Alzheimer’s Disease and Related Dementias in The Most Incarcerated Generation: An Understudied Population with Health Disparities - The proposed project, which responds to NOT-AG-21-033 (Health Disparities and Alzheimer’s Disease), is the first longitudinal and epidemiological examination of justice-involvement and dementia. Americans who experience justice-involvement, moving from the community to incarceration and from incarceration back to the community, are aging rapidly. Moreover, justice-involvement disproportionately impacts persons of color and of low socioeconomic status, who are also at high risk for all forms of dementia yet are frequently excluded from dementia-related research. This study will contribute to our understanding of health disparities in dementia by evaluating the inter-relationship among incarceration, dementia, and a number of important social risk factors and multi-morbidity factors over time in a national sample. We will optimize the Veterans Health Administration’s (VHA) capacity to access Incarceration History Files from the Centers for Medicare and Medicaid Services (CMS). We propose to leverage a longitudinal “prison release” cohort which we created for a different NIH-funded study and supplement (R01 MH117604 and S1). This cohort includes >30,000 individuals enrolled in both Medicare and VHA, who reentered the community at age ≥50 (between 2008-2018) following an incarceration. We will enhance this cohort to include all veterans who were age ≥50 between 2008 to 2022, including those incarcerated at any point during that timeframe and who were released, those who remained incarcerated (no community reentry), and those never incarcerated, for a total of more than 46,000 justice-involved veterans among 10.5 million veterans. Using this rich, longitudinal dataset, we have the unprecedented opportunity to develop social risk factor profiles and multi-morbidity profiles associated with risk of incarceration among those with dementia (Aim 1) and risk of dementia among those released from incarceration (Aim 2). Access to VA and Medicare data provides more complete outcome ascertainment, thus increasing the opportunity to determine if these profiles differ according to dementia subtypes (e.g., Alzheimer’s Disease, vascular, frontotemporal, mild cognitive impairment (MCI)). We will also make novel use of transition models to evaluate probabilities of experiencing distinct pathways (e.g., pathway to entering incarceration, to being released from incarceration, to developing dementia) and determine precursors that predict these pathways (Aim 3). We will evaluate all Aims within health disparity populations such as non- Hispanic Black, Hispanic, native/indigenous groups and those experiencing indicators of poverty (e.g., homelessness and socioeconomic disadvantage). This study has substantial public health significance. It will inform strategies to mitigate risk of patients with dementia entering incarceration, will delineate those at highest risk of developing dementia after incarceration so as to inform prison-to-community transitional care planning, and will identify prime intervention points where optimizing dementia care could reduce health disparities between those with and without justice-involvement and even within the justice-involved.
