African Americans are twice as likely to develop Alzheimer's disease (AD) as Whites, but few studies have focused on these cognitive disparities and related mechanisms. Perceived stress in minority groups such as African Americans, directly affects cognition and also plays a role in worsening of CVD risk factors and unhealthy behaviors such as smoking, improper diet, and physical inactivity. Further understanding the role of modifiable risk factors such as perceived stress in cognitive decline could have an important role in developing effective preventive strategies and addressing health disparities in aging populations. The overarching goal of this proposal is to examine the association of stress and cognition, role of CVD risk factors, and related health disparities. The research proposed in this Mentored Patient-Oriented Research Career Development Award includes data analyses involving two cohort studies and determining the feasibility of a pilot clinical trial. The plan describes three separate but interrelated projects designed to examine the association of perceived stress and cognition.
Specific Aim -1: The study will prospectively examine the relationship between perceived stress and incident cognitive impairment among African Americans and Whites in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Cohort (n=30,239) and explore if CVD risk factors mediate this relationship.
Specific Aim -2: The study will assess the relationship of perceived stress with specific cognitive domains among African Americans and Whites with Mild Cognitive Impairment in the Vascular Contributors to Prodromal Alzheimer's disease (VASCULAR) cohort study (n=341) at Emory.
Specific Aim -3: The study will determine the feasibility of a novel web-based multidisciplinary stress reduction program and assess the program's effects on perceived stress, related biomarkers, and cognition among African Americans and Whites with Mild Cognitive Impairment (n=30). Candidate: The candidate (Dr. Kulshreshtha) is a board certified Family Physician in the Department of Family and Preventive Medicine at Emory University. His long-term career goal is to become an independent clinician researcher investigating the mechanisms of behavioral and lifestyle interventions to improve cognitive health and reduce health disparities. The integrated research and training program described in this proposal will build on the candidate's prior experience in cardiovascular epidemiology, health disparities, and primary care clinical work. It will incorporate new training in cognitive and stress measurements, and clinical trials, to develop expertise in the area of stress and cognition research for AD prevention. Overall this research will form the basis for larger studies investigating potential mechanisms and interventions for AD prevention and establish Dr. Kulshreshtha as a young investigator in patient-oriented clinical research.
As the elderly population in United States continues to grow rapidly, Alzheimer's disease poses a major public health challenge, and the disease may disproportionately burden older African Americans. Our proposal is designed to reduce the knowledge gaps regarding the role of modifiable risk factors such as perceived stress and how it may differentially impact cognitive function in high-risk groups. Findings from our proposal would lay the foundation of understanding the association of stress and cognitive impairment, mechanistic pathways, and targeted interventions to reduce Alzheimer's disease disparities.
