>> GOOD AFTERNOON, EVERYONE. I'M JANINE CLAYTON, DIRECTOR OF OFFICE OF RESEARCH ON WOMEN'S HEALTH, MY PLEASURE TO INTRODUCE OUR WEDNESDAY AFTERNOON LECTURE TODAY. DR. LISA BARNES IS PROFESSOR IN THE DEPARTMENTS OF NEUROLOGICAL SCIENCES AND BEHAVIORAL SCIENCES AT RUSH UNIVERSITY MEDICAL CENTER. SHE'S COGNITIVE NEUROPSYCHOLOGIST IN THE NIH FUNDED RUSH ALZHEIMER'S DISEASE CENTER. DR. BARNES EARNED HER BACHELORS DEGREE FROM CLARK ATLANTA UNIVERSITY AND HER Ph.D. FROM UNIVERSITY OF MICHIGAN AND SHE COMPLETED AN NIMH POST DOC AT UC DAVIS BEFORE JOINING THE FACULTY AT RUSH MEDICAL COLLEGE. HER RESEARCH FOCUS IS ON RACIAL DISPARITIES AND CHRONIC DISEASES OF AGING INCLUDING ALZHEIMER'S DISEASE AND HIV. SHE IS PRINCIPLE INVESTIGATOR OF THREE COMMUNITY BASED COHORTS STUDIES OF OLDER AFRICAN AMERICANS AND THE DIRECTOR OF THE RUSH CENTER OF EXCELLENCE OF DISPAIR THES AND HIV AND -- DISPARITIES HIV AND AGING. ONE COHORT STUDY, THE MINORITY AGING RESEARCH STUDY NOBODY AS MARS IS NATIONALLY RECOGNIZED AS A PREMIER STUDY OF MINORITY AGING AND HAS BEEN CONTINUOUSLY FUNDED BY THE NATIONAL INSTITUTE ON AGING SINCE 2004. DR. BARNES HAS BEEN RECOGNIZED FOR HER CONTRIBUTIONSES TO MINORITY AGING AND HEALTH DISPARTUS BY MANY PROFESSIONAL ORGANIZATIONS AND HAS RECEIVED NUMEROUS AWARDS. SHE IS THE AUTHOR OF OVER 150 MANUSCRIPTS AS -- AND SHE ALSO PROVIDED OVER 100 COMMUNITY PRESENTATIONS TO OLDER AFRICAN AMERICANS AND THEIR FAMILIES. ONE OF THE DEFINING MOMENTS OF HER CAREER WAS THE OPPORTUNITY TO WORK WITH HM ALSO KNOWN AS THE MAN WITH NO MEMORY, WHICH REPRESENTED SEMINOLE CASE FOR NEUROLOGICAL RESEARCH IN THE 21st CENTURY. PLEASE JOIN ME IN WELCOMING DR. LISA BARNES, HER LECTURE TODAY IS RACE, RISK AND RESILIENCE, UNDERSTANDING RACIAL DIFFERENCES AND COGNITIVE AGING AND BRAIN PATHOLOGY. [APPLAUSE] >> GOOD AFTERNOON. I WOULD LIKE TO FIRST THANK DR.S CLAYTON AND BERNARD AND THE WOMEN OF COLOR COMMITTEE FOR NOMINATING ME FOR THIS PRESTIGIOUS LECTURE SERIES, IT IS TRULY AN HONOR TO BE HERE TO PRESENT SOME OF THE WORK WE HAVE BEEN DOING IN CHICAGO FOR CLOSE TO 20 YEARS NOW. I WOULD ALSO LIKE TO THANK YOU AND THE AUDIENCE AND ANYONE WATCHING ON VIDEO FOR TAKING THE TIME OUT OF YOUR BUSY SCHEDULE TO COME AND LISTEN TO MY WORK. I APPRECIATE THE TIME. BEFORE I START I WOULD LIKE TO JUST ACKNOWLEDGE THE FUNDING AGENCIES FOR THE WORK THAT WE HAVE BEEN DOING AS WELL AS STUDY PARTICIPANTS OF THE DIFFERENT COHORT STUDIES I WILL TALK ABOUT TODAY. WITHOUT THESE TWO SOURCES OF SUPPORT, NONE OF THE WORK THAT WE DO WOULD BE POSSIBLE. TO GIVE YOU SORT OF A LAY-OUT OF WHAT I PLAN TO DISCUSS TODAY WITH YOU IN THE NEXT 45 MINUTES OR SO, I WILL REVIEW RACIAL DIFFERENCES IN COGNITIVE FUNCTION IN THE FIELD IN GENERAL AND FROM SOME OF OUR WORK. I WILL THEN TALK ABOUT JUST SELECT RISK FACTORS FOR COGNITIVE DECLINE AND ALZHEIMER'S DISEASE AND OLDER AFRICAN AMERICANS. THEN I WOULD LIKE TO TALK ABOUT SOME OF THE ONGOING WORK LOOKING AT RACIAL DIFFERENCES IN UNDERLYING BRAIN PATHOLOGY. AND HOPEFULLY THESE THINGS TAKEN TOGETHER WILL HELP ME ARGUE FOR THE IMPLICATIONS FOR UNDERSTANDING RESILIENCE IN AFRICAN AMERICANS. THEN I WILL END WITH GAPS AND OPPORTUNITIES AND TALK ABOUT FUTURE DIRECTIONS THAT WE'RE TAKING IN OUR WORK, IN THE NEAR FUTURE. TO CONTEXTUALIZE THE PROBLEM AND MAKE SURE WE'RE ON THE SAME PAGE I WANTED TO PRESENT WHAT THE LAY OF THE LAND IS. IT IS WELL DOCUMENTED THAT AFRICAN AMERICANS PERFORM MORE POORLY ON AVERAGE THAN WHITES ON COGNITIVE FUNCTION TESTS. THIS HAS BEEN SHOWN IN NUMEROUS STUDIES ACROSS THE COUNTRY FOR SEVERAL DECADES. HERE I'M SHOWING YOU TWO EXAMPLES OF TYPICAL FINDING YOU SEE IN THE FIELD WHEN YOU COMPARE AFRICAN AMERICANS AND WHITES ON COGNITIVE FUNCTION. ON THIS PANEL HERE IS -- DATA LOOKING AT RACIAL DISPARITIES IN COGNITIVE PERFORMANCE IN MID AND LATE ADULTHOOD FROM TWO WELL KNOWN STUDIES, MITUS AN WHIT CAP OUT OF COLUMBIA. THE PANELS ON THE TOP ARE DATA FROM Y CAP, IT'S SHOWING PERFORMANCE ON TWO COGNITIVE DOMAINS EPISODIC MEMORY APPROXIMATE EXECUTIVE FUNCTION, THE PETALS ON THE BOTTOM ARE RESULTS FROM MYDAS. WHAT YOU SEE IS THERE'S TWO LINES IN EACH GRAPH AND THE TOP GRAPH IN EVERY CASE IS PERFORMANCE OF WHITES ON THESE TWO COGNITIVE FUNCTION TESTINGS ACROSS DIFFERENT AGES. AND THE LINE ON THE BOTTOM ARE THE AFRICAN AMERICANS. YOU CAN CLEARLY SEE ACROSS THE AGES AFRICAN AMERICANS ARE PERFORMING MORE POORLY THAN AGE MATCHED WHITES. SIMILARLY IF YOU LOOK AT THE DATA ON THE RIGHT, THIS IS SHOWING YOU THE PREVALENCE OF COGNITIVE IMPAIRMENT AMONG AMERICANS AGE 55 AND OLDER FROM THE HEALTH AND RETIREMENT STUDY. AFRICAN AMERICANS ARE SHOWN IN THE BLUE BARS AND YOU CAN SEE THAT AT EVERY AGE AFRICAN AMERICANS HAVE HIGHER PREVALENCE OF COGNITIVE IMPAIRMENT COMPARED TO HISPANICS AND WHITES. IT'S NOT ADVANCING. THIS IS ALSO BORNE OUT BY DEMENTIA INCIDENTS STUDIES. HERE I'M SHOWING YOU DATA FROM KEISER OUT OF SAN FRANCISCO SHOWING THE INCIDENCE RATES FOR DEMENTIA BY AGE AND ETHNICITY. AFRICAN AMERICANS ARE SHOWN IN THE PURPLE BAR, YOU CAN SEE AT EVERY AGE AFTER AGE 69 AFRICAN AMERICANS HAVE HIGHER INCIDENCE OF DEMENTIA THAN THE OTHER ETHNIC AND RACIAL GROUPS THAT THEY MEASURED. SO THIS PERSISTENT DISPARITY COUPLED WITH THE FACT THE OLDER AFRICAN AMERICAN POPULATION IS RAPIDLY GROWING, FASTER THAN THE OLDER WHITE POPULATION, TAKEN TOGETHER THIS SUGGESTS THAT THE BURDEN OF COGNITIVE IMPAIRMENT ALZHEIMER'S