WELCOME TO
THOSE HERE IN THE CONFERENCE
ROOM AND THOSE ONLINE.
IT'S MY GREAT PLEASURE TO
WELCOME YOU TO THE FLORENCE
MAHONEY LECTURE, AND OUR
LECTURER, JEN MANLY, WHO'S GOING
TO BE TALKING ABOUT POLICIES TO
PTAU.
WE'LL INTRODUCE HER IN MORE
DETAIL LATER BUT FIRST SOME
HOUSEKEEPING TOPICS.
FOR THOSE LOOKING FOR C MSME
CREDIT, 50124 IS THE CODE.
FOR THE REST OF YOU, PLEASE DO.
IN TERMS OF FEEDBACK, FOR THOSE
ONLINE, USE THE "SEND LIVE
FEEDBACK" BUTTON ON THE
VIDEOCAST AND AT THE END OF THE
MEETING, WE WILL READ AND GET
RESPONSES FROM JEN TO YOUR
QUESTIONS AND FOR THOSE HERE IN
THE ROOM, WE HAVE A COUPLE OF
MICROPHONES THAT WILL BE LIVE AT
THE END AS WELL.
WITH THAT HOUSEKEEPING OUT OF
THE WAY, LET ME JUST INTRODUCE
FIRST THE FLORENCE MAHONEY
LECTURE IS NAMED OBVIOUSLY FOR
FLORENCE MAHONEY, AN OUTSTANDING
WOMAN WHO ALONG WITH MARY LASKER
WAS RESPONSIBLE FOR MANY OF THE
INNOVATIONS AND CONGRESSIONAL
ACTIONS THAT ESTABLISHED
COMPONENTS OF NIH, NOTABLY NIA.
I HAD THE GREAT PLEASURE FOR
MANY YEARS OF KNOWING HER AND
MEETING WITH HER AT HER HOME IN
GEORGETOWN, AND IT WAS ALWAYS
INTO THE ADVANCED AGE, OVER 100
WHEN WE LAST MET, DIED I THINK
AT THE AGE OF 103, BUT TO THE
END, SHE WAS VITAL AND
INTERESTED IN THESE LECTURES,
SHE SAID I DON'T WANT ANY
NONSENSE.
I WANT YOU TO HAVE GREAT
SPEAKERS WHO ARE TALKING ABOUT
REAL HARD SCIENCE.
THAT'S WHAT I WANT.
AND WE WOULD DISCUSS WHO WAS
COMING UP NEXT, SHE WOULD
APPROVE AND SHE WOULD BE
THRILLED, OF COURSE, WITH
JENNIFER BEING HERE NOW.
THE OTHER ANNIVERSARY WE'RE
MARKING NOW IS THE 50TH
ANNIVERSARY OF NIA SINCE ITS
INCEPTION, SO ACCOUNT THIS AND
JEN'S PRESENCE AS AN IMPORTANT
PART OF THAT CELEBRATION.
SO NOW JUST TO BRIEFLY INTRODUCE
JENNIFER TO YOU, SHE DID HER
UNDERGRADUATE WORK AT UC
BERKELEY, THEN HER GRADUATE WORK
AT UC SAN DIEGO BEFORE GOING TO
CRUMB GLCOLUMBIA.
SHE'S DONE OUTSTANDING GROUP --
A RARE ACCOMPLISHMENT IN LINKING
SOCIAL, ENVIRONMENTAL
DETERMINANTS TO CLINICAL
OUTCOMES AND TO THE BIOLOGIC
BIOMARKERS IN BETWEEN, ALL
CAPTURED IN HER TITLE HERE,
POLICIES TO PTAU, SOCIAL AND
STRUCTURAL DRIVERS OF
ALZHEIMER'S DISEASE,
OPPORTUNITIES FOR BRAIN HEALTH
AND JUSTICE.
HER CAREER HAS BEEN PROLIFIC,
EXEMPLARY AND NOTABLE FOR MANY
ASPECTS BUT FOR ONE AMONG THE
MANY, THE WAY IN WHICH SHE HAS
MADE COMMUNITY ENGAGEMENT WORK
AND DEMONSTRATED THE CRITICAL
IMPORTANCE OF ENGAGEMENT WITH
COMMUNITIES FOR THE KIND OF
RESEARCH THAT NEEDS TO BE DONE.
SHE TAUGHT US ALL LESSONS,
SERVED ON OUR ADVISORY COUNCIL
AND HELPED US THERE, AND NOW
SHE'S HERE TO IMPART SOME OF HER
WISDOM TO ALL OF YOU.
SO JEN, IT'S A PLEASURE TO HAVE
YOU HERE.
WELCOME.
[APPLAUSE]
>> THANK YOU SO MUCH, RICHARD.
IT REALLY IS AN HONOR TO BE WITH
YOU TODAY.
I DID READ "THE NEW YORK TIMES"
OWE OBITUARY, INTERESTING FOR MY
REASONS, AS YOU SAID, SHE WAS A
CONSTANT ADVOCATE, AND THE OTHER
THING WAS THAT SHE SAID THAT SHE
DIDN'T BOTHER -- YOU KNOW, SHE
NEEDED SOMETHING, SHE JUST WENT
STRAIGHT TO THE TOP.
SO THAT MEANT GOING TO THE
PRESIDENT, WHOEVER IT WAS AT THE
TIME, AND APPARENTLY THEY WOULD
GROAN WHEN THEY SAW HER BECAUSE
THEY KNEW SHE WAS GOING TO BE
ASKING FOR MORE FUNDING FOR THE
NATIONAL INSTITUTES OF HEALTH
AND SPECIFICALLY THE NATIONAL
INSTITUTES ON AGING.
SO HAPPY ANNIVERSARY, AND I AM
EXTREMELY PROUD AND HONORED TO
BE HERE.
I AM GOING TO THANK THE GROUP OF
PEOPLE THAT I WORK WITH AT
COLUMBIA UNIVERSITY.
THEY ARE REALLY THE GEARS THAT
MAKE EVERYTHING WORK, AND THE
FUNDING THAT SUPPORTS THE WORK
THAT I DO.
OTHER THAN THESE NIH GRANTS, I
DON'T HAVE ANY DISCLOSURES.
SO FIRST I'M GOING TO REMIND ALL
OF YOU IN THE ROOM, BECAUSE I
RECOGNIZE MANY OF YOU, I KNOW
THAT I DON'T HAVE TO DO THIS IN
DETAIL, BUT I'M GOING TO REMIND
YOU OF THE SCOPE OF THE
CHALLENGE THAT WE'RE FACING.
THIS IS A LINE GRAPH THAT SHOWS
THE INCREASE IN MILLIONS OF
PEOPLE WITH DEMENTIA IN LOW AND
MIDDLE INCOME COUNTRIES COMPARED
TO HIGH-INCOME COUNTRIES FROM
2013 TO 2050.
SO WHAT WE ARE ESTIMATING IS
THAT BY 2025, MORE THAN 70% OF
THE GLOBAL DEMENTIA POPULATION
WILL LIVE IN LOW AND MIDDLE
INCOME COUNTRIES, AND RIGHT NOW,
DEMENTIA IS THE FIFTH LEADING
CAUSE OF DEATH WORLDWIDE, AND BY
2028, THE COST OF DEMENTIA CARE,
THAT INCLUDES FORMAL MEDICAL
CARE AND ALSO INFORMAL
CAREGIVING COSTS, WILL BE MORE
THAN 2 TRILLION U.S. DOLLARS
WORLDWIDE.
SO WE MUST INTERVENE TO REDUCE
THE CURRENT AND FUTURE BURDEN OF
DEMENTIA WORLDWIDE, AND WHAT
THAT MEANS IS THAT WE NEED TO
IDENTIFY MODIFIABLE FACTORS,
MODIFIABLE RISK FACTORS,
MODIFIABLE RESILIENCE FACTORS.
AND SO THIS FIGURE, WHICH ALL OF
YOU HAVE SEEN A THOUSAND TIMES
BECAUSE IT'S SO COMPELLING, FROM
THE LIVINGSTON SYSTEMATIC REVIEW
IN LANCET IN 2020, ESSENTIALLY
CARRIES US THROUGH THE LIFE
COURSE, AND THE SIZE OF EACH OF
THESE CIRCLES THAT REPRESENTS A
MODIFIABLE RISK FACTOR IS
DETERMINED BASED ON HOW COMMON
THAT RISK FACTOR IS AND ALSO ITS
STRENGTH OF IMPACT ON DEMENTIA
RISK.
AND THAT PERCENTAGE THAT YOU SEE
WITHIN EACH CIRCLE IS THE
PERCENT REDUCTION IN DEMENTIA
PREVALENCE IF THE RISK FACTOR IS
ELIMINATED.
SO BY THE TIME YOU GET TO THE
END, YOU FIND THAT AROUND 40% OF
DEMENTIA IS CONSIDERED
MODIFIABLE USING THE BEST
EVIDENCE THAT THEY HAD AT THE
TIME FOR THIS REVIEW.
AND THAT IS A TREMENDOUS AMOUNT
THAT WE CAN DO TO PRESERVE
COGNITIVE HEALTH.
AND BECAUSE MODIFIABLE FORCES
LIKE THE ONES THAT ARE LISTED
HERE ARE THE CAUSE OF ANY
QUALITIES IN COGNITIVE
IMPAIRMENT AND DEMENTIA, THIS
ALSO SUGGESTS THERE ARE
TREMENDOUS OPPORTUNITIES TO
NARROW DISPARITIES.
BUT THESE DATA ARE BASED ALMOST
ENTIRELY ON DATA FROM WHITE
PEOPLE IN HIGH-INCOME COUNTRIES.
SO I ALWAYS SHOW THIS BECAUSE I
LOVE WHAT ROCK NEONOGO DID,
WHICH IS TO USE U.S.
REPRESENTATIVE DATA ON
PREVALENCE ESTIMATES OF THOSE
NOT GUYABLEMODIFIABLE RISK FACT.
HE USED THE BURFS TO GET THOSE
DATA, AND THEN IN EACH RACIAL
AND ETHNIC GROUP THAT HE HAD
INFORMATION FOR.
WHAT HE FOUND WAS THE PROPORTION
OF ALZHEIMER'S DISEASE AND
RELATED DEMENTIAS ASSOCIATED
WITH THE TOP MODIFIABLE RISK
FACTORS WAS RELATIVELY HIGHER
AMONG MEN VERSUS WOMEN, AND
AMONG BLACK INDIVIDUALS,
AMERICAN INDIAN AND ALASKA
NATIVE INDIVIDUALS AND HISPANIC
INDIVIDUALS COMPARED WITH ASIANS
AND WHITES.
