Division of Geriatrics and Gerontology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
Wisconsin Alzheimer's Disease Research Center, Madison, Wisconsin, USA.
Alzheimers Dement. 2022 Aug;18(8):1545-1564. doi: 10.1002/alz.12511. Epub 2021 Dec 6.
Black Americans are disproportionately affected by dementia. To expand our understanding of mechanisms of this disparity, we look to Alzheimer's disease (AD) biomarkers. In this review, we summarize current data, comparing the few studies presenting these findings. Further, we contextualize the data using two influential frameworks: the National Institute on Aging-Alzheimer's Association (NIA-AA) Research Framework and NIA's Health Disparities Research Framework. The NIA-AA Research Framework provides a biological definition of AD that can be measured in vivo. However, current cut-points for determining pathological versus non-pathological status were developed using predominantly White cohorts-a serious limitation. The NIA's Health Disparities Research Framework is used to contextualize findings from studies identifying racial differences in biomarker levels, because studying biomakers in isolation cannot explain or reduce inequities. We offer recommendations to expand study beyond initial reports of racial differences. Specifically, life course experiences associated with racialization and commonly used study enrollment practices may better account for observations than exclusively biological explanations.
美国黑人受痴呆症影响的比例不成比例。为了扩大我们对这种差异机制的理解，我们关注阿尔茨海默病（AD）生物标志物。在这篇综述中，我们总结了目前的数据，比较了提出这些发现的少数研究。此外，我们使用两个有影响力的框架来对数据进行背景化处理：美国国家老龄化研究所-阿尔茨海默病协会（NIA-AA）研究框架和 NIA 的健康差异研究框架。NIA-AA 研究框架提供了一种可以在体内测量的 AD 的生物学定义。然而，目前用于确定病理性与非病理性状态的截止值是使用主要为白人的队列开发的，这是一个严重的局限性。NIA 的健康差异研究框架用于将研究中发现的生物标志物水平种族差异进行背景化处理，因为单独研究生物标志物并不能解释或减少不平等现象。我们建议在最初报告种族差异后扩大研究范围。具体来说，与种族化相关的生命历程经历和常用的研究招募实践可能比仅从生物学角度更好地解释观察结果。