DISEASE WILL BE DISPROPORTIONATE FOR OLDER AFRICAN AMERICANS. WE DON'T KNOW THE CAUSE OF ALZHEIMER'S DISEASE AND CURRENTLY THERE ARE NO EFFECTIVE DISEASE MODIFYING THERAPEUTICS. GIVEN THE STARK REALITY PREVENTION BECOMES AN IMPORTANT ACTION AREA. AT RUSH WE ARE SQUARELY FOCUSED ON PREVENTION STUDIES WHERE WE IDENTIFY RISK FACTORS FOR DISEASE GENETIC AND ENVIRONMENTAL AND WE DETERMINE THE BIOLOGIC PATHWAYS LINKING RISK FACTORS TO DISEASE. SO THAT WE MAY DEVELOP STRATEGIES TO PREVENT ALZHEIMER'S DISEASE AND REDUCE DISPARITIES BY EITHER MODIFYING LIFESTYLE BEHAVIORS OR IDENTIFYING DRUGGABLE TARGETS AND DEVELOPING EFFECTIVE THERAPEUTICS. IN ORDER TO DO THIS YOU NEED STUDIES THAT INCLUDE PEOPLE WITHOUT DEMENTIA, AND YOU NEEDY VERSE STUDIES THAT INCLUDE ADULTS FROM THE COMMUNITY BEYOND THOSE WHO SHOW UP FOR MEDICAL CARE. BECAUSE WE KNOW THAT MINORITIES WHO HAVE ACCESS TO CARE DIFFER ON A VARIETY OF FACTORS. THAT CONFOUND RESULTS IN YOUR STUDY. YOU ALSO NEED STUDIES THAT INCLUDE ASSESSMENT OF RISK FACTORS REGULAR TESTING, TO DOCUMENT INCIDENT DISEASE, AND BLOOD DOEMATION FOR GENETIC TESTING IF YOU'RE INTERESTED IN IDENTIFYING GENETIC RISK FACTORS. AT RUSH WE HAVE SEVERAL COHORT STUDIES THAT INCLUDE THESE DESIGN FEATURES. I'M ONLY GOING TO FOCUS ON FOUR TODAY, I WILL JUST LIKE TO GIVE YOU A BRIEF DESCRIPTION OF THE STUDIES SO YOU UNDERSTAND THE DATA COMING FROM THAT I'M GOING TO DESCRIBE LATER IN THE PRESENTATION. SO FIRST PROJECT IS CHICAGO HEALTH AND AGING PROJECT KNOWN AS CHAP, IT'S A POPULATION BASED STUDY, THAT TOOK PLACE STARTING IN 1993, WE DID A COMPLETE CENSUS OF ALL HOUSEHOLDS ON THE SOUTH SIDE OF CHICAGO INDICATING HERE IN YELLOW. SO HERE IS RUSH, WEST OF DOWNTOWN AND CHAP IS TEN MILES SOUTH OF RUSH. WE DID A CENSUS AND INVITED ALL RESIDENTS OVER THE AGE OF 65 TO PARTICIPATE AND OF ABOUT 7800 ELIGIBLE, 6100 ENROLLED AND 60% WERE AFRICAN AMERICAN. ALL DATA COLLECTION OCCURS IN PERSON IN THE HOME AS INTERVIEWS, AND THREE YEAR CYCLES, STARTING IN 1993. IN 2000, WHICH WOULD BE THE THIRD WAVE WE BEGAN NEWLY AGED PERSONS, PEOPLE WHO TURNED 65. SO THE ORIGINAL SUCCESSIVE COHORTS TOGETHER YIELDED A SAMPLE SIZE OF 10,800 PEOPLE. PEOPLE COME FROM VERY MIDDLE CLASS NEIGHBORHOODS AS WELL AS MORE AFFLUENT NEIGHBORHOODS. IF YOU KNOW ANYTHING ABOUT CHICAGO IT'S VERY SEGREGATED BY RACE, BUT THE NEIGHBORHOOD ON THE SOUTH IDE ARE ONE OF THE FEW THAT HAVE AFRICAN AMERICANS AND WHITES LIVING TOGETHER IN CONTIGUOUS NEIGHBORHOODS SO IT ALLOWS US TO LOOK AT A RANGE OF SOCIOECONOMIC STATUS IN AFRICAN AMERICANS AND WHITES. THE OTHER STUDY THAT I WILL DESCRIBE TODAY IS THE MINORITY AGING RESEARCH STUDY KNOWN AS MARS, WHICH BEGAN RECRUITING IN AUGUST OF 2004. THIS IS A VOLUNTEER COHORT CONSISTS OF OVER 700 AFRICAN AMERICAN WHOSE ARE 65 YEARS OLE AT ENROLLMENT WITHOUT KNOWN DEMENTIA. MEANING THEY DON'T HAVE A DIAGNOSIS AND THEY'RE NOT TAKING MEDICATIONS FOR DEMENTIA. THEY ARE RECRUITED FROM CHURCHES, SENIOR BUILDINGS AND ORGANIZATIONS THAT CATER TO OLDER AFRICAN AMERICANS, TESTING OCCURS ANNUALLY THANK YOU IN HOME COGNITIVE TESTING RISK FACTOR ASSESSMENT AND BLOOD DRAWS. OUR FOLLOW UP RATE HAS BEEN VERY GOOD WITH OVER 90% FOLLOW-UP AMONG SURVIVOR, AND FOR THOSE ONGOING ENROLLMENT PROCESS. SO FOR THOSE WHO ENROLLED IN 2004, WE HAVE UP TO 13 YEARS OF FOLLOW-UP. IF THEY'RE STILL LIVING. BEGINNING IN 2011 WE STARTED TO RECRUIT FOR AUTOPSY, BUT STILL CONSIDERED OPTIONAL COMPONENT FOR PEOPLE WHO CHOOSE TO SIGN UP FOR THAT PART OF THE STUDY. NOW, MARS IS COMPLETELY AFRICAN AMERICAN, AND IT WAS DESIGNED TO UNDERSTAND WITHIN RACE HETEROGENEITY BUT THERE ARE TIMES WHEN I WANT TO UNDERSTAND RACIAL DIFFERENCES, SO TO DO THAT I NEED A COMPARISON COHORT. SO FOR THAT, I'M I'M SORRY, I NEED TO TELL YOU THIS FIRST. BECAUSE IT'S COMMUNITY BASED, WE ARE VERY, VERY ENGAGED WITH THE COMMUNITY AND WE USE TECHNIQUES THAT ALLOW US TO RECRUIT A VERY ENRICHED SAMPLE OF AFRICAN AMERICANS OR TRY TO. IN THE HEART OF COMMUNITY EVER SEEKING TO WIN COMMUNITY'S HEART. THIS IS ME HERE. I FOUND A GROUP OF PEOPLE WHO HAVE BEEN GETTING TOGETHER 40 YEARS TO PLAY TENNIS AND WE TOOK LUNCH AND I GAVE A PRESENTATION ON HEALTHY AGING AND I WAS ABLE TO RECRUIT ABOUT 75% OF THE PEOPLE. MANY STILL IN THE STUDY SO WE DO THIS IN THE COMMUNITY IN DIFFERENT ORGANIZES TO ENHANCE RECRUITMENT, IT'S VERY EFFECTIVE FOR NOT ONLY RECRUITMENT BUT RETENTION PRACTICES AS WELL. COMPARISON COHORT WE USE IS TWO WELL KNOWN STUDIES OUT OF THE RUSH, THE RELIGIOUS ORDER STUDY AND THE RUSH MEMORY AND AGING PROJECT. THESE STUDIES HAVE BEEN ONGOING FOR 20 PLUS YEARS AND THEY CONSIST OF O OVER 3,000 OLDER PEOPLE WITHOUT KNOWN DEMENTIA FROM ACROSS THE USA, ABOUT 91% WHITE. THEY AGREE TO ANNUAL DETAIL CLINICAL EVALUATION WITH RISK FACTORS ASSESSED AND BLOOD DONATION AND IMPORTANTLY THEY ALL AGREE TO ORGAN DONATION AT DEATH. THAT'S A REQUIREMENT TO BE IN THE STUDY, SOMETHING YOU CAN NEVER DO MANY THE MINORITY POPULATION. BUT BECAUSE THEY DO THIS THEY HAVE OVER 1200 AUTOPSIES IN THESE STUDIES. AND IMPORTANTLY THERE'S A SIGNIFICANT OVERLAP IN RISK FACTORS WITH THESE STUDIES IN MARS AND WE USE THE SAME COGNITIVE BATTERY ALLOWING US TO MERGE THE DATA AND LOOK ACROSS RACE. ALL THREE STUDIES FOLLOW FOLLOW THE SAME LONGITUDINAL COHORT DESIGN ENROLLING PEOPLE AT BASELINE WITH NO DISEASE AND THEN WE DOCUMENT A RANGE OF RISK FACTORS, WE FOLLOW THEM ANNUALLY OVER TIME TO