SO THIS, I THINK, UNDERSCORES
THE IMPORTANCE OF NATIONALLY
REPRESENTATIVE DATA WHERE THE
SAMPLING ALLOWS FOR GROUP
COMPARISONS AND ALSO TO INFORM
OPTIMAL PREVENTION EFFORTS IN
GROUPS THAT EXPERIENCE HIGHER
BURDEN OF COGNITIVE IMPAIRMENT
AND DEMENTIA.
SO WHAT IS THE BEST WAY FOR US
TO EXAMINE THESE MODIFIABLE RISK
AND RESILIENCE FACTORS AND TO
DEVELOP STRATEGIES FOR NARROWING
DISPARITIES?
WITH THE GOAL TO EXTEND --
HOPEFULLY TO EXTEND COGNITIVE
LIFE EXPECTANCY FOR EVERYONE,
AND MINIMIZE DISABILITY D DUE TO
COGNITIVE IMPAIRMENT?
IT REALLY DEMANDS A LIFE COURSE
PERSPECTIVE WHICH ALL OF YOU AT
NIA ARE DEEPLY FAMILIAR WITH.
BUT I THINK IT'S RELATIVELY NEW,
A LIFE COURSE PERSPECTIVE, FOR
PEOPLE WHO STUDY ALZHEIMER'S
DISEASE.
SO I'M GOING TO BRING YOU
THROUGH ONE HERE THAT SORT OF
GUIDES MY WORK.
AND WE'RE GOING TO START WITH
PROXIMAL CAUSES OF COGNITIVE
IMPAIRMENT AND DEMENTIA.
ALZHEIMER'S DISEASE PATHOLOGY
AND VASCULAR DEMENTIA ARE
PROBABLY THE MOST COMMON
DEMENTIA SUBTYPES OR THE
PATHOLOGY SUBTYPES IN THE UNITED
STATES.
AND YOU CAN SEE THAT I'M
STARTING IN THE BRAIN, AND
LEADING TO COGNITIVE FUNCTION
AND DEMENTIA ON THE RIGHT SIDE
OF THIS PROCESS.
AND THEN WE HAVE THINGS THAT CAN
BE SEEN IN THE CLINIC WHEN
PEOPLE SHOW UP AT THE CLINIC,
BOTH RISK AND RESILIENCE
FACTORS, AND I WONDER IF MY
RESILIENCE FACTORS ARE GOING TO
SHOW UP AT SOME POINT, BUT
THEY'RE IN HERE.
ESSENTIALLY POINTING OUT THAT
THERE ARE NOT JUST FACTORS THAT
RELATE TO DEFICIT IN ONE'S
ENVIRONMENT, BUT ALSO FACTORS
THAT RELATE TO STRENGTHS.
THE THINGS WE CAN SEE IN THE
HERE AND NOW, LIKE DISEASES THAT
INCREASE RISK FOR ALZHEIMER'S
PATHOLOGY AND COGNITIVE
IMPAIRMENT ARE INFLUENCED BY
THESE SOCIAL DETERMINANTS OF
HEALTH.
I LIKE TO TALK ABOUT RESILIENCE
FACTORS BECAUSE THEY INTERACT
WITH RISK FACTORS.
THERE WAS A REALLY NICE STUDY
WHERE EVEN THOUGH BLACK OLDER
ADULTS REPORTED GREATER EXPOSURE
THAN WHITE OLDER ADULTS, THEY'RE
LESS UPSETTING THAN WHITES.
SO EVEN THOUGH STRESS APPRAISAL
DIDN'T REALLY MODERATE THOSE,
APPRAISING STRESSORS AS LESS
UPSETTING WAS ASSOCIATED WITH
BETTER MEMORY IN BLACK ADULTS.
AND SO I'M POINTING OUT HERE,
YOU CAN SEE WHERE RACE AND
ETHNICITY IS IN MY MODEL, RACE
AND ETHNICITY IS A DOWNSTREAM
FACTOR.
THE CLASSIFICATIONS OF RACE AND
ETHNICITY IN THESE MODELS CONOTE
THAT THOSE CLASSIFICATIONS ARE
MADE, THEY ARE HISTORICAL,
POLITICAL, ECONOMIC, AND
CULTURAL, AND I SAW A TWEET THE
OTHER DAY FROM DEDRIC WILLIAMS
WHICH SAID RACISM MAKES THE IDEA
OF RACE POSSIBLE.
AND I LIKE HOW THAT'S PHRASED.
AND THAT'S WHAT I'M TRYING TO
CONOTE WITH THE ARROWS GOING
INTO THE RACE BOX.
HERE.
SO STRUCTURAL AND SOCIAL
DETERMINANTS OF HEALTH CAN
BUFFER OR EXACERBATE RISK.
WHAT YOU CAN SEE AT THE CORE OF
THIS LIFE COURSE MODEL IS
HISTORICAL AND CONTEMPORARY
SYSTEMS OF OPPRESSION, DPIS CRIM
DISCRIMINATORY BELIEFS AND ALSO
THE INSTITUTIONAL POWER THAT
COMES ALONG WITH THOSE BELIEFS.
I ADDED A NEW ONE FOR THIS TALK,
I'M GOING TO TYPE I MORE, WHICH
IS MILL TARRI MILITARISTIC HYPE,
BECAUSE I THINK THAT THAT'S ONE
FORM OF INSTITUTIONAL POWER THAT
CAN GET UNDER THE SKIN IN
NEIGHBORHOODS FOR INDIVIDUALS
AND TARGETS PEOPLE FROM
MINORITIZED GROUPS.
THE OTHER THING TO KEEP IN MIND
IS THAT OUR EXPERIENCES OF THESE
SOCIAL FORCES AND STRUCTURAL
FORCES REALLY CHANGES DEPENDING
ON WHEN WE'RE HERE ON EARTH.
BIRTH YEAR IS A FACTOR AND
THAT'S ACTUALLY ONE OF THE
WONDERFUL DESIGN ASPECTS OF
STUDIES LIKE THE HEALTH AND
RETIREMENT STUDY, WHERE WE CAN
LOOK AT DIFFERENT BIRTH YEARS
AND DIFFERENT WAVES OVER TIME.
OKAY.
AND THEN THE RED ARROWS ARE
REALLY CONOTING THAT RISK AND
RESILIENCE FACTORS AND SOCIAL
DETERMINANTS ACROSS THE LIFE
COURSE COULD PLAY A PART IN
COGNITIVE RESERVE, OR COGNITIVE
RESILIENCE, SO THAT GAP BETWEEN
THE LEVEL OF PATHOLOGY IN THE
BRAIN AND THE EXPERIENCE OF
COGNITIVE FUNCTION, DYSFUNCTION.
SO THE FIRST QUESTION, ONCE WE
DECIDE WE WANT TO INTERROGATE
THIS LIFE COURSE MODEL OF SOCIAL
AND STRUCTURAL FACTORS AS THEY
RELATE TO ADRDs, WHO SHOULD WE
STUDY?
AND I'M GOING TO TALK ABOUT THAT
FOR A BIT.
SO THIS IS A MAP.
IT'S A LITTLE BIT OLDER, BUT
IT'S STILL PROBABLY ROUGHLY
ACCURATE THAT SHOWS THE OVERLAP
BETWEEN COUNTY LEVEL PREVALENCE
OF ALZHEIMER'S DISEASE AND
NIA-FUNDED ADRD CENTERS.
SO YOU CAN SEE THAT THERE ARE
SOME BIG LOCATION GAPS,
ESPECIALLY IN THE DEEP SOUTH, SO
LOOKING FOR COLLABORATORS IN THE
DEEP SOUTH THAT ARE ALZHEIMER'S
DISEASE RESEARCH CENTERS IS
ACTUALLY VERY DIFFICULT.
AND SO I THINK THAT IN PART, WHO
WE STUDY DEPENDS ON WHERE WE'RE
AT, AND WE NEED TO BE AT THOSE
PLACES WHERE PEOPLE WITH
ALZHEIMER'S DISEASE ARE.
AND THAT'S ESSENTIALLY WHAT I'M
TRYING TO SAY WITH THIS GRAPH.
THE OTHER THING THAT COMES UP IS
SELECTION BIAS, AND WE WERE JUST
CHATTING BEFORE THE TALK ABOUT
THE RECENT STUDY THAT WAS BASED
IN NACC LOOKING AT PEOPLE WITH
TWO COPIES OF THE APOE4 ALLELE,
AND IT JUST IMMEDIATELY MADE ME
THINK OF THIS PAPER BY MIGUEL
ARCE, WHO COMPARED THE
DEMOGRAPHICS OF PEOPLE IN THE
NACC STUDY WITH THE DEMOGRAPHICS
OF THE PEOPLE IN THE HEALTH AND
RETIREMENT STUDY, WHICH IS
POPULATION-BASED.
AND THIS IS A FIRST STEP IN THEN
BEING ABLE TO TRANSPORT FINDINGS
THAT YOU HAVE SHOWN IN NACC TO A
POPULATION-BASED COHORT.
AND YOU DO THAT BY CREATING
WEIGHTS FOR EACH INDIVIDUAL IN
THE HRS DEPENDING ON HOW THEY
ARE REPRESENTED -- SORRY,
WEIGHTS FOR PEOPLE IN NACC
DEPENDING ON HOW THEY ARE
REPRESENTED IN THE HRS.
SO ESSENTIALLY THIS FIRST STEP
IS LOOKING AT COVARIATE BALANCE,
AND THEN THOSE DASHED LINES OR
THE STANDARD MEAN DIFFERENCE
BETWEEN THE NACC AND THE HEALTH
AND RETIREMENT STUDY, AND WHAT
MIGUEL FOUND WAS THAT NACC
PARTICIPANTS ARE OLDER, THEY HAD
MORE SCHOOLING, THEY HAVE WORSE
SUBJECTIVE MEMORY, AND WORSE
HEARING, BUT THEY ENDORSED FEWER
DEPRESSIVE SYMPTOMS COMPARED TO
HRS PARTICIPANTS.
