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