MEASURE CHANGE IN COGNITIVE FUNCTION AND ABLE TO ALSO MEASURE INCIDENT DISEASE AND PEOPLE WHO DEVELOP DISEASE EVENTUALLY, AND PEOPLE WHO COME TO AUTOPSY, WE GET A RANGE OF PATHOLOGY FROM NO PATHOLOGY TO MORE PATHOLOGY AND WE'RE ABLE TO CORRELATE EVERYTHING WE LEARNED ABOUT THEM WHEN LIVING TO TRAJECTORY OF CHANGE OVER TIME TO THE PATHOLOGY UNDERLYING TO UNDERSTAND HOW COGNITIVE AGING IS PLAYING A ROLE IN THE AGING BRAIN. ALL IN ONE DESIGN, ONE STUDY, POWERFUL WAY TO LOOK AT AGING IN OLDER ADULTS. SO JUST TO REMIND YOU OF THE COHORT STUDIES, WE HAVE CHAT, THE LARGE POPULATION BASE PEOPLE LIVING IN CONTIGUOUS NEIGHBORHOODS, ABOUT 60% AFRICAN AMERICANS WITH RANGE OF SES ACROSS BOTH GROUPS. THEN WE HAVE MARS WITH MATT ROSS VOLUNTEER COHORTS RECRUITED FROM THE COMMUNITY, THEY ENROLL WITHOUT DEMENTIA, FOLLOWED ANNUALLY AND THEY INVOLVE ORGAN DONATION. THOSE ARE THE COHORTS I'LL TALK ABOUT TODAY. SO I HAVE ALREADY TOLD YOU COGNITIVE FUNCTION IS WORSE IN AFRICAN AMERICANS ACROSS A NUMBER OF DIFFERENT STUDIES AND THE PREVALENCE OF DEMENTIA IS THIS WORKS AS WELL. WE KNOW COGNITIVE FUNCTION IS INFLUENCED BY MANY FACTORS SHOWN HERE ON THIS DIAGRAM. MANY OF THESE FACTORS VARY BY RACE MAKING IT CHALLENGES TO INTERPRET BLACK WHITE DIFFERENCES AND COGNITIVE PERFORMANCE WHEN WE SEE THEM. IT ALSO LEADS TO INCREASE REPORTS FOR COGNITIVE IMPAIRMENT AND RISK OF DISEASE. I'M GOING TO SHOW YOU DATA THAT I THINK WILL ILLUSTRATE THAT. BECAUSE OUR STUDIES ARE SET UP TO BE LONGITUDINAL, WE ARE ABLE TO LOOK AT CHANGE OVER TIME. FUNDAMENTALLY AGING IS A PROCESS OF CHANGE OVER TIME. SO IF YOU REALLY INTERESTED IN COMPARING BLACKS AND WHITES, YOU HAVE TO BE ABLE TO LOOK AT LONGITUDINAL TRAJECTORIES. AND WE DO THIS IN OUR STUDIES HERE IS DATA FROM CHAP, SHOWING YOU ON THE Y AXIS IS PERFORMANCE ON GLOBAL MEASURE COGNITION, Z SCORES SO POSITIVE NUMBERS, BETTER PERFORMANCE, THE NEGATIVE NUMBERS IS WORSE PERFORMANCE AND YOU HAVE TWO LINES, YOU HAVE THE WHITES AND YOU HAVE THE BLACKS WHO STARTED THE STUDY AT DIFFERENT AGES. WHAT YOU CAN SEE ACROSS THE BOARD IS YOU HAVE THESE PERSISTENT LEVEL DIFFERENCES WHERE WHITES ARE PERFORMING BETTER THAN AFRICAN AMERICANS BUT THE LINES ARE PARALLEL. THAT'S NO DIFFERENCE IN THE RATE OF CHANGE OVER TIME WHEN YOU LOOK AT PEOPLE OVER PERIODS OF TIME. WE HAVE SHOWN SIMILAR RESULTS IN OUR VOLUNTEER COHORT, HERE I'M SHOWING YOU DATA FROM SEMANTIC MEMORY AND PER ACCEPT ACTUAL SPEED TEST. THE WHITES ARE SHOWN IN THE GREEN BARS ON TOP AND THE BLACKS ARE IN THE PURPLE BLUE BARS ON THE BOTTOM, PERSISTENT LEVEL DIFFERENCES BUT THE LENGTH OF THE LINE SHOWS YOU HOW LONG WE FOLLOW PEOPLE WHO STARTED THE STUDY OF DIFFERENT AGES, YOU CAN SEE LINES ARE PARALLEL, IF ANYTHING, IT LOOKS LIKE BLACKS ARE DECLINING SLOWER IN P OLDER AGES IN THESE TWO PARTICULAR DOMAINS. WE HAVE LOOKED AT THIS ALSO WITH NON-LINEAR CHANGE BECAUSE WE KNOW IF WE FOLLOW PEOPLE LONG ENOUGH CHANGE STOPS BEING LINEAR. YOU DEVELOP A NON-LINEAR COMPONENT. WE LOOK AT THIS IN OUR COHORT, OUR CHAT COHORT, WE DIVIDED BLACKS AND WHITES INTO TWO GROUPS. THOSE WHO WERE ALIVE THROUGHOUT THE FOLLOW-UP PERIOD SHOWN IN THE LINE ON THE TOP AND THOSE WHO DIED DURING THE FOLLOW-UP PERIOD. WHAT YOU SEE IS ABOUT SIX YEARS INTO THE FOLLOW-UP YOU HAVE A CHANGE POINT WHERE DECLINE STARTS TO GO DOWN PRECIPITOUSLY AND THIS IS THE SAME POINT IN BOTH BLACKS AND WHITES. U YOU SEE THE LEVEL DIFFERENCES BUT THE LINES ARE PARALLEL. WE HAVE ALSO SHOWN IN OUR STUDIES THAT MUCH OF COGNITIVE DECLINE SEEMS TO BE DRIVEN BY PEOPLE WHO HAVE ALZHEIMER'S DISEASE, HERE I'M SHOWING YOU DATA FROM EUROPEAN AMERICANS, WHITES AND AFRICAN AMERICANS TWO LINES ON THE TOP ARE PEOPLE WHO NEVER DEVELOPED COGNITIVE IMPAIRMENT THROUGHOUT THE STUDY PERIOD AND THE TWO LINES ON THE BOTTOM ARE PEOPLE WHO DEVELOP ALZHEIMER'S DISEASE. . WHITES ARE HERE ON THE TOP, THEY ARE PERFORMING BETTER PLAQUES WHO DIDN'T DEVELOP COGNITIVE IMPAIRMENT LINES ARE PARALLEL AND HERE THOSE WHO ARE DEVELOPED ALZHEIMER'S DISEASE LOOKS LIKE THE AFRICAN AMERICANS ACTUALLY ARE DECLINING SLOWER OVER TIME. ONCE ABOUT THREE YEARS BEFORE DIAGNOSIS YOU START TO SEE THIS SHARP DROP IN COGNITION T. WE HAVE LOOKED AT AFRICAN AMERICANS WITH ALZHEIMER'S DISEASE AND COMPARE THEM TO AFRICAN AMERICANS WHITES WITH ALZHEIMER'S DISEASE AND WE FOUND AFRICAN AMERICANS DECLINED ABOUT 25% SLOWER RATE THAN WHITES SO HERE IS A LINE FOR WHITES WITH ALZHEIMER'S AND HERE IT IS FOR AFRICAN AMERICANS, YOU CAN SEE AT SOME POINT THERE'S A CROSS OVER. TO SUM RIDES THESE COGNITIVE AGING FINDINGS WE HAVE SHOWN THE AFRICAN AMERICANS PERFORMANCE WORSE ON AVERAGE ON TEST OF COGNITION AND CROSS SECTIONAL ANALYSES BUT THERE DOESN'T APPEAR TO BE ANY EVIDENCE FOR FASTER RATES OF DECLINE IN LONGITUDINAL ANALYSIS, ATHLETE THE DATA IN OUR HANDS DON'T SHOW ANY DIFFERENCE BY RACE. BUT THERE ARE STILL THIS PROBLEM WE HAVE. WE HAVE THE PERSISTENT LEVEL DIFFERENCE WE NEED TO UNDERSTAND. WHAT WE WANT TO KNOW, CAN WE IDENTIFY FACTORS THAT MIGHT PREDICT DECLINE AND WHAT IS THE ROLE OF RACE BECAUSE IF WE CAN DO THAT WE CAN PREVENT DECLINE OR SLOW THE ONSET OF DECLINE AND IMPORTANTLY ARE THERE FACTORS THAT HELP US UNDERSTAND THESE PERSISTENT LEVEL DIFFERENCES. WE HAVE LOOKED AT A NUMBER OF DIFFERENT RISK FACTORS SOME THAT WERE WELL ESTABLISHED IN THE LITERATURE, I WON'T GO THROUGH ALL OF THEM BUT I DID WANT TO PRESENT DATA ON ONE GENETIC POLYMORPHISM