AND THOSE DIFFERENCES IN AGE,
DEPRESSIVE SYMPTOMS AND HEARING
DIFFICULTIES WERE LARGER AMONG
THE LATINX AND NON-LATINX BLACK
PARTICIPANTS COMPARED TO THE
NON-LATINX WHITE PARTICIPANTS.
SO THIS IS JUST TO SAY, AND IT'S
PROBABLY TOO SMALL FOR THOSE OF
YOU IN THE ROOM, HOPEFULLY NOT
ONLINE, BUT YOU CAN SEE IN ONE
OF THE TABLES THAT MIGUEL HAS IN
THE PAPER THAT THE OVERALL
REPRESENTATION OF BLACK AND
LATINX PEOPLE IN NACC IS PRETTY
GOOD.
IT'S ESSENTIALLY MATCHING THAT
OF THE HRS.
BUT JUST BECAUSE THE COMPOSITION
OF A SAMPLE MAY MATCH THE
NATIONAL POPULATION, IT DOESN'T
MEAN THAT THOSE PARTICIPANTS ARE
REPRESENTATIVE OF THE NATIONAL
POPULATION.
AND IT'S ESPECIALLY PROBLEMATIC
WHEN WE HAVE THOSE INTERACTIONS
BETWEEN THE DEMOGRAPHIC FACTORS
AND RACE/ETHNICITY IF WE'RE
GOING TO BE MAKING CONCLUSIONS
ABOUT RACIAL AND ETHNIC
DIFFERENCES.
AND THIS COMES INTO PLAY WITH
TRIALS AS WELL.
SO THIS IS A PAPER BY CASEY
DIETE RS WHO LOOKED AT THE
A4 TRIAL AND THIS TABLE IS
BURIED IN THE SUPPLEMENT BUT ALL
OF YOU SHOULD LOOK AT IT AND IT
SHOWS THAT SHE TRACES BLACK
VOLUNTEERS FOR THE A4 TRIAL
THROUGH THE SCREENING PROCESS.
AT THE FIRST STAGE, THEY HAD TO
UNDERGO COGNITIVE TESTING AND A
CDR, SO BLACK PARTICIPANTS IN
THE A4 TRIAL WERE MORE LIKELY
THAN WHITE PARTICIPANTS TO HAVE
CDR SCORES ABOVE ZERO, WHICH WAS
A REQUIREMENT TO HAVE A CDR
SCORE OF ZERO FOR THE A4, AND
THEY ALSO HAD LOWER MENTAL AND
LOGICAL SCORES FOR WHITE
PARTICIPANTS AND MORE LIKELY TO
BE SCREENED OUT AT THAT FIRST
STAGE THAN THE WHITE
PARTICIPANTS.
THEN AT THE SECOND STAGE, THE
PEOPLE WHO GOT THROUGH
REGARDLESS OF RACE DID AN
AMYLOID SCAN, AND IF THEY
WEREN'T A AMYLOID-POSITIVE, THEY
COULD NOT BE PART OF THE TRIAL.
AS IT TURNS OUT, BLACK AND ASIAN
PARTICIPANTS WERE MORE LIKELY TO
BE SCREENED OUT AT THAT STAGE AS
WELL SO THEY WERE LESS LIKELY TO
HAVE AMYLOID AT THAT SECOND
STAGE.
AND SO THERE'S ONE PIECE OF
EVIDENCE THAT UP UNTIL LAST WEEK
I WAS SAYING, WELL THIS IS
BECAUSE YOU'RE SCREENING OUT
PEOPLE BASED ON THE COGNITIVE
TEST, WHICH IS BIASED, AND THEN
YOU ARE TRYING TO LOOK FOR
AMYLOID BUT YOU'VE ALREADY
SCREENED OUT ALL THE BLACK
PEOPLE WITH AMYLOID BECAUSE YOU
MADE THEM PERFORM MUCH BETTER
THAN THE POPULATION OF BLACK
PEOPLE DOES ON THESE BIASED
TESTS.
AND SO THAT MADE SENSE TO ME
UNTIL I LOOKED AT THIS STUDY,
WHICH CAME OUT IN APRIL.
IN THIS STUDY, THEY POOLED FOUR
DIFFERENT TRIALS THAT THE FIRST
SCREENING METHOD WAS BASICALLY
PLASMA A BETA LEVELS.
IF YOU HAD A HIGH PLASMA A BETA
LEVEL, THEN YOU COULD GO ON AND
GET YOUR PET SCAN.
AND THIS IS DORIS MOLINA HENRY,
BUT ESSENTIALLY THE FIGURE SHOWS
THE PROPORTION OF PLASMA
BIOMARKER ELIGIBLE PEOPLE BY
RACE AND ETHNIC GROUP, AND THE
RESULTS WERE ACTUALLY VERY
SIMILAR TO CASEY'S RESULTS, THAT
PEOPLE OF HISPANIC ETHNICITY OR
BLACK OR ASIAN RACE WERE LESS
LIKELY TO QUALIFY FOR THE
TREATMENTS BASED ON THAT PLASMA
BIOMARKER BEFORE THEY EVEN DID
ANY COGNITIVE TESTING, AND
THE -- BUT THE UNDERLYING REASON
THAT THE AUTHOR CITED FOR THIS
WAS THAT THESE GROUPS HAVE LOWER
RATES OF BIOMARKER CONFIRMED
ALZHEIMER'S DISEASE.
SO THIS IS AMONG SEVERAL NOW
RESULTS COMING OUT FROM MULTIPLE
COHORTS, AND PEOPLE ARE STARTING
TO SUGGEST THAT THE DIAGNOSIS OF
ALZHEIMER'S DISEASE SHOULD RELY
ON MAYBE DIFFERENT CUT POINTS BY
RACE IN TERMS OF BIOMARKERS, AND
THAT DIFFERENT THERAPIES WILL
HAVE TO BE DEVELOPED FOR
NON-WHITE PEOPLE.
BUT I GUESS I WANT TO -- I WANT
TO KNOW WHETHER SELECTION BIAS
COULD AFFECT THESE RESULTS AS
WELL.
SO I'M GOING TO BRING YOU NOW
INTO SOME STUDIES I'VE BEEN
WORKING ON FOR A REALLY LONG
TIME TO KIND OF INTERROGATE
THIS.
SO THIS IS THE WHITE CAP STUDY,
THE WASHINGTON HEIGHTS, HAMILTON
HEIGHTS, INWOOD COLUMBIA AGING
PROJECT THAT'S BEEN GOING ON
SINCE 1992, AND IT'S A COHORT OF
PEOPLE WHO ARE MEDICARE-ELIGIBLE
WHO LIVE IN THE CENSUS TRACTS
AROUND THE COLUMBIA MEDICAL
CENTER IN NORTHERN MANHATTAN.
OVER 6,500 PEOPLE HAVE
PARTICIPATED AND WE VISIT THEM
IN THEIR HOME TO DO A WORKUP, SO
THEY GET NEUROPSYCH TESTING,
THEY GET MEDICAL EVALUATION,
BLOOD, MANY OF THEM COME IN TO
THE MEDICAL CENTER TO GET MRI,
AND CENSUS RECORDS SHOW US THAT
THIS COHORT IS REPRESENTATIVE OF
OLDER ADULTS WHO LIVE IN THESE
NEIGHBORHOODS.
SO WE ARE RIGHT ON IN TERMS OF
RACE/ETHNICITY, IN TERMS OF
EDUCATION, IN TERMS OF LANGUAGE.
ALL OF OUR -- THE PEOPLE ON OUR
STAFF ARE BILINGUAL IN SPANISH
AND ENGLISH, AND ALL OF THE
MEASURES HAVE BEEN ADAPTED IN
SPANISH AND ENGLISH, AND USED
FOR MANY YEARS, AND IT'S A
LONGITUDAL COHORT.
AND WHEN PLASMA BIOMARKERS FIRST
CAME ALONG, THEY WERE SENT OUT
FOR ANALYSIS AND THE QUESTION
COULD BE ASKED FIRST, HOW WELL
CAN THESE BLOOD-BASED PLASMA
BIOMARKERS DISTINGUISH BETWEEN
THOSE WITH AND WITHOUT A
CLINICAL DIAGNOSIS OF DEMENTIA
IN WHICAP, AND ALSO ARE THERE
RACIAL AND ETHNIC DIFFERENCES IN
THE LEVELS OF THESE PLASMA
BIOMARKERS.
SO FIRST THING TO TELL YOU IS
THAT THE LEVELS OF AMYLOID TAU
AND NFL WERE NOT RELIABLY
DIFFERENT IN WHICAP ACROSS
RACE/ETHNICITY, SO WE ARE NOT
REPLICATING THE MOLINA-HENRY
PAPER.
AND THE BIOMARKER JUST FOR YOU
TO LOG, THE BIOMARKER THAT BEST
DISTINGUISHED BETWEEN THOSE WHO
HAD A CLINICAL DIAGNOSIS OF
ALZHEIMER'S DISEASE VERSUS --
YOU CAN SEE FROM THOSE AREAS
UNDER THE CURVE, THE CONDITION
FOR EACH BIOMARKER WAS CERTAINLY
NOT AS GOOD AS YOU WILL FIND IN
CLINIC-BASED SAMPLES, THIS IS A
COMMUNITY-BASED SAMPLE, BUT ALL
MARKERS TAKEN TOGETHER HAD AN, I
GUESS, RELATIVELY DECENT AREA
UNDER THE CURVE.
AND HERE'S ANOTHER CHAPTER IN
THE WHO TO STUDY SAGA WITH A
BIOMARKER -- PLASMA BIOMARKER
PLOT.
AFTER 25 YEARS OF WORK IN
WHICAP, WE REALIZED THAT
STARTING RESEARCH PARTICIPATION
AT AGE 65 IN THIS COHORT WAS WAY
TOO LATE, THAT A LOT OF THE
ACTION THAT HAD TO DO WITH RISK
AND RESILIENCE HAD ALREADY
HAPPENED IN MID LIFE, AND WE
WERE ALREADY SEEING VERY HIGH
LEVELS OF ESPECIALLY
CEREBROVASCULAR DISEASE ON BRAIN
SCANS.
SO WE WERE INTERESTED IN
CATCHING THOSE MECHANISMS EARLY
AND STUDYING CRITICAL PERIODS IN
THE COURSE OF ALZHEIMER'S
DISEASE AMONG BLACK AND LATINX
PEOPLE, IN PART BECAUSE OF
ACCELERATED AGING AND ALSO
DIFFERENTIAL SURVIVAL.
