Healthcare Factors and Cardiovascular Risk Influences on Accelerated Brain Aging and Disability in Hispanic Persons with Multiple Sclerosis - This is a mixed methods study examining healthcare factors, medical comorbidities [i.e., cardiovascular risk factors (CRF)], and accelerated brain aging in Hispanic persons with multiple sclerosis (H-pwMS). This Career Development Award (CDA) will provide the necessary support for Dr. Cristina Román, a trained clinical neuropsychologist and early career researcher, to obtain the mentorship and training needed to become an independent clinical researcher and leading expert in healthcare factors, disparities in neurological disease, brain aging, CRFs, and mixed methods. H-pwMS have disproportionately worse outcomes than their non-Hispanic counterparts. These disparities can be driven by healthcare factors, especially since early intervention and consistent, ongoing healthcare are critical to MS prognosis. Hispanics encounter unique factors related to accessing healthcare, not only contributing to poorer MS outcomes, but also increasing their risk for comorbid medical conditions, like CRF. CRFs independently and disproportionately impact pwMS and Hispanic persons living in the U.S. Accelerated brain aging is emerging as an important biomarker of disease progression in MS that is also sensitive to CRFs. The primary aim of the proposed study is to use mixed-methods to investigate the impact of healthcare factors and CRFs on MS-related outcomes, namely level of disability and accelerated brain aging. This project aligns with NIMHD’s mission for the “advancement of scientific knowledge and improving the health of NIH-designated populations experiencing health disparities.” We will recruit eighty English and/or Spanish-speaking H-pwMS to partake in virtual or in-person study sessions. In addition, a subset of the sample (N=40) will undergo structural brain imaging. Study aims are as follows: (1) investigate how CRFs moderate the relationship between healthcare factors and disability; (2) correlate accelerated brain aging to healthcare factors, accelerated brain aging, and disability; and (3) qualitatively examine lived experiences around healthcare. This work will have direct implications for early intervention, while also filling a substantial gap in our understanding of how non-medical factors directly impact brain health and health disparities in neurological disorders. To this end, the current CDA will capitalize on the on the rich infrastructure and resources of the Keck School of Medicine of the University of Southern California and provide necessary training in: (1) healthcare factors and disparities in MS; (2) modeling (i.e., machine learning) of brain aging and cardiovascular influences; (3) mixed-methods design and analysis; and (4) professional development. Dr. Román has assembled an exemplary mentorship team of experts: Lilyana Amezcua, MD, John DeLuca, PhD, Jennifer Manly, PhD, Adam Brickman, PhD, Denise Fyffe, PhD with expertise in H-pwMS, healthcare factors, health disparities in neurological disorders, cardiovascular influences on brain aging, and mixed methods design and analysis. The training afforded by this CDA will ensure Dr. Román makes a successful transition to independent investigator who continues to carry NIMHD’s mission to reduce health disparities.