THAT HAS BEEN VERY CONTROVERSIAL IN THE FIELD WHEN IT COMES TO RACE DIFFERENCES. THE APOE LIPOPROTEIN E-4 ALLELE. THIS IS THE MOST ROBUST GENETIC RISK FACTOR FOR ALZHEIMER'S DISEASE IN WHITES. BUT THE FREQUENCY OF THE E 4 ALLELES ACTUALLY HIGHER IN AFRICAN AMERICANS, BUT AFFECT APPEARS TO BE WEAKER. SO IN A NUMBER OF STUDIES PEOPLE EITHER FIND THERE'S NO RELATIONSHIP OF E-4 WITH ALZHEIMER'S DISEASE OR SORRY OR THEY FIND THE EFFECT IS MUCH WEAKER T. THE DISPARITY MAY BE DUE TO RACE -- NOT DOING ANYTHING. GOING BY ITSELF. THE DISPARITY MAYBE DUE TO RACE SPECIFIC VARIATION OF HAPLO TYPES ACROSS APOE AND NEIGHBORING GENES. WE KNOW FROM PRIOR STUDIES THAT THE PATTERN OF LINKAGE BETWEEN APOE AND NEIGHBORING GENE CALLED TOM 40 DIFFERS BETWEEN AFRICAN AMERICANS AND WHITES. IN WHITES THE E-4 ALLELE IS ALMOST PERFECTLY LINKED WITH TOM 4523 LONG ALLELE BUT IN AFRICAN AMERICANS THE E-4 LINKED TO 523 SHORT IN ADDITION TO 523 LONG. COULD THIS EXPLAIN THE WEAKER EFFECT OF E-4 ON ALZHEIMER'S DISEASE IN AFRICAN AMERICANS. . AND HERE I'M SHOWING YOU DATA FROM VOLUNTEER COHORTS, THE PANEL HERE ON THE LEFT IS THE CUMULATIVE OF ALZHEIMER'S DISEASE IN WHITES WHO HAD E-4 AND TOM 4523 ALLELE. WHAT YOU CAN SEE IS THAT IT MIGHT BE HARD TO SEE BUT THESE ARE SIX LINES. AND THE SOLID LINE ARE E-4 ALLELES. THESE ARE PEOPLE WHO ARE HOMOZYGOUS FOR E-4 AND THESE ARE PEOPLE WHO WERE HETEROZYGOUS FOR E-4 AND THESE WERE PEOPLE NON-E-4 CARRIERS. SUPER IMPOSE ARE THE DOTTED LINES FOR THE 3523 ALLELE AND THERE'S PLEAS LINKAGE DISEQUALIBRIUM FOR 523 AND E-4 ALLELE, YOU DON'T SEE THE SAME PATTERN IN AFRICAN AMERICANS ON THE RIGHT SIDE. WHAT YOU SEE HERE IS THE RISK OF E-4 BUT THE RISK FOR THE 523 ALLELES IS NOT REPLICATED IN AFRICAN AMERICANS IN THE BOTTOM GRAPH. ING WE HAVE SIMILARLY LOOKED AT THE EFFECT OF E-4 ON COGNITIVE DECLINE IN OUR COHORTS, AND WE FIND THE E-4 ALLELE IS ASSOCIATED WITH FASTER DECLINE EPISODIC MEMORY IN BOTH BLACKS AND WHITES SO HERE IS OUR PEOPLE ARE WHITES WHO HAVE NO E-4 ALLELE AND DOTTED LINE OF WHITES WHO HAD E-4 ALLELE, THAT IS A MUCH FASTER RATE OF DECLINE. THE AFRICAN AMERICANS ARE THE SHORTER LINES BECAUSE THE STUDY STARTED LATER. THESE ARE THE NON-E-4 CAREIERS, AND HERE ARE THE E-4 CARRIERS, A FASTER RATE OF DECLINE BUT IN CONTRAST WHEN YOU LOOK AT ANOTHER DOMAIN LIKE WORKING MEMORY YOU CAN SEE THE SAME EFFECT IN WHITES, THE E-4s RELATED TO FASTER RATE OF DECLINE, BUT LOOK AT THE LINES FOR AFRICAN AMERICANS, THEY'RE COMPLETELY SUPER IMPOSED. E-4 HAS NO EFFECT IN THIS PARTICULAR DOMAIN OF COGNITION. WE HAVE EXAMINED A NUMBER OF ENVIRONMENTAL AND EXPERIENTIAL FACTORS IN ADDITION TO THE GENETIC RISK FACTORS. AND THERE ARE MANY FACTORS THAT INCREASE YOUR RISK OF DISEASE LISTED HERE OPT SLIDE AND MANY THAT DECREASE YOUR RISK. ONE COULD ARGUE THAT ONE THAT DECREASE YOUR RISK COULD REALLY BE RESILIENCE MARKERS FOR COGNITIVE AGING, IT PROTECTS YOU FROM DISEASE SLOW RATE OF DECLINE. INTERESTINGLY WE HAVE NOT FOUND FACTORS TO DIFFER BY RACE. WE HAVE FOUND SOME FOR THE INCREASE RISK THAT DIFFER BY RACE AND I'M NOT GOING TO GO THROUGH THOSE TODAY BUT I THINK THERE'S SOMETHING WE CAN LEARN BY LOOKING AT THE DECREASE RISK FACTORS AND TRYING TO UNDERSTAND AND MODEL RESILIENCE FACTORS. THE QUESTION WE WANT TO ANSWER THOUGH IS WHY DO DISPARITIES AND COGNITIVE LEVEL EXIST? AND TO DO -- TO ANSWER THIS QUESTION WE USE DATA FROM CHAP AGAIN, PARTICIPANTS WERE RANDOMLY SPLIT INTO EXPLORATORY AN CONFIRMATORY SUBGROUPS AND POTENTIAL CORRELATES OF COGNITION WERE SELECTED FROM A WIDE RANGE OF DEMOGRAPHIC HEALTH RELATED AND EXPERIENTIAL SUBGROUP USING STEP WISE SURGE ALGORITHM WE EXAMINED COGNITIVE DIFFERENCE BY RACE AND ALLOW CANDIDATE MEASURES AND RACE BY CANDIDATE MEASURES TO ENTER THE MODEL. THE COGNITIVE SCORE EXPLORATORY SUBGROUP WAS A MEAN OF .403 LOWER IN H BLACKS. AND RACE ACCOUNTED FOR 7% COGNITIVE VARIABILITY. AFTER THE CANDIDATE SELECTION PROCESS 16 MEASURES WERE RETAINED. NOT SHOWING YOU THE DATA FOR ALL 16. BUT IN THIS MODEL WHICH ACCOUNTED FOR 45% OF VARIABILITY IN COGNITION, RACE WAS NO LONGER SIGNIFICANT WHEN WE HAD THESE TWO MARKERS HERE. RACE BY READING, COGNITIVE ACTIVITY AND RACE BY NEUROTICISM. THE FINDING WAS ASSOCIATION OF HIGHER LEVELS OF READING COGNITIVE ACTIVITY WITH HIGHER COGNITIVE FUNCTION WAS WEAKER IN AFRICAN AMERICANS AND NEUROTICISM FINDING WAS THE ASSOCIATION OF HIGHER NEUROTICISM WITH LOWER LEVEL COGNITION WAS STRONGER IN AFRICAN AMERICANS. THESE CANDIDATE MEASURES ONLY ACCOUNTED FOR 45% OF THE VARIABILITY SUGGESTING THERE MAYBE OTHER FACTORS THAT WE NEED TO EXAMINE TO UNDERSTAND COGNITIVE AGING IN AFRICAN AMERICANS. IN OUR STUDIES WE ARE ABLE TO LOOK AT A NUMBER OF RACE RELEVANCE FACTORS. THE PROBLEM HAS BEEN TYPICALLY IN THESE LARGE COHORT STUDY THEY FOCUS ON TRADITIONAL RISK FACTORS, VERY FEW STUDIES INCORPORATED RACE RELEVANT FACTORS. I KNOW THAT NIA AND N IMHD BOTH HAVE RESEARCH FRAMEWORK WHERE THEY ARE REALLY ADVANCING RESEARCH IS TO REALLY CONSIDER A BROADER RANGE OF FACTORS ACROSS MANY LEVELS TO TRY TO UNDERSTAND HEALTH OUTCOMES. SO WE HAVE BEEN DOING THIS FOR A WHILE IN OUR STUDIES AND I WANT TO PRESENT SOME OF THE DATA THAT WE'RE SEEING. I'M GOING TO FOCUS ON THE FIRST THREE HERE IN GREEN. SELF-REPORTED EXPERIENCES OF DISCRIMINATION IS A VERY IMPORTANT PSYCHOSOCIAL UNIQUE PSYCHOSOCIAL STRESSOR IN AFRICAN AMERICANS AND HAVE BEEN LINKED TO A NUMBER OF