SO DIFFERENCES AT RACIAL AND
ETHNIC DIFFERENCES AT AGE 65 ARE
REALLY AS WIDE AS THEY'RE GOING
TO GET, BECAUSE OF DIFFERENTIAL
SURVIVAL.
SO THE SECOND REASON WHY WE
WANTED TO START ANOTHER STUDY
WAS THAT FEWER LARGE SCALE
COHORT STUDIES HAD
PERSPECTIVELY -- HAD
PERSPECTIVELY COLLECTED DATA
FROM BOTH PARENTS AND OFFSPRING
GENERATIONS, AND MOST
INTERGENERATIONAL RESEARCH ON
ALZHEIMER'S DISEASE TO DATE HAD
BEEN MOSTLY WHITE COHORTS.
WELL EDUCATED COHORTS.
SO WE WERE ABLE TO GET FUNDING
FOR THE OFFSPRING COHORT, AND SO
FAR WE'VE RECRUITED ABOUT 2,100
ADULT CHILDREN OF THE WHICAP
PARENTS.
AND ARE STUDYING THEM
LONGITUDALLY.
WE HAVE DONE PLASMA BIOMARKER
LEVELS AMONG THESE OFFSPRING AND
THEIR MEAN AGE IS ABOUT 55.
THERE ARE NO RACIAL AND ETHNIC
DIFFERENCES IN AMYLOID, IN PTAU,
IN NFL OR GFAP.
SO AGAIN, WE'RE NOT REPLICATING
THE PAPERS THAT ARE COMING OUT
FROM CONVENIENCE SAMPLES OR
CLINIC-BASED COHORT WITH RESPECT
TO RACIAL AND ETHNIC
DIFFERENCES.
SO TO SUM UP THE RESULTS IN
CONVENIENCE SAMPLES DO NOT
GENERALIZE TO POPULATION
SAMPLES.
I SHOULD SAY WHAT'S NOT
PUBLISHED YET ARE RESULTS FROM
REGARDS, RESULTS FROM THE HEALTH
AND RETIREMENT STUDY, THE
RESULTS FROM THE HIGH SCHOOL AND
BEYOND STUDY THAT ARE BASICALLY
ESSENTIALLY THE SAME AS WHAT I'M
SHOWING YOU WITH THE WHICAP AND
OFFSPRING, NO DIFFERENCES ACROSS
GROUPS, AND SO THUS FAR, I THINK
THOSE CLINIC-BASED STUDIES CAN
LEAD TO MISLEADING COP
COLLUSIONS ABOUT IDENTIFIABLE
RISK FOR ALZHEIMER'S DISEASE AND
RELATED DEMENTIAS.
I WANTED TO POINT OUT HERE ONE
OF MY FAVORITE NEW STUDIES,
WHICH IS THE ACHIEVE TRIAL, THE
HEARING RANDOMIZATION TRIAL,
WHERE THEY REALLY ONLY FOUND THE
RESULTS IN THE COMMUNITY-BASED
COHORT.
AND SO GENERALIZATION IS THAT
THERE DON'T BE A BETTER EXAMPLE
OF HOW IMPORTANT IT IS TO HAVE
REPRESENTATIVE COHORT.
SO LET'S MOVE ON NOW, WE'VE
TALKED ABOUT WHO WE'RE GOING TO
STUDY, LET'S MOVE ON TO WHAT
SHOULD WE MEASURE.
EARLY IN MY CAREER, I WAS REALLY
CONCERNED WITH COGNITIVE TEST
BIAS.
SOME MEASURES, LIKE
LANGUAGE-BASED MEASURES OR
REASONING-BASED MEASURES ARE
MORE BIASED THAN MEASURES
THAT -- LIKE A WORDLESS LEARNING
TASK FOR PEOPLE WITH LOW
LITERACY, FOR PEOPLE WITH A
DIFFERENT EDUCATIONAL
BACKGROUND, WITH PEOPLE WITH
DIFFERENT CULTURAL BACKGROUNDS
THAN THOSE WHO THE TESTS WERE
ORIGINALLY DEVELOPED AND NORMED
ON.
I FOUND IN MY RESEARCH THAT
FIRST THERE WERE NIECE
DIFFERENCES ACROSS DOMAINS.
THERE'S SOME DOMAINS WE COULD
REALLY RELY ON, SOME TESTS WE
COULD REALLY RELY ON TO BE
ACCURATE REFLECTIONS OF
COGNITION REGARDLESS OF LITERACY
LEVEL, REGARDLESS OF EDUCATIONAL
AND CULTURAL BACKGROUND.
AND SOME WERE JUST BASICALLY NOT
HELPFUL AT ALL IN MAKING A
DISTINCTION BETWEEN COGNITIVE
IMPAIRMENT, REAL COGNITIVE
IMPAIRMENT, AND NORMAL
COGNITION, NORMAL AGING.
I ALSO FOUND THAT LONGITUDAL
ASSESSMENT OR CHANGE OVER TIME
AS AN OUT COME OUTCOME IN THESES
WAS MUCH MORE -- LESS BIASED,
LESS BIASED THAN INTERCEPT OR,
YOU KNOW, PERFORMANCE AT ANY ONE
CROSS-SECTION.
TREMENDOUS ADVANCEMENTS HAVE
HAPPENED IN NEUROPSYCH
ASSESSMENT SINCE I STARTED OUT,
AND IN ADDITION TO ADAPTIVE
COGNITIVE MEASUREMENT SYSTEMS
LIKE NIH TOOLBOX, WE HAVE MORE
DATA ON THESE TRADITIONAL TASKS
THAT HAVE BEEN ADAPTED ACROSS
CONTEXT, LANGUAGE, AND
HARMONIZED ACROSS COHORTS, SOME
OF THEM HAVE BEEN HARMONIZED
INTENTIONALLY, LIKE THE
HEALTH -- LET ME SEE IF I CAN
GET THIS RIGHT -- THE HARMONIZED
COGNITIVE ASSESSMENT PROTOCOL.
I ALMOST DID A JOHN KING THERE
BECAUSE HE CALLS IT SOMETHING
ELSE.
AND ALSO THE HARMONIZATION MIGHT
BE UNPLANNED, LIKE A RECENT
EFFORT TO HARMONIZE ALL OF THE
STUDIES INVOLVED IN THE C4R
COLLABORATIVE COHORT.
SO WHAT DOES IT REALLY MEAN TO
HARMONIZE?
I'M SHOWING YOU SOME OF THESE
STARTING STEPS HERE, WHICH IS TO
IDENTIFY UNIVERSAL DOMAINS OF
COGNITION THAT ARE IMPORTANT TO
COGNITION IN AGING, AND THEN
REPRESENT THOSE WITH MULTIPLE
DIFFERENT MEASURES.
AND THAT'S KIND OF WHAT'S
CLARIFIED IN THESE FACTOR
ANALYSES, IN THESE CONFIRMATORY
FACTOR ANALYSES THAT HAVE
OCCURRED IN BOTH HALSI ON THE
LEFT WITH LINDSAY KOBAYASHI,
THAT'S A STUDY IN SOUTH AFRICA
THAT'S ONE OF THE HCAP GLOBAL
NETWORK STUDIES, AND THE U.S.
HCAP, THAT'S RICH JONES' PAPER
THERE ON THE RIGHT.
SO I THINK IT'S BEEN A MAJOR
ACHIEVEMENT TO FIND THESE
BATTERIES OF TESTS THAT CAN BE
ADAPTED ACROSS SETTINGS, ACROSS
LIKE DRASTICALLY DIFFERENT
SETTINGS TO MEASURE THESE
DIFFERENT DOMAINS.
BUT I DO JUST WANT TO REMIND YOU
THAT WE NEED TO DO OUR DUE
DILIGENCE, ESPECIALLY WHEN WE
HARMONIZE, TO FIGURE OUT, TO
SYSTEMATICALLY TEST WHETHER OUR
MEASURES ARE INVARIANT ACROSS
GROUPS AND SUBGROUPS, ACROSS
RACE/ETHNICITY, LANGUAGE,
THROUGHOUT MY CAREER, MY CONCERN
ABOUT BIAS IN TESTING HAS REALLY
EVOLVED TO WE NEED TO DO THIS
STEP, TO LOOK FOR INVARIANTS
ACROSS THESE DIFFERENT TESTS.
AND WHAT JUSTINA ABALRIGER FOUND
WAS THAT WHEN WE DID THAT ACROSS
RACE/ETHNICITY, AGE, SEX, GENDER
AND TIME OF MEASUREMENT, MEANING
FIRST VISIT, SECOND VISIT, AND
SO ON, THAT SOME OF OUR TESTS
NEEDED TO GET THROWN OUT BECAUSE
THEY HAD METRIC -- BECAUSE THEY
DID NOT HAVE INVARIANTS, METRIC
INVARIANCE ACROSS THESE
DIFFERENT GROUPS, AND SO IF WE
WERE TO CREATE A FACTOR SCORE
THAT INCLUDED THOSE TESTS, IT
WOULD INTRODUCE BIAS ACROSS
DIFFERENT GROUPS.
AND SO NOW THESE ARE THE TOOLS,
THESE ARE THE PSYCHOMETRIC TOOLS
THAT WE HAVE TO ADDRESS THESE
MEASUREMENT PROBLEMS.
LET'S SAY YOU'RE IN THE AUDIENCE
AND AWR LIKE, JEN, I DON'T CARE
ABOUT COGNITIVE TESTING, I JUST
WANT TO KNOW WHO HAS DEMENTIA
AND WHO HAS MCI.
THOSE CLASSIFICATIONS, THEY'RE
NOT BIASED BECAUSE THEY HAVE --
HE YES, THEY HAVE A COGNITIVE
COMPONENT, BUT THEY ALSO HAVE A
FUNCTIONAL COMPONENT, AND THAT'S
REAL.
SO THEY'RE TOO MESSY, GIVE ME
THE ADJUDICATED DEMENTIA STATUS.
AND THAT'S WHAT MIGUEL DID WHEN
HE LOOKED AT, IN THE WHICAP
COHORT, WHETHER ILLITERATE
PEOPLE ARE AT HIGHER RISK FOR
INCIDENT CASES OF ALZHEIMER'S
DISEASE COMPARED TO LITERATE
PEOPLE.
