Project Summary
African Americans (AAs) have disproportionately higher rates and earlier onset of Alzheimer’s disease and
related dementias (ADRD) relative to White Americans. Although prior research has made significant
contributions to our understanding of racial disparities in ADRD, we still lack a comprehensive understanding of
how the individual lived experience of being AA, including cumulative exposure to structural racism, contributes
to elevated ADRD risk and the potential mechanisms underlying those risks. Building on the existing,
community-based research infrastructure developed by our team’s previously funded studies, we will follow a
cohort of residents (n=1133) living in two historically disinvested, predominantly AA communities to understand
how dynamic neighborhood socioeconomic conditions across the lifecourse contribute to cognitive outcomes in
mid- and late-life adults. This proposal rests on the premise that neighborhood segregation and subsequent
disinvestment contributes to poor cognitive outcomes for AAs via factors including a) lower access to
educational opportunities and b) higher exposure to race- and socioeconomically-relevant stressors, including
discrimination, trauma, and adverse childhood events. In turn, these cumulative exposures foster psychological
vigilance in residents, leading to cardiometabolic dysregulation and sleep disruption, which may mediate
associations between neighborhood disadvantage and ADRD risk. We also will examine potential protective
factors that may promote cognitive health, including neighborhood social cohesion, safety, and satisfaction.
The proposed study will leverage our existing longitudinal data on risk and protective factors, biobehavioral
mediators, and baseline cognitive assessments, and will include: 1) three waves of cognitive assessments in
the full cohort of participants who are 50 years+ (participants who are aged 35-49 years will have two
assessments) and clinical adjudication of ADRD in participants who are 50+ (n=906), 2) additional
assessments of blood pressure and objective sleep, 3) a comprehensive assessment of life and residential
history using the questionnaire from the Health and Retirement Study (HRS); and 4) in-depth qualitative
interviews to reveal lifecourse opportunities and barriers experienced by AAs in achieving optimal cognitive
health in late life. Understanding how structural racism has influenced the lived experience of AAs including
dynamic changes in neighborhood conditions over time is critical to inform multi-level intervention and policy
efforts to reduce pervasive racial and socioeconomic disparities in ADRD.