ADVERSE HEALTH OUTCOMES. SOME BUT NOT ALL STUDIES HAVE FOUND IT PARTIALLY EXPLAINED DISPARITIES IN HEALTH. WE WERE ONE OF THE FIRST GROUPS TO LOOK AT THE RELATIONSHIP OF PERCEIVED DISCRIMINATION TO COGNITIVE OUTCOMES TO OLDER ADULTS. AND WHAT WE FOUND IS PERCEIVED DISCRIMINATION WAS ASSOCIATED WITH WORSE EPISODIC MEMORY AND PER ACCEPT ACTUAL SPEED IN OUR PARTICIPANTS SHOWN HERE IN THE RED BOX. MUCH OF THE ASSOCIATION WAS EXPLAINED BY DEPRESSIVE SYMPTOMS. WE ALSO LOOKED AT THE EFFECT OF DISCRIMINATION ON C REACTIVE PROTEIN MEASURED IN THE BLOOD AND WE FOUND A VERY NICE DOSE RESPONSE CURVE SUCH THAT THOSE REPORTED MORE DISCRIMINATION HAD HIGHER LEVELS OF CRP IN THE BLOOD SUGGESTING A POTENTIAL MECHANISM OF INFLAMMATION LINKING DO DISCRIMINATION TO POOR HEALTH. ANOTHER IMPORTANT RISK MARKER IN AFRICAN AMERICANS IS PERCEIVED STRESS WHICH IS THE DEGREE TO WHICH A PERSON FINDS THEIR LIVES UNPREDICTABLE, UNCONTROLLABLE AND OVERLOADING. WE LOOKED AT THIS IN THE MINORITY AGING RESEARCH STUDY AND WE FOUND THAT PERSONS WHO REPORTED MORE PERCEIVED STRESS SHOWN IN BLUE LINES HERE HAD A FASTER RATE OF DECLINE IN EPISODIC MEMORY AND VISUAL SPATIAL ABILITY. WE ASKED SIMPLE QUESTION IN OUR DATA SET, WE KNOW WHERE PEOPLE WERE BORN AND WHERE THEY WERE LIVING AT AGE 12. WE WANTED TO SEE IF EARLY LIFE RESIDENCE WOULD CORRELATE WITH PERFORMANCE ON OUR COGNITIVE FUNCTION TEST AND WHAT WE FOUND WAS FOR AFRICAN AMERICANS WHO WERE BORN OR LIVING IN THE SOUTH AT AGE 12 SHOWN IN THE RED BARS, THESE ARE Z SCORES ON OUR 19 BATTERY COGNITIVE FUNCTION TEST, THOSE BLACKS SHOWN IN RED AT POOR COGNITIVE PERFORMANCE FUNCTION THAN BLACKS BORN OR OR LIVING IN THE NORTH AT AGE 12. I WAS INTERESTED TO SEE IF I WOULD SEE THE SAME PATTERN IN WHITES. HERE I'M SHOWING YOU THE DATA FOR WHITES. IT'S IN THE SAME DIRECTION BUT IT'S NOT NEARLY AS DRAMATIC AS A DIFFERENCE BETWEEN THE BLACKS BORN IN THE SOUTH AND BLACKS BORN IN THE NORTH. I WANT TO POINT OUT THAT WE DIDN'T HAVE AS MANY WHITES WHO WERE BORN IN THE SOUTH. WHICH ALSO POINTS TO THE IMPORTANCE OF UNDERSTANDING THE SOCIAL EXPERIENCE OF OLDER BLACKS IN THIS COUNTRY, WE KNOW ABOUT THE MIGRATION PATTERNS THAT HAPPEN FROM THE SOUTH WHERE PEOPLE ENDED UP IN CHICAGO. SO PERFORMANCE ON THESE TESTS IS BEING REFLECTED IN WHERE PEOPLE STARTED OUT. THIS COULD BE DIETARY DIFFERENCES, HEALTH DIFFERENCES, IT COULD BE A HOST OF DIFFERENCES, WE ADJUST FOR A NUMBER OF FACTORS, AND WE STILL GET THE SAME FINDING. SO THIS NEEDS TO BE PROBED A LITTLE BIT FURTHER TO KNOW WHAT'S GOING ON HERE. WE HAVE JUST STARTED REALLY PRELIMINARY DATA TO TRY TO UNDERSTAND PERCEIVED DISCRIMINATION A LITTLE BIT FURTHER AND WE HAVE BEEN DOING FUNCTIONAL IMAGING, FUNCTIONAL MRI LOOKING HOW PERCEIED DISCRIMINATION IS SHOWING UP IN THE BRAIN. AND COMPARED TO WHITES, AFRICAN AMERICANS WITH HIGHER PERCEIVED DISCRIMINATION THOUGH GREATER CONNECTIVITY BETWEEN THE INSULA AND THE LEFT CAUDAL. WE KNOW FROM PRIOR WORK THIS NETWORK IS IMPORTANT FOR EMOTION COGNITIVE PROCESSING. DISCRIMINATION MEASURE, IT'S REAL, IT'S DOING SOMETHING, WE OBVIOUSLY NEED TO HAVE MUCH HIGHER NUMBERS TO SEE IF THIS WILL BE REPLICATED BUT IT'S COMPELLING AND INTERESTING DATA TO SEE HOW WE CAN TAKE SOCIAL EXPERIENCE AND RELATE IT TO SOME UNDERLYING BRAIN MEASURE. SO JUST TO SUMMARIZE THE RISK FACTORS THAT I HAVE JUST TALKED ABOUT THE EFFECT OF APOE, POTENT GENETIC RISK FACTOR, THE EFFECT OF APOE ON RISK OF DISEASE AND COGNITIVE DECLINE IN AFRICAN AMERICANS IS LIKELY DRIVEN BY VARIATION IN THE PATTERN OF LINKAGE WITH NEIGHBORING GENES. WE CAN IDENTIFY RISK FACTORS THAT REDUCE THE BLACK WHITE DIFFERENCE IN THE LEVEL BUT AS I TOLD YOU, THEY ONLY ACCOUNT FOR 45% OF THE VARIABILITY. COGENTLY RELEVANT FACTORS ARE IMPORTANT TO UNDERSTAND WITHIN RACE HETEROGENEITY AND NEED TO BE INCORPORATED IN THESE STUDIES. BUT THE QUESTION THAT I REALLY WANT US TO ANSWER TODAY IS THERE SOMETHING ELSE GOING ON? RACE AND PATHOLOGY, WE KNOW FROM STUDIES IN WHITES THAT ACCUMULATION OF PATHOLOGY STARTS DECADES BEFORE YOU START TO SEE CLINICAL SYMPTOMS. IN OUR STUDIES IN WHITES, WE HAVE OVER 1200 BRAINS, WE PHOBIC 85 ALZHEIMER'S DISEASE CHANGES ARE PRESENT IN NEARLY EVERY BRAIN, WHETHER OR NOT PEOPLE SHOWED WHETHER OR NOT PEOPLE HAD CLINICAL ALZHEIMER'S DISEASE. WE KNOW CEREBROVASCULAR DISEASE IS PRESENT IN MORE THAN HALF OF THE BRAINS, AN PARKINSON DISEASE CHANGES ARE PRESENT IN 40% OF THE BRAINS AND UP TO 40% ARE POSITIVE FOR TBP 43, A PROTEIN ASSOCIATED WITH FRONTAL TEMPORAL DEMENTIA. IN FACT WE HAVE PUBLISHED THAT MIX BRAIN PATHOLOGIES, SO COMBINATION OF ALL COMMON PATHOLOGIES IS THE MOST COMMON CAUSE OF DEMENTIA AND OLD AGE, FOLLOWED BY ALZHEIMER'S DISEASE PATHOLOGY. THERE'S VERY GOOD DATA ON NEURAL PATHOLOGY IN AFRICAN AMERICANS AND NONE IN AFRICAN AMERICANS WHO START A STUDY WITHOUT DEMENTIA. THE DATA THAT ARE OUT THERE, COME FROM STUDIES WHERE PEOPLE ARE AT A MEMORY CLINIC, THEY DIE, THEY COME TO AUTOPSY, SO THEY HAVE THE DISEASE OR THEY'RE FROM AUTOPSY SERIES MEDICAL EXAMINERS CASES, THERE'S A LITTLE CLINICAL INFORMATION. SO WE WANT TO KNOW PATHOLOGY THE MISSING LINK IN UNDERSTANDING THE DISPARITIES IN COGNITIVE LEVEL AND RISK OF AD. WE KNOW THAT AFRICAN AMERICANS HAVE A HIGH PREVALENCE OF VASCULAR CONDITIONS LIKE HYPERTENSION DIABETES, COULD THEY POTENTIALLY HAVE MORE VASCULAR DISEASE IN THE BRAIN. WE FIRST LOOKED AT THIS IN ANOTHER COHORT STUDY THAT