ALL OF THESE PEOPLE HAD
ESSENTIALLY NO FORMAL EDUCATION,
SO THAT'S SOMETHING VERY UNIQUE
ABOUT THE WHICAP COHORT, IS THAT
THERE'S SOME PEOPLE WHO KNOW HOW
TO READ AND WRITE BECAUSE THEY
WERE TAUGHT BY THEIR OLDER
SIBLINGS OR THEY ESSENTIALLY HAD
SOME -- A LITTLE BIT OF HOME,
YOU KNOW, EDUCATION, BUT THEY
NEVER HAD FORMAL SCHOOLING.
AND MOST OF THEM ARE ILLITERATE
IN THE WHICAP COHORT, BUT THIS
THEREARE A GROUP OF PEOPLE THATE
LITERACY SKILLS.
THEY'RE NOT LIKE THE TOP READERS
BUT THEY HAVE TOP LITERACY
SKILLS.
AND WHAT MIGUEL AND GLORIA FELIX
FOUND WAS THAT LITERACY, JUST
INDEPENDENT FROM EDUCATIONAL
EXPOSURE, SCHOOLING, PROTECTED
PEOPLE AGAINST INCIDENT
ALZHEIMER'S DISEASE.
BUT WHEN YOU LOOK AT THE
COGNITIVE TEST SCORES OVER TIME,
THIS IS WHAT YOU SEE.
THERE IS NO DIFFERENCE IN THE
SLOPE HERE WHATSOEVER.
YOU CAN SEE THE ILLITERATE FOLKS
ARE STARTING AT A LOWER
INTERCEPT, AND THE LITERATE
FOLKS ARE STARTING AT A HIGHER
INTERCEPT, BUT THERE'S LIKE NO
SLOPE DIFFERENCE.
AND SO WE ALWAYS HAVE TO KIND OF
KEEP THIS DIAGNOSTIC THRESHOLD
IN MIND, IT DOESN'T REALLY
MATTER IN OUR HANDS WHETHER IT'S
BASED ON JUST COGNITION OR
WHETHER IT'S BASED ON COGNITION
AND FUNCTION AND ADJUDICATED
CONSENSUS CONFERENCE.
WE DO HAVE THESE ISSUES OF
DIAGNOSTIC THRESHOLD THAT MAKES
IT SO THAT PEOPLE WHO START OFF
LOWER HAVE A LOWER INTERCEPT,
THEY MEET THAT THRESHOLD SOONER,
AND THAT WILL AFFECT THE
INCIDENCE RATES.
MORE BEHIND THE SCENES DRAMA
WITH DIAGNOSTIC CATEGORIES.
WHILE ADULTS WITH MILD COGNITIVE
IMPAIRMENT ARE CERTAINLY AT
HIGHER RISK FOR DEVELOPING
DEMENTIA, NOT ALL OF THEM THAT
ARE DIAGNOSED WITH MCI ARE
DIAGNOSED WITH DEMENTIA.
THIS SHOWS ALMOST HALF THE
INDIVIDUALS WITH INCIDENT MCI IN
WHICAP WERE CLASSIFIED AS
COGNITIVELY NORMAL AT FOLLOW-UP,
WHICH WAS ABOUT 2 1/2 YEARS
LATER.
WE DID FIND ABOUT 13% PROGRESSED
TO DEMENTIA AND 30% STAYED AT
MCI, AND MULTIPLE DOMAIN MCI WAS
LESS LIKELY TO REVERT BACK TO
NORMAL, BUT THIS IS SORT OF THE
MESSY INNER WORKINGS OF THE
DIAGNOSES THAT WE HAVE WHEN
WE'RE IN THE COMMUNITY, WHEN
WE'RE IN THE COMMUNITY WE SEE A
LOT OF FLUCTUATION.
SO WE JUST REVIEWED THE
CHALLENGE AT HAND, I DISCUSSED
WHO TO STUDY IN MY HUMBLE
OPINION, AND ALSO WHAT OUTCOMES
WE MIGHT MEASURE AND WHAT WE
NEED TO WATCH OUT FOR WITH THOSE
OUTCOMES, AND NOW I'M GOING TO
DIVE INTO POINT ON OUR LIFE
COURSE MODEL, WORKING FROM THE
RIGHT HAND OF THAT LIFE COURSE
MODEL, WHICH IS DOWNSTREAM, ALL
THE WAY LEFT, WHICH IS UPSTREAM
IN THAT MODEL, TO IDENTIFY
MEANINGFUL SOCIAL AND STRUCTURAL
RISK AND RESILIENCE FACTORS FOR
ALZHEIMER'S DISEASE.
I'M GOING TO START WITH SOME
COMPELLING EVIDENCE THAT
ACCELERATED AGING CONTRIBUTES TO
INEQUALITIES IN BRAIN AND
COGNITION AMONG OLDER ADULTS.
THIS FIRST STUDY USED A WHITE
MATTER HYPERINTENSITY PROGRAM
THAT ADAM BRICKMAN HAS PIONEERED
IN THE WHICAP AND OFF SPRING
STUDIES, AND AGE EFFECTS -- IN
WHICAP AND OFFSPRING COHORTS.
SO ALL THESE ANALYSES FOR THE
PEOPLE WHO ARE RELATED, WHO DID
MRI, WE ARE ADJUSTING FOR THAT,
SO YOU DON'T HAVE TO WORRY ABOUT
THAT IN THIS STUDY, BUT YOU CAN
SEE IN THE WHITE AND LATINX
PARTICIPANTS ON THE LEFT AND
RIDE SIDES, THE RED, PINK AND
BLUE, THERE'S AN INFLECTION
POINT IN LATER AGE, BUT AMONG
BLACK ADULTS IN THE MIDDLE, YOU
SEE THAT THIS ACCELERATION IS
ALREADY APPARENT IN MIDDLE AGE.
SO IDIRA INTERPRETED THESE
FINDINGS OF EVIDENCE OF
SO-CALLED WEATHERING OR
ACCELERATED BRAIN AGING WHICH IS
A CUMULATIVE IMPACT OF
STRUCTURAL RACISM AND SOCIAL
PHYSICAL ECONOMIC ADVERSITIES
THAT ARE FACED BY MINORITIZED
PEOPLE, AND EMBODIED
BIOLOGICALLY.
SHE ALSO LOOKED AT CORTICAL
THICKNESS, AND ESSENTIALLY FOUND
THE SAME THING.
THE LACK OF THAT INFLECTION
POINT IN THE BLACK OFFSPRING AND
WHICAP PARTICIPANTS.
THIS IS JUSTINA'S PAPER WHERE
SHE LOOKED AT DNA METHYLATION IN
THE HEALTH AND RETIREMENT STUDY
AND HOW THAT RELATED TO MEMORY
LEVEL AND MEMORY SLOPE.
OVER
TIME.
SHE FOUND THAT OVERALL
ACCELERATED BIOLOGICAL AGING WAS
ASSOCIATED WITH LOWER MEMORY
PERFORMANCE IN THE HEALTH AND
RETIREMENT STUDY, BUT THIS WAS
ESPECIALLY THE CASE FOR WHITE
MEN AND WHITE WOMEN.
MANY OF THE RELATIONSHIPS
BETWEEN BIOLOGICAL AGING
INDICATORS, THESE BIOLOGICAL
CLOCKS AND MEMORY PERFORMANCE,
WERE THE STRONGEST FOR LATINX
WOMEN BUT THERE WEREN'T ENOUGH
OF THEM IN HRS, THIS BIOLOGICAL
COHORT, TO HAVE STATISTICAL
PRECISION.
BLACK WOMEN CONSISTENTLY
DEMONSTRATED THE WEAKEST
ASSOCIATIONS BETWEEN DNA
METHYLATION AND MEMORY
TRAJECTORIES.
WE'VE JUST NOW TALKED ABOUT
BIOLOGICAL AGING.
NOW WE'RE GOING TO MOVE LEFT
AGAIN ON OUR LIFE COURSE MODEL
AND TALK ABOUT SCHOOLING, ABOUT
WHAT WE KNOW ABOUT -- WELL, WE
DO KNOW THAT EDUCATIONAL
ATTAINMENT IS CONSISTENTLY
ASSOCIATED WITH LOWER RISK OF
ADRD.
IS IT CAUSAL, IS IT LIMITED TO
ATTAINMENT, ARE THERE SIMILAR
RETURNS ACROSS GROUPS?
THIS IS A PICTURE OF A SCHOOL IN
THE DOMINICAN REPUBLIC IN THE
1940s ON THE LEFT, AND A
ONE-ROOM ALL-BLACK SCHOOL ROOM
IN ALABAMA IN THE 1930s.
AND MANY OF OUR PARTICIPANTS
WENT TO SCHOOL IN THOSE PLACES
IN THE WHICAP STUDY IN NORTHERN
MANHATTAN.
BECAUSE WE HAD RECRUITED PEOPLE
OVER THREE WAVES IN WHICAP, IT
MADE IT POSSIBLE TO STUDY COHORT
OR PERIOD EFFECTS IN ADRD, AND
IN 2019, WE HAD FOLLOWED PEOPLE
LONG ENOUGH THAT WE COULD MATCH
BIRTH COHORTS ON AGE IN THE
STUDY, SO ALL THESE PEOPLE IN
THIS FIGURE HERE ARE THE SAME
AGE WHEN WE'RE GETTING DATA FROM
THEM.
BUT THEY ARE FROM DIFFERENT
BIRTH COHORTS.
AND WHAT WAS FOUND WAS A BENEFIT
OF BEING BORN LATER, BOTH WITH
RESPECT TO I TO INCIDENT ALZHEIS
DISEASE, BUT PEOPLE BORN LATER
HAD A SLOWER MEMORY TEE KLEIN
OVER TIME.
WHAT WAS FOUND WAS THE BENEFIT
OF BEING BORN LATER WAS
EXPLAINED BY HIGHER CHILDHOOD OR
FAMILY SES AND HIGHER
EDUCATIONAL ATTAINMENT.
I MEAN, THESE SLOPES WERE
OVERLAPPING.
AFTER ACCOUNTING FOR THOSE TWO
FACTORS.
BECAUSE THOSE SECULAR TRENDS IN
EDUCATIONAL ATTAINMENT WERE DUE
TO POLICY CHANGES, REQUIRING
ADDITIONAL YEARS OF SCHOOL, I
THINK THIS ADDS TO THE LIST OF
EVIDENCE THAT THERE'S A CAUSAL
LINK BETWEEN EDUCATIONAL
ATTAINMENT AND ALZHEIMER'S
DISEASE.
