Examining Unique Markers and Risk Factors for AD/ADRD in Foreign- and Native-born Older Chinese Americans: A Study of Social Determinants of Health, Sleep Patterns, Neuroimaging, and Plasma Biomarkers

Icahn School Of Medicine At Mount Sinai, New York NY

Investigators

Abstract

Chinese Americans are one of the fastest-growing populations in the U.S.; however, their participation in Alzheimer’s Disease and Alzheimer’s Disease-Related Dementias (AD/ADRD) research remains low. This lack of representation may mask health outcomes in this group, which varies by generation status (foreign- vs. native-born) and social determinants of health (SDOH). SDOH factors include, but are not limited to acculturation, language proficiency, healthcare access, educational quality, stress, environmental exposures, and social support networks, which can contribute to health disparities in Chinese American older adults, worsening AD/ADRD outcomes. However, the relationship between SDOH and AD/ADRD risks in this population is not well-studied, particularly in relation to other health issues like sleep disruption, which is prevalent in older populations. Consistent with the existing literature, our preliminary research suggests that foreign-born Chinese Americans experience poorer sleep quality. However, it is unclear whether there is an association between sleep disruption and elevated AD/ADRD biomarkers, as has been observed in non-Hispanic White participants. Overall, differences in cognitive function and AD/ADRD biomarkers may exist between foreign- and native-born older Chinese Americans due to differential experiences of SDOH, including stress, which has been linked to AD/ADRD-related functional/structural changes (e.g., hippocampal atrophy) and increased levels of Aβ production in other groups. Our team demonstrated that increased levels of distress was associated with higher levels of plasma p-tau level and better performance on tests of attention, executive function, processing speed, and memory in a small sample of older Chinese Americans. Yet, a limited number of studies have explored these relationships specifically in a well-characterized sample of Chinese American older adults born in and outside of the US. This study aims to address these gaps by examining the interplay between SDOH, sleep disruption, and biological factors in AD/ADRD risks among older Chinese Americans. The research team will recruit 250 participants (125 foreign-born and 125 native-born) for baseline evaluations and 200 participants (100 foreign- born and 100 native-born) for one- and two-year follow-ups. The study will use objective measures like at- home sleep tests, cognitive testing, PET/MR, and blood-based proteomic and single cell multiomic biomarkers to investigate how sleep disturbances and SDOH contribute to AD/ADRD risks. Additionally, a novel, integrative network biology and machine learning (ML) based approach will be employed to develop highly predictive diagnostic and prognostic biomarkers of AD/ADRD by integrating all clinical, imaging and multiomic data. This project, consistent with NIH priorities, will provide crucial data to understand the unique health disparities faced by Chinese Americans in AD/ADRD research.