WE HAVE, OF PEOPLE RECRUITED FROM OUR MEMORY CLINIC . WHO HAD A DIAGNOSIS OF DEMENTIA AND CAME TO AUTOPSY AND WE COMPARED AFRICAN AMERICANS AND WHITES. WE FOUND THAT MIXED DISEASE WAS THE MOST COMMON CAUSE OF DEMENTIA IN BOTH GROUPS BUT AFRICAN AMERICANS WERE LIKELY TO HAVE MIXED PATHOLOGY AS CAUSE OF DEMENTIA, SHOWN WITH THIS RED SLICE COMPARED TO THE LITTLE TINY RED SLICE FOR WHITES. ONE THING TO POINT OUT IS THAT ALL THESE PATIENTS WERE FROM THE CLINIC. AND WE KNOW WE DISCOVERED OR EXAMINED WHAT THE MIX PATHOLOGIES WERE AND WE THOUGHT THEY WOULD HAVE BEEN ALZHEIMER'S DISEASE AND -- GIVEN PATTERN OF VASCULAR DISEASE IN AFRICAN AMERICANS. BUT SURPRISINGLY THE MIXED COMBINATIONS OF ALZHEIMER'S DISEASE AND LOUIS BODIES WHICH WE DIDN'T EXPECT. WE KNOW LOUIS BODIES ARE ASSOCIATED WITH BEHAVIORAL PROBLEMS, HALLUCINATIONS, SLEEP DISORDERS. SO IT'S LIKELY THAT AFRICAN AMERICANS PRESENT TO A MEMORY CLINIC SHOWING UP BEHAVIOR PROBLEM AND NOT FROM MEMORY PROBLEMS WHICH IS WHY WE'RE GETTING THE COMBINATION OF DISEASE PATHOLOGY. IT HAS IMPORTANT IMPLICATIONS FOR HOW WE MOVE FORWARD AS WE TRY TO UNDERSTAND WHAT IS THE PATHOLOGY WE'RE MEASURING IN THE BRAIN AND HOW ARE THESE THERAPEUTICS WE'RE TARGETING GOING TO DIFFERENTIALLY WORK IN DIFFERENT POPULATIONS. IT ALSO SUGGESTS THAT OR SUPPORTS THE FACT THAT PEOPLE WHO ARE JUST USING CLINIC BASED SAMPLES MAY NOT HAVE A REPRESENTATIVE SAMPLE OF THE COMMUNITIES ACTUALLY COMMUNITITY SO THAT'S THE QUESTION WE ARE ASKING OUR DATA WHICH IS OF COURSE ONGOING YOU'RE COLLECTING BRAINS OVER TIME BUT WE LOOKED -- TOOK AN INITIAL LOOK AND 202 DECEASED SUBJECTS WHO ENROLLED WITHOUT DEMENTIA FROM THREE VOLUNTEER COHORT STUDIES, MINORITY AGE AND RESOURCE STUDY, MEMORY AGING PROJECT, WE USE CONSECUTIVE DISEASE AFRICAN AMERICAN SUBJECTS WITH AVAILABLE PATHOLOGY AND WE MATCHED THEM TO DISEASED WHITES, WE HAVE OVER 1200 WHITES SO ABLE TO MATCH THEM COGNITION. WE QUANTIFY COMMON PATHOLOGIES USING STANDARD TECHNIQUES NEUROPATHOLOGIST WAS BLINDED TO CLINICAL CHARACTERISTICS OF PARTICIPANTS. HERE I'M SHOWING YOU THE CASH TICKS OF THOSE 202 PEOPLE -- CHARACTERISTICS OF THOSE 202 PEOPLE SO WE HAVE 79 BRAINS OF AFRICAN AMERICANS MATCHED TO 123 WHITES. THEY WERE MATCHED ON AGE AT DEATH, EDUCATION, AND THE PERCENTAGE THAT WERE FEMALE. THE ONLY DIFFERENCE BETWEEN THE TWO GROUPS ARE AFRICAN AMERICANS WERE MORE LIKELY TO HAVE THE APOE E-4 ALLELE AT 42% COMPARED TO 19.8 IN WHITES. THEY WERE MORE LIKELY TO HAVE CLINICAL ALZHEIMER'S DISEASE BY THE TIME THEY DIED BUT IT WAS NOT DIFFERENT FROM THE WHITE, 41.8 COMPARED TO 34.1. T EVERYONE STARTS THE STUDY WITHOUT DEMENTIA AND SOME DEVELOP IT OVER TIME. IMPORTANTLY, THERE WERE NO RACIAL DIFFERENCES IN THE BURDEN OF PATHOLOGY, UNLIKE THE CLINIC STUDY WITH MORE MIXED PATHOLOGY CONSISTING OF ALZHEIMER'S AND LOUIS BODIES, WE SAW NO DIFFERENCES ACROSS RACE AND THESE COMMON PATHOLOGIES THAT WE MEASURED. BUT WE WANTED TO KNOW THE IMPACT OF PATHOLOGY ON RISK OF DISEASE, IS THERE A DIFFERENTIAL IMPACT BY RACE. HERE I'M SHOWING YOU A COX MODEL WHERE WE ENTER THE DIFFERENT PATHOLOGY TO SEE WHAT WAS RELATED TO RISK OF DISEASE. VALUES IN RED SHOW YOU THAT BOTH AD PATHOLOGY AND MICROINFARCTS INCREASE THE RISK OF ALZHEIMER'S DISEASE BUT THERE WAS A RACE BY MICROINFARCTS INTERACTION. . SUCH THAT MICROINFARCTS HAD A STRONGER ASSOCIATION WITH CLINICAL AD AFRICAN AMERICANS THAN WHITES. THESE MODELS WERE ADJUSTED FOR AGE, SEX, EDUCATION AND WHITE RACES OF REFERENCE GROUP. SHOW YOU WHAT IT LOOKS LIKE IN A DIAGRAM. HERE IS WHEN WE JUST LOOKED AT AD PATHOLOGY, YOU CAN SEE THERE'S AN INCREASE RISK OF DEMENTIA SHAH, THE MORE PATHOLOGY YOU HAVE, THERE'S NO DIFFERENCE BY RACE, WE ADDED GROSS INFARCTS, NOTHING GOING ON THERE. BUT WHEN WE ADDED MICROINFARCTS THIS IS THE INTERACTION I JUST TALKED ABOUT, THIS IS THE EFFECT IN AFRICAN AMERICANS COMPARED TO THE DOTTED LINE FOR WHITES SO MUCH STRONGER ASSOCIATION FOR INFARCTS FOR AFRICAN AMERICANS THAN WHITES. SO TO SUMMARIZE PATHOLOGY DATA WE HAVE SHOWN CLINIC PATIENTS VERSUS COMMUNITY BASED PARTICIPANTS WITHOUT DEMENTIA AT ENROLLMENT HAVE DIFFERENT PATTERNS OF PATHOLOGY, AFRICAN AMERICANS WITH DIMANE IS THIS FROM A MEMORY CLINIC, MORE LIKELY TO HAVE MIXED PATHOLOGY TO WHITES BUT THERE ARE NO RACIAL DIFFERENCES WHEN YOU LOOK AT PATHOLOGY FROM PEOPLE WHO COME FROM THE COMMUNITY WHO STARTED THE STUDY WITHOUT DEMENTIA. THE IMPACT OF PATHOLOGY ON RISK OF DISEASE SEEMS TO VARY BY RACE HOWEVER, BOTH AD PATHOLOGY AND MICROINFARCTS INCREASE RISK OF DEMENTIA, BUT THE MICROINFARCTS INCREASE ODDS MORE STRONGLY THAN AFRICAN AMERICANS OVER AND BEYOND THE OTHER PATHOLOGIES. TO CONCLUDE, INCREASE RISK OF ALZHEIMER'S DISEASE AMONG AFRICAN AMERICANS WE HEAR ABOUT ALL THE TIME IS LIKELY DUE TO PERSISTENT RACIAL DIFFERENCES IN COGNITIVE LEVEL. RELEVANT VARIABLES NEED TO BE INCORPORATED IN STUDIES OF MINORITY AGING TO UNDERSTAND THE PROMOTERS OF HEALTHY AGING. AS I HAVE SHOWN YOU, WE POINTED OUT A NUMBER OF RISK MARKERS PERCEIVED DISCRIMINATION, PERCEIVED STRESS, EARLY LIFE RESIDENCE, REFLECTING STRESSFUL SOCIAL CONDITIONS OR DISADVANTAGE, THESE WERE ASSOCIATED WITH DECLINE. SUGGESTING THAT MODIFYING OR INTERVENING ON THE WAYS THAT PEOPLE EXPERIENCE STRESS MAY BE TARGETS TO PROMOTE RESILINCE. WHILE BURDEN OF PATHOLOGY IS NOT HERE TO DIFFER THE EFFECT WAS DIFFERENT UNEXPECTEDLY WE DIDN'T SEE VAS VIEW CAR PATHOLOGY DESPITE