POLICY CHANGES ACROSS THE NATION
ARE NATURAL EXPERIMENTS, OR THEY
CAN BE OFFERED NATURAL
EXPERIMENTS TO ESTABLISH THESE
CAUSAL LINKS.
AND WE LOOKED UP INFORMATION
ABOUT LENGTH OF SCHOOL YEAR,
STUDENT-TEACHER RATIO AND
PERCENT ATTENDANCE IN
ADMINISTRATIVE RECORDS FROM 1911
ALL THE WAY TO 1960.
AND IN THE REGARDS COHORT, WHERE
BLACK PEOPLE AND PEOPLE IN THE
STROKE BELT ARE OVERSAMPLED, WE
WERE ABLE TO INCLUDE ALMOST
20,000 PEOPLE AND FOUND THAT
HIGHER INVESTMENT WITHIN THESE
ADMINISTRATIVE RECORDS IN
ELEMENTARY SCHOOLS WERE
ASSOCIATED WITH LOWER RISK OF
COGNITIVE IMPAIRMENT LATER IN
LIFE.
THAT EFFECT WAS STRONGEST IN
WHITE PEOPLE, ESPECIALLY WHITE
WOMEN, BUT WEAKEST IN BLACK
PEOPLE, ESPECIALLY BLACK MEN.
I'M GOING TO TURN TO PROJECT
TALENT, WHICH IS ONE EXAMPLE OF
THESE EDUCATIONAL COHORT THAT
ARE NOW BEING LEVERAGED THANKS
TO NIA FUNDING TO STUDY LATER
LIFE COGNITION, AND SO PROJECT
TALENT STARTED IN 1960 WITH
377,000 9TH THROUGH 12TH GRADERS
WHO WERE FROM 1,200 SCHOOLS
AROUND THE COUNTRY THAT WERE
RANDOMLY SAMPLED.
AND EVERY STUDENT IN EACH SCHOOL
THAT WAS SELECTED WAS A
PARTICIPANT IN TWO DAYS OF
TESTING.
AND THAT INCLUDED PERSONALITY,
KNOWLEDGE AND COGNITIVE ABILITY
DATA, AND DEMOGRAPHIC QUESTIONS,
AND THEN THE PROJECT TALENT
AGING STUDY 58 YEARS LATER
TRACKED 22,000 PEOPLE WHO WERE A
PART OF THAT INITIAL STUDY IN
1960, AND SO THIS IS A
SCHOOL-BASED COHORT.
AND WHAT NIKA FOUND AND WAS ABLE
TO PUBLISH LAST YEAR, SHE FIRST
DEVELOPED INDICATORS OF HIGH
SCHOOL QUALITY THAT WERE
REPORTED BY PRINCIPALS AT THE
TIME OF SCHOOLING, AND PREDICTED
COGNITIVE FUNCTION, WHICH WAS
DONE OVER THE PHONE, 58 YEARS
LATER.
SO THOSE SCHOOL QUALITY
INDICATORS WERE TEACHER SALARY,
SCHOOL SIZE, NUMBER OF TEACHERS
WITH GRADUATE TRAINING AS AN
EXAMPLE.
WHAT NIKA FOUND WAS THAT
ATTENDING SCHOOLS WITH A HIGHER
NUMBER OF TEACHERS WITH GRADUATE
TRAINING WAS THE CLEAREST
PREDICTOR OF LATER LIFE
COGNITION, AND SCHOOL QUALITY
ESPECIALLY MATTERED FOR LANGUAGE
ABILITIES, AS THEY WERE MEASURED
BY PROJECT TALENT AGING STUDY.
SHE ALSO FOUND THAT TEACHER
SALARY AND SCHOOL SIZE HAD A
LARGER IMPACT AMONG WOMEN IN
PROJECT TALENT AS OPPOSED TO
MEN.
BLACK RESPONDENTS WERE DISPRO
FDISPROPORTIONATELY EXPOSED TO
LOW QUALITY HIGH SCHOOLS, I
DON'T THINK THAT'S NEW
KNOWLEDGE, BUT THERE WERE NO
INTERACTIONS.
SO IN OTHER WORDS, THE MAIN
EFFECT OF THE SCHOOL QUALITY
FACTORS WAS THE SAME ACROSS
RACIAL AND ETHNIC GROUPS.
BUT WHAT THIS MEANS BECAUSE
THERE'S A HIGHER SORT OF
PREVALENCE OF PEOPLE IN THE
BLACK POPULATION WHO ARE BEING
EXPOSED TO THESE LOWER SCHOOL
QUALITY CONDITIONS, THAT
INCREASED INVESTMENT IN SCHOOLS,
ESPECIALLY THOSE THAT SERVE
BLACK CHILDREN, COULD BE A VERY
POWERFUL STRATEGY TO IMPROVE
LATER LIFE COGNITIVE HEALTH
AMONG OLDER ADULTS IN THE U.S.
FINALLY TO END UP THE TALK I'M
GOING TO TALK ABOUT SYSTEMIC --
THIS IS THE MEAN AGE 55 PEOPLE
WHERE WE GAVE A MEASURE, A
CLASSIC MEASURE OF EXPOSURE TO
DISCRIMINATION, INCLUDING DAILY
DISCRIMINATION.
AND BASICALLY WHAT THIS CHART
SHOWS IS THAT AMONG NON-HISPANIC
BLACK PARTICIPANTS IN THE
OFFSPRING STUDY WHO ARE IN
ORANGE HERE, THEY HAD THE
HIGHEST MEAN EXPOSURE TO DAILY
RACISM COMPARED TO LATINX, BLACK
AND WHITE IN GREY.
BLACK PEOPLE EXPERIENCED
INTERPERSONAL DISCRIMINATION AT
LEAST ONCE EVERY WEEK.
WE ALSO LOOKED AT REPORTS OF
OCCURRENCE AND FREQUENCY ON THE
MAJOR DISCRIMINATION SCALE TO
MEASURE INSTITUTIONAL RACISM,
AND THE SECOND BAR CHART THAT I
JUST PULLED UP SHOWS THAT
NON-HISPANIC BLACK PEOPLE
EXPERIENCED ALMOST SIX CIVIL
RIGHTS VIOLATIONS ON AVERAGE IN
THEIR LIFETIME.
WE ALSO KNEW THAT RACISM IS
MAINTAINED BY POLICIES AND OTHER
STRUCTURAL FACTORS, AND SO TO
REPRESENT THIS, WE ACTUALLY HAD
THE PARENTS RESIDENTIAL
SEGREGATION, WHICH REPRESENTS
THE CONDITIONS UNDER WHICH THESE
OFFSPRING LIVED AS CHILDREN
DURING CHILDHOOD, AND WE DID
THAT TO STUDY INSTITUTIONAL
DISINVESTMENT THAT REINFORCE
RACIAL INEQUALITIES.
AT LEAST HALF OF THE BLACK AND
LATINX PARTICIPANTS LIVED IN
SEGREGATED NEIGHBORHOODS DURING
CHILDHOOD, AND IN CONTRAST, THAT
WAS TRUE OF ONLY ABOUT 8% OF THE
NON-HISPANIC WHITE PARTICIPANTS.
SO WE USE LINEAR REGRESSION AND
ADJUSTED FOR AGE AND EDUCATION,
SCHOOLING, YEARS OF SCHOOLING,
TO EXAMINE THE RELATIONSHIPS
BETWEEN INTERPERSONAL RACISM AND
MEMORY.
THIS PLOT SHOWS BETA ESTIMATES
AND CONFIDENCE INTERVALS FOR
THIS RELATIONSHIP IN THE OVERALL
SAMPLE AND ALSO FOR EACH OF THE
RACIAL AND ETHNIC GROUPS.
AND THEN THE YELLOW DOT AT THE
END IS SHOWING THE RELATIONSHIP
OF AGE TO MEMORY FOR COMPARISON
FOR YOU.
WE FOUND RELIABLE RELATIONSHIPS
BETWEEN DAILY EXPERIENCES OF
RACISM AND MEMORY IN THE WHOLE
SAMPLE, AND THIS CORRESPONDS TO
ABOUT THREE YEARS OF
CHRONOLOGICAL AGE AND WAS DRIVEN
BY THE NON-HISPANIC BLACK
PARTICIPANTS.
I WANT TO MENTION THAT ACTUALLY
MICHELLE MIELKE BROUGHT IT TO MY
ATTENTION BECAUSE I DON'T READ
EVERY JOURNAL ARTICLE BUT SHE
DID A REALLY COOL STUDY IN THE
ALZHEIMER'S ASSOCIATION JOURNAL
RECENTLY, WHERE SHE LOOKED AT A
BLACK COHORT THAT'S BEEN
FOLLOWED FOR MANY, MANY YEARS
AND USED MANY DIFFERENT BLOOD
DRAWS IN LOOKING AT PLASMA
AMYLOID LEVELS, AND SHE FOUND A
RELATIONSHIP IN THAT BLACK
COHORT BETWEEN ER EVERY DAY
DISCRIMINATION AND LEVELS OF
PLASMA AMYLOID IN THAT SAMPLE.
SO CHECK THAT ONE OUT, I'M STILL
PROCESSING IT MYSELF.
AND HOPE TO TAKE A LOOK AT IT
AND SEE IF IT IS REPLICATED.
THIS PLOT HAS THE SAME IN OUR
COHORT.
THIS PLOT HAS THE SAME LAYOUT.
THIS TIME WE'RE SHOWING THE
RELATIONSHIP OF INSTITUTIONAL
RACISM WITH DELAYED MEMORY.
THERE WAS A RELIABLE
RELATIONSHIP BETWEEN
INSTITUTIONAL RACISM AND MEMORY
SCORES AMONG NON-HISPANIC BLACK
PARTICIPANTS SO THAT EACH
REPORTED CIVIL RIGHTS VIOLATION
CORRESPONDED TO THE EFFECT OF
ABOUT 4 1/2 YEARS OF AGE ON
MEMORY.
AND THEN FINALLY, PARTICIPANTS
WHO LIVED IN MORE RACIALLY AND
ETHNICALLY SEG TATE GATED
NEIGHBORHOODS WHEN THEY GREW UP
HAD MORE DELAYED MEMORY SCORES
BUT THIS WAS NOT RELIABLE
STATISTICALLY IN MOST OF THE
SAMPLE EXCEPT FOR THE ENTIRE
SAMPLE.
