINDS)
Type
Research Project--Cooperative Agreements (U01)
Project #
5U01NS041588-18
Application #
9646392
Study Section
Neurological, Aging and Musculoskeletal Epidemiology (NAME)
Program Officer
Corriveau, Roderick A
Project Start
2001-09-24
Project End
2023-01-31
Budget Start
2019-02-01
Budget End
2020-01-31
Support Year
18
Fiscal Year
2019
Total Cost
Indirect Cost
Name
University of Alabama Birmingham
Department
Biostatistics & Other Math Sci
Type
Schools of Public Health
DUNS #
063690705
City
Birmingham
State
AL
Country
United States
Zip Code
35294
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Moise, Nathalie; Khodneva, Yulia; Jannat-Khah, Deanna Pereira et al. (2018) Observational study of the differential impact of time-varying depressive symptoms on all-cause and cause-specific mortality by health status in community-dwelling adults: the REGARDS study. BMJ Open 8:e017385
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Moore, Justin Xavier; Akinyemiju, Tomi; Bartolucci, Alfred et al. (2018) A prospective study of cancer survivors and risk of sepsis within the REGARDS cohort. Cancer Epidemiol 55:30-38
Sarmiento, Elisa J; Moore, Justin Xavier; McClure, Leslie A et al. (2018) Fine Particulate Matter Pollution and Risk of Community-Acquired Sepsis. Int J Environ Res Public Health 15:
Mefford, Matthew T; Rosenson, Robert S; Cushman, Mary et al. (2018) PCSK9 Variants, Low-Density Lipoprotein Cholesterol, and Neurocognitive Impairment: Reasons for Geographic and Racial Differences in Stroke Study (REGARDS). Circulation 137:1260-1269
Sterling, Madeline R; Durant, Raegan W; Bryan, Joanna et al. (2018) N-terminal pro-B-type natriuretic peptide and microsize myocardial infarction risk in the reasons for geographic and racial differences in stroke study. BMC Cardiovasc Disord 18:66
Colantonio, Lisandro D; Booth 3rd, John N; Bress, Adam P et al. (2018) 2017 ACC/AHA Blood Pressure Treatment Guideline Recommendations and Cardiovascular Risk. J Am Coll Cardiol 72:1187-1197
Sterling, Madeline R; Jannat-Khah, Deanna; Bryan, Joanna et al. (2018) The Prevalence of Cognitive Impairment Among Adults with Incident Heart Failure: The REasons for Geographic and Racial Differences in Stroke (REGARDS) Study. J Card Fail :
Inker, Lesley A; Grams, Morgan E; Levey, Andrew S et al. (2018) Relationship of Estimated GFR and Albuminuria to Concurrent Laboratory Abnormalities: An Individual Participant Data Meta-analysis in a Global Consortium. Am J Kidney Dis :

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