WELL DOCUMENTED BURDEN OF RISK. BUT ARE THERE OTHER VASCULAR PATHOLOGIES THAT WEREN'T MEASURED, THAT WE HAVEN'T DISCOVERED YET OR ARE THERE DIFFERENT REGIONS LIKE THE WATER SHED AREAS THAT MAYBE PLAYING A ROLE TO LOOK AT FURTHER. I THINK THIS POINTS OUT A NUMBER OF GAPS AND OPPORTUNITIES THAT WE CAN INCORPORATE TO MOVE PAST DISPARITIES AND IMPROVE HEALTH EQUITY FOR OUR OLDER AFRICAN AMERICANS. FEW KEY POINTS BUT THEY'RE IMPORTANT. NUMBER ONE, WE NEED TO INCREASE MINORITY POPULATIONS IN CLINICAL RESEARCH IN GENERAL AND IN AGING STUDIES IN PARTICULAR. AS WE HAVE SHOWN THE DRIVERS OF DISEASE MAYBE DIFFERENT, WE ALSO NEED LONGITUDINAL DESIGNS IF WE'RE GOING TO COMPARE AFRICAN AMERICANS AND WHITES. SO WE MAY DISTINGUISH FACTORS THAT AFFECT TEST PERFORMANCE FROM TRUE CHANGE OVER TIME. WE NEED STUDIESES WITH BIOLOGIC OUTCOMES, STUDIES THAT INCLUDE GENOMICS, PROTEOMICS METABALOMICS, ET CETERA, BECAUSE WE CURRENTLY HAVE A LIMITED UNDERSTANDING OF BIOLOGIC MECHANISMS UNDERLYING DISPARITIES. AND WE NEED TO UNDERSTAND WHY THERE ARE LEVEL DIFFERENCES. IT'S A PROBLEM THAT WE HAVE THESE PERSISTENT LEVEL DIFFERENCES THAT ARE LEADING TO MORE IMPAIRMENT AND WE NEED TO START LOOKING AT PREVALENT CONDITIONS LIKE THE ADVERSE SOCIAL CONDITIONS, BUT ALSO TAKING COMPLEX SYSTEMS APPROACH THAT TAKES INTO ACCOUNT THE INTERACTION OF RISK AND RESILIENCE FACTORS, AND ACROSS THE LIFE COURSE. BECAUSE ONE THING WE HAVE LEARNED IS THAT THESE DISPARITIES THAT WE'RE SEEING ARE OCCURRING WHEN PEOPLE START TO STUDY AGE 65. SO WE'RE NOT JUST HAPPENING AFTER AGE 65, THEY'RE IN PLACE ALREADY SUGGESTING WE NEED TO MOVE THE LENS BACK EARLIER AND BE ABLE TO LOOK AT WHAT'S HAPPENING IN MID LIFE SO WHERE WE HAVE MORE AN OPPORTUNITY TO ACTUALLY MAKE A DIFFERENCE AND MAYBE CHANGE THE TRAJECTORY WHAT'S GOING ON IN OLE AGE. THERE ARE EXCITING BIOMARKER AND DRUG DISCOVERY PROJECTS, RUSH IS PARTICIPATING IN SOME OF THESE AD PROJECTS, STUDIES FROM WHITES BUT THERE ARE FEW MINORITIES ENROLLED IN THESE INITIATIVES. FROM BECAUSE YOU NEED BRAIN TISSUE. BUT THE AREA OF SCIENCE THAT'S MOVING FORWARD THE FASTEST IS NOT INCLUDING MINORITY POPULATION WHERE RISK SEEMS TO BE GREATEST. WE NEED SOMETHING ABOUT THAT TO CHANGE THAT SCENARIO. SO JUST TO BRIEFLY TOUCH ON THE FUTURE DIRECTIONS THAT WE ARE TAKING IN THESE STUDIES, WE ARE LIKELY TO BE DOING MORE NEUROIMAGING TO UNDERSTAND THE NEUROBUY LODGE UK SUBSTRATES OF COGNITIVE AGING OF PEOPLE WHILE ALIVE, WE'RE FUNDING TO LOOK AT DECISION MAKING TO UNDERSTAND DETERMINANTS AND ADVERSE CONSEQUENCES OF RACIAL DIFFERENCES AND DECISION MAKING. WE KNOW VERY LITTLE ABOUT THAT. COULD THAT BE A WINDOW TO UNDERSTANDING DISPARITIES, AND WE HAVE A NEW INVESTIGATOR THAT JUST RECEIVED DIVERSITY SUPPLEMENT TO CONDUCT A MIX METHODS APPROACH TO STUDY BARRIERS AND FACILITATORS OF BRAIN DONATION IN UNDER-REPRESENTED POPULATIONS INCLUDING AFRICAN AMERICANS, LATINOS AND LOW SES WHITES SO WE CAN START TO IMPROVE THIS PICTURE OF LIMITED DATA FROM THESE UNDER-REPRESENTED GROUPS. THIS WORK IS NOT DONE BY ONE PERSON OBVIOUSLY, WE HAVE A FANTASTIC CENTER AT RUSH. MULTI-DISCIPLINARY WITH PEOPLE DOING ALL KINDS OF REALLY FASCINATING WORK. AND LOTS OF EXCITING NEW THINGS GOING ON. I WOULD LIKE TO ACKNOWLEDGE THE MANY, MANY CO-INVESTIGATORS WHO HAVE PARTICIPATED IN SOME ASPECT OF THE WORK THAT I PRESENTED TODAY. THANK YOU, VERY MUCH FOR YOUR ATTENTION. [APPLAUSE] >> I CAN TAKE QUESTIONS. IF THERE ARE ANY. >> DID YOU LOOK AT THE DIFFERENCES BETWEEN BLACK HUMAN OR AFRICAN AMERICAN WOMEN AND MEN? >> OUR AGING STUDIES ARE ABOUT 70% WOMEN BECAUSE WOMEN LIVE LONGER. WE DON'T HAVE THE POWER TO DO THAT. I CAN TRY TO LOOK AT IT BUT I'M NOT SURE I WILL FIND ANYTHING. I STRUGGLE WITH GETTING AFRICAN AMERICAN MEN ENROLLED IN THESE STUDIES. I HAVE TRIED ALL KINDS OF TECHNIQUES. I HAVE THE ACTUALLY -- I GOT THE RECOMMENDATION TO LOOK AT THE VA TO GET MORE MEN BUT THAT'S AN IMPORTANT AREA TO LOOK AT IN THE FUTURE. >> THANKS, IF I CAN HAVE TWO QUICK ONES. ARE THE MICROINFARCT MORE PREVALENT IN YOUR AFRICAN AMERICAN PARTICIPANTS THAN IN THE WHITES PARTICIPANTS? >> WE DID NOT SEE MORE MICROINFARCTS IN THE AFRICAN AMERICANS. >> THE SECOND, COULD YOU ELABORATE ON YOUR IDEA THAT YOU TOSSED OUT ABOUT WATER SHEDS? DO YOU HAVE IN MIND SOMETHING TO PURSUE ON THAT? >> WE KNOW THAT A LOT OF VASCULAR DISEASE IS OCCURING IN THE WATER SHED AREAS, WE CURRENTLY DON'T LOOK AT THE WATER SHED AREAS IN OUR STUDIES. WE LOOK AT ABOUT EIGHT DIFFERENT REGIONS IN THE BRAIN TO MEASURE BE BOTH GROSS INFARCTS AND MICROINFARCTS. THAT'S AN AREA THAT'S MISSING THAT WE THINK MAYBE -- WE EXPECT TO SEE SOMETHING WHEN IT COMES, THERE'S NO REASON WITH ALL THE HYPERTENSION DIABETES YOU'RE NOT SEEING THIS IN THE BRAIN. SO WE WANT TO LOOK AT WATER SHED AREAS TO SEE, WE DON'T HAVE A SPECIFIC HYPOTHESIS AROUND IT. IT'S MISSING FROM OUR PROTOCOL CURRENTLY. >> YOU MENTION ABOUT SOME IMAGING METHODS INCLUDING MRI BUT WE HAVE GREAT TECHNIQUES TO -- AS WELL AS THE TAU USING FAT IMAGING SO THAT IS A MORE PREDICTABLE BIOMARKER FOR DIAGNOSIS, OBVIOUSLY THERE IS NO THERAPY. ALSO SECOND QUESTION IS, REGARDING THE USE OF ESTROGEN. ESTROGEN HAS SOME AFFECT ON SOME OF THESE ISSUES. DID YOU LOOK AT SOME OF THESE PATIENTS, WHERE THEY NEED INTERVENTION IN EARLY STAGE SO THAT WILL AFFECT THE MICROINFARCT AND OTHER PATHOLOGY INFARCT RELATED? FROM DEEP VAIN THROMBOSIS. >> FIRST QUESTION