YOU CAN SEE HOW SEGREGATED OUR
SAMPLE IS BY THAT.
SO IN SUM, I HAVE GONE OVER THE
CONSIDERATIONS FOR WHO TO STUDY,
WHAT TO MEASURE, AND THE WAYS
THAT WE HAVE TRIED TO TACKLE
SOME OF THESE STRUCTURAL AND
SOCIAL FACTORS.
I THINK THAT SOME CHALLENGES
THAT WE AND THE FIELD ARE FACING
ARE ABOUT THE COMMITMENT TO
COMMUNITY ENGAGEMENT, HOW MUCH
IT TAKES, HOW LONG IT TAKES, HOW
MUCH MONEY IT COSTS.
I AM CONFLICTED OF OUR FINDING
OF RETURNS TO SCHOOLING,
DIFFERENTIAL RETURNS TO
SCHOOLING ACROSS RACIALIZED
GROUPS BECAUSE I THINK THIS HAS
IMPLICATIONS FOR INTERVENTIONS,
WHICH COULD WIDEN DISPARITIES IF
THEY ARE NOT TARGETED CORRECTLY.
WE ARE WORRIED ABOUT THE SPATIAL
SCALE FOR AREA LEVEL EXPOSURES
AND, THEREFORE, SORT OF THE
SPATIAL SCALE IN WHICH
INTERVENTIONS MIGHT IMPACT
COGNITION AND COGNITIVE AGING.
WE NEED TO WORK ON INCORPORATING
MORE RESILIENT STRATEGIES INTO
OUR WORK AND NOT RELYING ON
DEFICIT MODELS.
MIDDLE AGE, MID LIFE COHORTS
NEED TO HAPPEN BECAUSE
DISPARITIES NARROW WITH AGE.
WE STILL HAVE SOME CHALLENGES
FOR COGNITIVE MEASURE
DEVELOPMENT, I THINK, IN
MULTIPLE DOMAINS.
AND I THINK THERE'S A CONFLICT
BETWEEN THE COST OF OVERSAMPLING
WHEN YOU DO A STUDY AND THIS
CHALLENGE OF INTERSECTIONALITY,
WHERE YOU KNOW, NOT ONLY DO YOU
NEED TO HAVE ENOUGH PEOPLE TO
LOOK AT RACIAL AND ETHNIC
GROUPS, BUT YOU REALLY NEED TO
CHARACTERIZE BLACK MEN AND BLACK
WOMEN AS SEPARATE GROUPS, LATINX
WOMEN AND LATINX MEN, AND SO ON,
AS SEPARATE GROUPS.
SO IN I THINK WHAT I'VE TALKED
ABOUT IS STRUCTURAL POLICIES
THAT NARROW BRAIN HEALTH
DISPARITIES FOR US TO AVOID THIS
IDEA OF HEALTHISM, WHICH WAS
REALLY SORT OF COINED BY THIS
GUY NAMED CRAWFORD AND THEN
RECENTLY BROUGHT UP IN A NICE
COMMENTARY BY TIM DALY WHICH IS
ESSENTIALLY BLAMING PEOPLE,
HEALTHISM IS BLAMING PEOPLE AND
PUTTING THE ONUS ON THEM FOR
IMPROVING THEIR SITUATION IN
LIFE.
INSTEAD, IF WE CAN FOCUS ON
STRUCTURAL POLICIES, INVESTMENT
IN TEACHERS AND SCHOOLS THAT
SERVE MINORITIZED CHILDREN,
HOUSING INVESTMENTS, REDUCING
NEIGHBORHOOD INEQUALITIES, I
KNOW THAT'S NOT EASY TO DO, BUT
I'VE LISTED SOME OF THOSE
FACTORS THERE.
WE HAVE -- THERE IS SOME NEW
EVIDENCE FROM SOUTH AFRICA THAT
CASH TRANSFERS BENEFIT LATER
LIFE HEALTH AND THAT WILL BE
COMING OUT SOON AND I'M VERY
INTERESTED IN THIS IDEA OF BABY
BONDS AS -- AND CASH AS A WAY OF
IMPROVING INCOME AND SECURITY,
REDUCING PRECARITY, UNIVERSAL
INCOME.
WE HAVE A STUDY FROM PEOPLE AT
BERKELEY SHOWING FOOD STAMPS AS
THEY GOT ROLLED OUT COUNTY BY
COUNTY THEN RELATE TO LOWER RISK
OF DIABETES LATER IN LIFE, AND I
THINK WE SHOULD DO THAT SAME
STUDY WITH COGNITION.
WE NEED TO REFORM POLICE
FUNDING, DEMILITARIZE AND
REINVEST THAT IN COMMUNITY
SAFETY PROGRAMS, BECAUSE
INCARCERATION AND POLICING IS A
STRESSOR RELATED -- AND PEOPLE
ARE WORKING ON HOW TO SHOW THAT
IT'S RELATED TO COGNITION, IT IS
RELATED TO OTHER HEALTH AND
WELLNESS OUTCOMES.
LOWER ELIGIBILITY AGE FOR
MEDICARE, AND FINALLY I THINK
NIA IS DOING A WON TER FULL JOBF
THIS, WHICH IS TO TRAIN AN
ANTI-RACIST AND DIVERSE RESEARCH
AND HEALTHCARE WORKFORCE.
THANK YOU.
[APPLAUSE]
>> WE DO HAVE A COUPLE QUESTIONS
ONLINE BUT I WOULD LOVE ANYONE
FROM HERE TO PLEASE GO TO THE
MICROPHONE.
I'LL REPEAT THE CME CODE, 50124.
50124.
DR. GOTTESMAN.
>> HI, THANK YOU, JEN, FOR THAT
WONDERFUL TALK.
I WAS JUST WONDERING IF YOU
COULD SORT OF SPECULATE ON WHAT
YOU THINK THE MECHANISMS ARE
LINKING THE SOCIAL AND
STRUCTURAL DETERMINANTS WITH THE
BIOLOGICAL CHANGES THAT YOU
DESCRIBED.
I KNOW THERE'S BEEN SOME WORK
DESCRIBING SORT OF INCREASED
INFLAMMATORY MARKERS THAT
PERHAPS THAT MIGHT
MECHANISTICALLY LINK THE TWO.
I'M JUST CURIOUS ABOUT YOUR
THOUGHTS.
>> RIGHT.
WELL, I THINK THAT, YOU KNOW,
WE'RE WORKING ON FINDING THAT --
WE'RE WORKING ON MAKING THOSE
CONNECTIONS.
PART OF IT IS RECOGNIZING THAT,
YOU KNOW, THAT SOME OF THESE
EXPOSURES, IT'S BETTER TO STUDY
THEM WHEN THEY'RE HAPPENING,
RIGHT?
SO THOSE SCHOOL-BASED COHORTS OR
THOSE ADOLESCENT COHORTS,
TRACKING PEOPLE OVER TIME, WHERE
WE HAVE LONGITUDAL BIOMARKERS
THAT CAN LOOK AT INFLAMMATION
BUT ALSO THOSE SOCIAL AND
STRUCTURAL FACTORS.
INCOME SEEMS TO HAVE A VERY
STRONG EFFECT ON MEMORY SLOPE
OVER TIME, BUT NOT SO MUCH ON
INTERCEPT, WHEREAS LIKE
FAMILY -- CHILDHOOD SES HAS A
MAJOR IMPACT ON INTERCEPT, BUT
NOT SO MUCH ON SLOPE.
SO I THINK OCCUPATION IS ONE
LIKELY MECHANISM, FAMILY
FORMATION AND THE STRESSES THAT
GO ALONG WITH SUPPORTING A
FAMILY, THAT CAN GO ALONG WITH
SUPPORTING A FAMILY IF YOU ARE
LIVING IN POVERTY OR ANOTHER
POSSIBLE, YOU KNOW, MECHANISM,
SO IF YOUR QUESTION IS WHAT ARE
THE SOCIAL AND STRUCTURAL
DRIVERS OF THOSE BIOLOGICAL
FACTORS, I THINK THAT WE'RE NOT
THERE YET, BUT I THINK THESE
LONGITUDAL STUDIES THAT ARE NOW
EMERGING, THAT HAVE LONGITUDAL
BIOMARKER COLLECTION, ARE GOING
TO HELP.
>> OKAY.
MAYBE A QUESTION FROM ONLINE
THEN.
IS THE RISE IN THE RATES OF
DEMENTIA IN LOW AND MIDDLE
INCOME COUNTRIES DIRECTLY
RELATED TO THE RISE OF LIFE
EXPECTANCY OR ARE OTHER FACTORS
INVOLVED?
I ASK BECAUSE GDP IS NOT A
PERFECT PREDICTOR OF LIFE
EXPECTANCY.
>> YEAH, I THINK THAT IT'S BOTH
LIFE EXPECTANCY AND ALSO THE
AGING OF THE POPULATION IN
GENERAL, JUST --
>> COHORT?
>> OF THE COHORT, RIGHT, SO
THERE ARE JUST MORE OLDER
PEOPLE, THAT THE BALANCE BETWEEN
OLDER PEOPLE AND YOUNGER PEOPLE
IS SHIFTING TOWARDS OLDER PEO
PEOPLE.
BUT SINCE AGE IS THE NUMBER ONE
RISK FACTOR, THAT'S WHAT'S
HAPPENING.
>> OKAY.
THAT'S AN NIH QUESTION HERE.
YOUR WORK SUGGESTED EDUCATION IN
GENERAL IS PROTECTIVE.
HAVE YOU SEEN ANY CORRELATION
WITH SPECIFIC TYPES OF EDUCATION
SUCH AS STEM VERSUS NON-STEM?
>> SO ONE OF THE STUDIES I'M
WORKING WITH NOW, HIGH SCHOOL
AND BEYOND, ONE OF THEIR KEY
FINDINGS IS THAT STEM COURSES,
THAT WHEN HIGH SCHOOL STUDENTS
WERE ABLE TO -- TOOK STEM
COURSES THEMSELVES, AND
OBVIOUSLY THEY TOOK THEM BECAUSE
THEY WERE AVAILABLE, YOU KNOW,
AT THE SCHOOL, THEY CORRELATE
WITH SORT OF THE HUMAN CAPITAL
OUTCOMES, YOU KNOW, EARNINGS,
OCCUPATIONAL STATUS, AND THE
THINGS THAT ECONOMISTS USUALLY
MEASURE.
