Persons with Alzheimer’s disease (AD) and AD-related dementia (AD/ADRD) are vulnerable to heat-illness,
particularly in socioeconomically disadvantaged neighborhoods, due to limited resources to combat heat
exposure. High temperature is a risk factor for acute ischemic stroke (AIS), and is associated with worse stroke
morbidity and mortality. The problem is that both environmental heat and socioeconomic stressors
independently impact persons with AD/ADRD and also are associated with worse stroke outcomes. Yet, no
extant studies have evaluated the combined impact of environmental heat and socioeconomic stressors (i.e.,
heat vulnerability) on stroke outcomes in persons with AD/ADRD. The objective of this proposal is to evaluate
the role of the heat vulnerability index (HVI) on stroke functional outcomes in persons with AD/ADRD. HVI was
developed by the New York State and City Departments of Health as a combined metric integrating
environmental and socioeconomic factors to identify neighborhoods with higher risk of heat-related deaths. We
hypothesize that persons with AD/ADRD in high-HVI neighborhoods suffer higher rates of AIS, worse stroke
severity (National Institutes of Health Stroke Scale - NIHSS≥6, Alberta Stroke Program Early CT Score -
ASPECTS<6), and worse outcomes on discharge with higher mortality (modified Rankin scale - mRS6),
dependent disability (mRS3-5), and new-onset oropharyngeal dysphagia. The rationale is based on our
preliminary data, which shows significantly higher AIS rates in high-HVI, compared to low-HVI neighborhoods.
In this proposal, we will establish the AD/ADRD and AIS rates and trends in high- and low-HVI neighborhoods
over the past decade from 2014-2023 (Aim 1); and we will compare AIS rates (Aim 2), stroke severity (Aim 3),
and stroke outcomes (Aim 4) between high- and low-HVI neighborhoods in patients with AD/ADRD. Since HVI
has not been evaluated in prior AD/ADRD studies, we will analyze the most comprehensive and diverse
database from New York State's largest health system, with the following advantages relevant to this proposal:
1) Large sample size of >1,100,000 hospitalized patients, >80,000 patients with AD/ADRD, and >25,000 AIS
events. 2) Broad racial and ethnic diversity for robust evaluation of socioeconomic disparities in the AD/ADRD
and AIS populations. 3) Over 200 unique, relevant clinical variables (that do not exist in state or nationwide
claims data) for patients with AD/ADRD and AIS that will advance studying health inequities in the AD/ADRD
population. Our proposal is highly significant because we aim to uncover the link between environmental heat,
socioeconomic disparities, and stroke outcomes in AD/ADRD that can drive meaningful change in the following
ways: a) Discover a novel stroke risk factor to provide new targets for intervention that will improve functional
outcomes in persons with AD/ADRD. b) Identify specific neighborhoods with health inequities to implement
preventative strategies that will reduce the stroke burden in the AD/ADRD population. c) Impact health policy
with new stroke interventions (e.g., cooling centers) to reduce health inequities in the AD/ADRD population.