ABOUT PET VERSUS MRI YOU ARE RIGHT. PET WOULD BE A MUCH BETTER WAY FOR US TO LOOK AT IT. THIS IS -- THESE ARE COMMUNITY BASED PARTICIPANTS WHO WE WOULD HAVE A CHALLENGING TIME RECRUITING FROM PET STUDIES WHERE WE'RE GOING TO INJECT SOMETHING INVASIVELY INTO THEIR VEINS THAT WE DON'T KNOW WHAT THE AFFECT IS GOING TO BE LATER. JUST FOR PURPOSES OF KEEPING THE COMMUNITIES TRUST, I WOULD LIKE TO HAVE A BIT FIRMER IDEA WHAT PET IS DOING OVER THE LONG TERM BEFORE I INTRODUCE IT. NOW, WE HAVE A CLINICAL ALZHEIMER'S DISEASE CENTER AND WE HAVE BEEN TALKING ABOUT INCORPORATING PET INTO THAT, THAT'S ALSO AFRICAN AMERICANS. WE HAVE A LATINO CORE, SO THAT WILL BE COMING. I HAVEN'T YET GOTTEN THE COURAGE TO DO IT IN MINORITY AGING RESOURCE STUDY, I DON'T WANT THE LOSE PEOPLE, ALREADY HARD ENOUGH GETTING THE BRAINS. SO FOR SECOND QUESTION ABOUT ASPIRIN, WE HAVE NOT LOOKED AT THAT BUT WE DO A VISUAL INSPECTION OF ALL MEDICATIONS EVERY YEAR AND WE HAVE MEDICATIONS CODED AND ENTERED INTO OUR DATABASE SO THERE IS SOMETHING WE CAN LOOK AT TO SEE IF IT'S AFFECTING ANY OF THESE FACTOR IT IS THAT I TALKED ABOUT TODAY. >> FOR DIABETES AT LEAST THE RACIAL FACTORS ARE PREDOMINANT, I -- FIND DIFFERENT GENES AFFECTED IN TO -- IN DIABETES. >> WE LOOKED AT DIABETES AND IT WAS ASSOCIATED WITH -- WE DIDN'T SEE A RACE EFFECT, IT WAS EQUALLY DETRIMENTAL IN BLACKS AND WHITES. >> >> THANK YOU, GOOD LUCK. >> THANK YOU. >> THANK YOU VERY MUCH FOR THAT SUPERB PRESENTATION. I COULDN'T HELP BEING STRUCK BY POTENTIAL LINK BETWEEN PERCEIVED DISCRIMINATION ACTIVATION OF THE ANGIOTENSIN SYSTEM AS WE SEE QUITE A BIT OF THAT IN CARDIOLOGY AS WELL TO THE LINK WITH THE MICROVASCULAR DISEASE. I WONDER IF YOU'RE STUDYING THE& ACTIVATION OF THE ANGIOTEN SIN SYSTEM, AS A MECHANISM FOR THE COGNITIVE LOSS OR THE DIFFERENCES IN COGNITIVE FUNCTION BETWEEN -- >> WE'RE IN LOOKING AT THAT. BUT THAT IS AN IMPORTANT MECHANISM TO INCORPORATE. THANK YOU FOR MY NEXT GRANT. >> I MAY HAVE YOUR NEXT GRANT AFTER THAT. AMAZING. AMAZING TALK, THANK YOU SO MUCH. YOU MAY HAVE ACTUALLY ADDRESSED IT BUT YOU SAID THIS LATINO CORE, LATINOS PARTICULARLY MEXICAN AMERICANS ARE HIGH RISK FOR ALZHEIMER'S DISEASE. AND MANY VARIABLES YOU TALK ABOUT ARE DOMINANT IN LATINOS AS WELL, GO THROUGH ANY-YEAR-OLD NURSING HOME IN TEXAS AND YOU WILL FIND THE SAME THING. HALLUCINATIONS AN THINGS ALONG THOSE LINES, EXCEPT IT'S NOT GOING TO BE -- SIGNS ARE LIKE NO MEXICANS AND DOGS ALLOWED OPPOSED TO HAVING -- HOW FAR ADVANCE DO YOU HAVE? SOUND LIKE YOU GOT WHITE AND BRAC GROUP AND IT DOESN'T SEEM TO BE THAT EXPENSIVE. IN THE LATINO GROUP. >> ACTUALLY WE WERE JUST FUNDED TWO YEARS AGO TO START A LATINO COHORT IN ALZHEIMER'S DISEASE CENTER. FUNDED BY NIA AND T PI OF THAT IS DAVE MARQUEZ, A KINESIOLOGIST OUT OF UICSC AND WE HAVE ENROLLED ABOUT 170 MEXICAN AMERICANS FROM CHICAGO WHO ARE GETTING THE SAME COGNITIVE BARRIER, TRANSLATED IN SPANISH MEASURE THE SAME RISK FACTORS. SO WE WILL HAVE SOME THAT INFORMATION BUT STUDY IS BRAND NEW AND THEY ARE VERY YOUNG. WE HAVE DECREASED ENROLLMENT AGE TO 55. SO THERE WILL BE REALLY INTERESTING TO SEE IF WE GET CHANGE IN THIS FIVE YEAR PERIOD. >> CHICAGO IS DIFFERENT IN THE SOUTHWEST. WHEN IT COMES TO DISCRIMINATION. AMAZING THAT YOU ARE ABLE TO FUND THAT. >> FROM THANK YOU. >> I WAS WONDERING IF YOU TAKE THIS INTERNATIONALLY AND LOOK AT AFRICAN BLACKS IN AFRICA BASICALLY AND THE EFFECT OF MAYBE AMERICA LIFESTYLE. >> I HAVEN'T DONE THAT BUT THERE IS A STUDY OUT THERE BY HUE HENRY THAT COMPARED AFRICAN AMERICANS IN INDIANAPOLIS TO NIGERIANS IN AFRICA. HE SEES VERY DIFFERENT RISKS OF DISEASE OF THE AFRICANS HAVE LOWER RISK. THERE'S MANY DIFFERENCES OBVIOUSLY THE AFRICAN AMERICANS INDIANAPOLIS ARE MORE SEDENTARY THE U.S. DIET, ALL KINDS OF THINGS. HE ALSO SEES DIFFERENCES FROM APOE. I WOULD LOVE TO DO AN INTERNATIONAL STUDY, I'M TRYING TO GET THIS ONE PERFECTED, SO THAT WOULD BE DOWN THE LINE. >> GREAT THANKS. >> GREAT TALK, THANKS. I'M GOING TO HAVE THE TENNIS PLAYERS SO I WANT TO HEAR DIFFERENCES BETWEEN TENNIS PLAYERS AN NON-TENNIS PLAYERS. BUT ASIDE FROM THAT, YOU TALK ABILITY THE MEAN DIFFERENCES -- ABOUT THE MEAN DIFFERENCES BETWEEN AFRICAN AMERICANS AND WHITES AND WE FLOW'S VARIABILITY IN BOTH GROUPS. I'M CURIOUS IF YOU FOUND WITHIN EACH GROUP THERE BEING HIGH PERFORMERS THAT DIFFER FROM THE NORM AND WHETHER THERE ARE DIFFERENCES BETWEEN THE HIGH PERFORMERS, WHATEVER THE COGNITIVE TASKS MIGHT BE BETWEEN THE RACIAL GROUPS. >> THAT'S A GREAT QUESTION. I HAVE A SLIDE THAT SHOWS WHERE WE TOOK A SUBSAMPLE OF 200 BLACKS AND WHITES AND THERE'S CLEAR HETEROGENEITY IN COGNITIVE DECLINE WITH SOME DECLINING PRECIPITOUS HI, SOME STABLE AND SOME IMPROVING SO THERE IS HETEROGENEITY ACROSS BOTH RACIAL GROUPS. WE HAVEN'T LOOKED AT RISK FACTORS THAT MIGHT PREDICT THAT YET BUT THAT'S SOMETHING WE CAN DO IN THE FUTURE. TENNIS,, RIGHT. >> ONE THING THAT I SHOULD MENTION IS THAT I LOVE TO SHARE. AND WE HAVE DATA AVAILABLE, YOU CAN GO TO OUR WEBSITE AT RUSH AND YOU CAN GET ANY COHORT STUDIES WHO WILL SEND YOU A DATA SET, SEND YOU BRAIN TISSUE, BLOODS AND YOU CAN CREATE THE NEXT GREAT STUDY OF MINORITY AGING. SO PLEASE CONSIDER LOOKING AT OUR WEBSITE AND SEEING WHAT WE HAVE AVAILABLE. WE HAVE LOTS OF WONDERFUL COHORTS AND WE'RE VERY OPEN TO SHARING. [APPLAUSE] SO PLEASE JOIN US IN THE LIE PRAYER FOR A RECEPTION THAT IS SPONSORED BY FAES. THANK YOU,