THAT TURNS OUT AS WE'RE SORT OF
DIVING INTO THE DATA, NOT TO BE
AS STRONG A PREDICTOR OF
COGNITION AS ONE WOULD THINK
THROUGH THOSE MECHANISMS OF
BETTER OCCUPATION, HIGHER
EARNINGS.
INSTEAD, YOU KNOW, THE TWO
THINGS IN THE HIGH SCHOOL AND
BEYOND COHORT THAT ARE REALLY --
SEEM TO BE DRIVING AND I HOPE
MAYBE NEXT TIME I COME AND TALK
I'LL BE ABLE TO SHOW YOU ALL
THOSE DATA, WHICH IS FAMILY SES
REALLY, REALLY DRIVES WHERE YOU
GO TO SCHOOL.
IT IS EXTREMELY, YOU KNOW,
STRONGLY RELATED TO THE QUALITY
OF SCHOOL THAT YOU GO TO.
SO ONCE YOU SORT OF ADJUST IN
YOUR MODELS OF FAMILY SES, THE
EFFECTS OF SKOLL, YOU SCHOOL, E
SCHOOL QUALITY VARIABLES,
BASICALLY FLATTEN.
AND THAT ALL LEADS TO
ATTAINMENT.
SO ATTAINMENT IS REALLY THE
THING, THAT THE BETTER YOU DO IN
SCHOOL, THE HIGHER QUALITY
SCHOOL THAT YOU GET, YOU HAVE A
HIGHER ATTAINMENT.
AND THAT CREDENTIAL SORT OF THEN
GOES A LONG WAY THROUGHOUT LIFE.
I THINK IT'S A VERY POWERFUL
THING.
SO WHILE YEARS AGO I STARTED OUT
TRYING TO ASK WELL, IT'S NOT
JUST ATTAINMENT, IT'S ABOUT
QUALITY, BUT THAT QUALITY THEN
LEADS TO THE ATTAINMENT, AND
THAT ATTAINMENT IS THE THING,
THE CREDENTIAL AND THAT
EXPERIENCE IS THE THING THAT
COGNITIVELY, I THINK, HAS THE
MOST EFFECT IN COHORTS LIKE HIGH
SCHOOL AND BEYOND THAT WENT TO
HIGH SCHOOL IN 1980.
>> OKAY.
SO WHILE YOU DIDN'T FIND MEAN
DIFFERENCES IN BLOOD BIOMARKERS
BY RACE IN WHICAP --
>> I DID NOT.
>> RIGHT, WHILE YOU DID NOT DO
THAT, THERE WAS A MUCH WIDER
RANGE OF MANY OF THEM IN THE
BLACK AND LATINX GROUPS COMPARED
TO WHITES.
CAN YOU SPEAK TO WHY THAT MIGHT
BE?
>> BECAUSE IT'S REALLY HARD TO
FIND WHITE PEOPLE IN THE
OFFSPRING STUDY.
SO I MEAN, IT'S REALLY JUST A
MATTER OF SAMPLE SIZE.
THE FAMILIES IN WHITE CAB WHO
ARE BLACK AND LATINX HAVE MORE
CHILDREN, AND THE WHITE PEOPLE,
AT LEAST IN THE BEGINNING,
BEFORE COVID WHEN WE WERE REALLY
COLLECTING A LOT OF BLOOD AND
NOW IT GOT BACK ONLINE
OBVIOUSLY, BUT WE SENT THOSE
SAMPLES OUT DURING COVID, AND SO
THE WHITE -- THE CHILDREN OF THE
WHITE PARTICIPANTS IN WHICAP ARE
MOST LIKELY TO HAVE MOVED AWAY,
OUT OF THE AREA.
AND SO THEY WERE HARDER TO FIND,
AND SO WE'RE ON OUR WAY TO GET
THEIR BLOOD NOW, BUT THAT'S THE
REASON WHY YOU SEE THAT SORT OF
VARIABILITY ISSUE.
IT'S A SAMPLE SIZE ISSUE.
>> JEN, THERE'S SO MANY
QUESTIONS THAT COME TO MIND, BUT
ONE OF THEM IS, SO WE SEE THAT
THE -- ESPECIALLY OVER THE LAST
TWO DECADES, THERE IS A WIDENING
OF THE DIFFERENCE BETWEEN THE
POOR AND THE RICH.
I MEAN, IT'S VERY WORRISOME THAT
SO MANY MORE PEOPLE ARE UNDER
THE -- OF POVERTY AND THERE ARE
SO MANY MORE PEOPLE THAT ARE NOT
ON THE THRESHOLD OF POVERTY BUT
STILL DON'T MAKE IT, AND SO
BASED ON WHAT YOU SEE IN YOUR
STUDY, YOU THINK THAT THE RISE N
THE RISK OF DEMENTIA THAT WILL
BE DUE TO THIS INCREASING
STRESS, INCREASING ACCESS TO
EDUCATION, INCREASING -- REDUCED
ACCESS OF OUR CARE, AND I THINK
THAT THAT'S SOMETHING THAT WE
DON'T TALK ABOUT, BUT IT'S
LIKELY THAT IT WILL HAVE HEALTH
CONSEQUENCE IN THE POPULATION.
>> I THINK THERE ARE MANY
FACTORS WORKING TOGETHER, AND
THAT'S WHY IT'S SO IMPORTANT FOR
US TO BE ABLE TO MEASURE
THOSE -- MEASURE ALL THESE RISK
FACTORS WITH THE RESILIENCE
FACTORS, SO ONE OF THE THINGS
THAT HAPPENED WITH THE WHICAP
STUDY THAT I DIDN'T MENTION IS
THAT IN THE LATER BORN COHORT,
THERE WAS A MUCH HIGHER
PREVALENCE OF DIABETES AND
HYPERTENSION THAN IN THE EARLIER
BORN COHORT.
BUT THE EFFECT OF HYPERTENSION
AND DIABETES SORT OF IN
EXPLAINING THOSE COHORT
DIFFERENCES WAS NOTHING.
AND ALSO JUST IN EXPLAINING THE
RISK OF DEVELOPING DEMENTIA WAS
LESS, LESS SO IN THE LATER BORN
COHORT, BECAUSE THEY'RE BEING
TREATED MORE EFFECTIVELY.
DID A DOCTOR EVER TELL YOU YOU
HAVE HYPERTENSION, DIABETES,
THAT'S ESSENTIALLY WHAT THOSE
QUESTIONS ARE BASED ON, AND IN
ADDITION TO WHETHER THEY'RE
TAKING MEDICATIONS, AND MANY
MORE PEOPLE WERE BEING
EASKTTIVELY TREATED IN THE LATER
BORN COHORT THAN IN THE EARLIER
BORN COHORTS.
SO EVEN THOUGH THE PREVALENCE IS
MUCH HIGHER IN THE LATER BORN
COHORT, THE TREATMENT IS BETTER.
SO I MEAN, I'M NOT SAYING LET'S
NOT WORRY ABOUT IT.
I'M SAYING I AGREE WITH YOU THAT
THONE THING I THINK WOULD BE VEY
INTERESTING TO EXPLORE IS
WHETHER THE DISPARITIES ARE MORE
SENSITIVE TO ABSOLUTE SORT OF --
SORT OF ABSOLUTE GAPS OR
ABSOLUTE DISPARITIES, ABSOLUTE
INEQUALITIES, OR WHETHER THEY
ARE SENSITIVE TO SORT OF
EVERYONE IS GOING UP BUT THOSE
INEQUALITIES ARE REMAINING --
YOU KNOW, THOSE GAPS ARE
REMAINING THE SAME.
AND I THINK COHORT DATA LIKE
THAT COLLECTED IN THE HRS WILL
BE ABLE TO HELP US UNDERSTAND
THAT.
>> AGAIN, FANTASTIC TALK.
IN TERMS OF YOUR GUIDANCE FOR
THE KIND OF RESEARCH WE CAN DO
TOWARD THE FUTURE, BIG
DISCREPANCY AS YOU'RE POINTING
OUT FOR COMMUNITY-BASED STUDIES
AND CLINIC BASED STUDIES, FOR A
TIME, BUT TO ASK, NOW THAT WE
HAVE BLOOD BIOMARKERS, DIGITAL
BIOMARKERS, SO MANY MORE
CREATIVE WAYS TO MONITOR
BIOLOGIC AND BEHAVIORAL
FUNCTIONS, THAT GAP OUGHT TO BE
CLOSED, WE OUGHT TO BE ABLE TO
DO BETTER, DON'T YOU THINK, IN
THE POPULATION STUDIES THAN
WE'VE BEEN ABLE TO SO FAR?
>> I THINK PART OF THAT IS GOING
TO TAKE A RETOOLING OF THE
INVESTIGATORS THAT -- YOU KNOW,
MY COLLEAGUES AND ME.
HE WITH NWE NEED TO RETOOL OURSO
BE BETTER PREAC PREPARED FOR
COMMUNITY-BASED STUDIES AND TO
ROLL OUT BIOLOGICAL -- IT IS
ACTUALLY EXPENSIVE, RICHARD, TO
DO, JUST TO LET YOU KNOW.
SO YOU KNOW, I THINK -- I THINK
YOU'RE ABSOLUTELY RIGHT, THAT I
FEEL VERY HOPEFUL ABOUT IT, VERY
EXCITED ABOUT IT, BUT I THINK
THERE NEEDS TO BE A RECKONING
ESSENTIALLY WITH THOSE STUDIES
THAT OVER TIME HAVEN'T REALLY,
YOU KNOW, BEEN ABLE TO
DIVERSIFY, AND A RETOOLING OF
THE TEAMS THAT ARE ASSOCIATED
WITH THEM BECAUSE I THINK SOME
VERY EXCITING SCIENCE CAN HAPPEN
WHEN WE MERGE THOSE SORT OF
POPULATION-BASED STUDIES WITH
POPULATION BIOMARKER TECHNOLOGY.
>> NO MORE QUESTIONS OR
COMMENTS?
JUST TO THANK YOU, THIS IS JUST
A TOUR DEFORCE IN DEMONSTRATING
TO US HOW ONE CAN JOIN
COMMUNITY-BASED SOCIAL
DETERMINANTS, BIOLOGICAL
DETERMINANTS, THEIR CONVERGENCE
AND THE INSPIRATION PROVIDED TO
ALL OF US.
FLORENCE MAHONEY WOULD BE PROUD.
THANK YOU SO MUCH.
>> THANK YOU.
[APPLAUSE]