Research Infrastructure for the study of Alzheimer's Disease and Alzheimer's Disease-related dementias in older Asian Americans

PROJECT SUMMARY The older Asian American population has been rising, with the risk of Alzheimer’s Disease and Alzheimer’s Disease-Related Dementias (AD/ADRD) also increasing. However, most of the disparities in health outcomes are masked because older Asian Americans are significantly underrepresented in clinical research. Social determinants of health (SDOH) are an individual’s personal circumstances that influence their health and well- being. SDOH contribute to wide health disparities and inequities. Research linking AD/ADRD to SDOH is expanding rapidly, yet much evidence is still needed in older Asian Americans. Additionally, there are relatively few studies incorporating health related risks, such as vascular conditions, and biomarkers to understand the link between SDOH and AD/ADRD; it remains unclear if vascular risk factors and/or biomarkers mediate such a relationship. Using validated cognitive tests in English/Chinese and culturally relevant measures of sociodemographic factors, the study MPI (Li) successfully enrolled over 200 older Asian Americans in clinical research at the Alzheimer’s Disease Research Center (ADRC) at Mount Sinai. Here, the study team will grow to include multidisciplinary members, proposing a 5-year study to develop a research infrastructure for studying AD/ADRD in older Asian Americans. The SDOH assessment will be available in English, Mandarin, and Cantonese – the most common spoken languages among Asian American older adults. This study will answer the following questions: (1) Do Chinese translation and cultural adaptation of SDOH measures effectively recruit new and existing older Asian Americans in AD/ADRD research? (2) Can we identify behavior, environmental, social, genetic, and neurobiological factors associated with AD/ADRD? (3) How neurobiological processes intersect with environmental, sociocultural, behavioral, and other demographic factors to affect AD/ADRD outcomes? The study team will establish a scientific advisory board to provide scientific perspectives for the proposed study, particularly in the areas of (1) Social science; (2) Clinical phenotypes of AD/ADRD; (3) Dementia research in Asian Americans; and (4) Risk factors and biomarkers for AD/ADRD. The team will also collaborate with key community stakeholders to ensure that the SDOH assessment is culturally and linguistically appropriate. Recruitment goal is set to be 300 older Asian Americans to complete a comprehensive dementia evaluation that includes SDOH measurement. Novel, theory based SDOH indices will be developed to characterize older Asian Americans in the normal, MCI, and AD/ADRD groups. Of the 300 enrollees, the study team aims to re-evaluate 100 participants for a 1-year follow-up and collect 200 biomarker samples for molecular profiling, including whole genome sequencing, RNA-sequencing and proteomics. An integrative network biology and machine learning based approach will be employed to develop highly predictive diagnostic and prognostic molecular biomarkers of AD/ADRD. The UH2 phase will be used to develop the research infrastructure and assessment tools necessary to apply for a larger RO1 project at the end of the UH3 phase.