Is Alzheimer's The Worst Disease – Publisher and reviewer affiliations are the most recent on their Loop survey profiles and may not reflect their status at the time of review.
Alzheimer’s disease and related dementias (ADRD) are a growing global crisis. In the absence of scientific breakthroughs, the worldwide incidence of ADRD will continue to increase as more people live longer. Racial or ethnic minority groups have an increased risk and incidence of ADRD and are often overlooked by the scientific research community. There is growing evidence that vascular insults in the brain can initiate a cascade of biological events leading to neurodegeneration, cognitive impairment, and ADRD. We are a group of researchers interested in developing and expanding ADRD research, with an emphasis on vascular contributions to dementia, to serve our diverse local community. To this end, the primary objective of this review was to explore and better understand health disparities in Alabama and the contributions of social determinants of health to these disparities, particularly in the context of vascular dysfunction in ADRD. Here we explain the neurovascular dysfunction associated with Alzheimer’s disease (AD), as well as the intrinsic and extrinsic risk factors that contribute to neurovascular unit (NVU) dysfunction. Next, we determine ethnoregional health disparities of individuals living in Alabama, as well as relevant vascular risk factors associated with AD. We also discuss current pharmaceutical and non-pharmaceutical treatment options for neurovascular dysfunction, mild cognitive impairment (MCI), and AD, including relevant studies and ongoing clinical trials. Overall, individuals in Alabama are negatively affected by the social and structural determinants of health that lead to health inequities caused by rural areas, ethnic minority status, and lower socioeconomic status (SES). In general, these communities have limited access to health care and healthy food and other amenities, resulting in reduced opportunities for early diagnosis and pharmaceutical treatments for ADRD. While this review focuses on the current health disparities of ADRD patients in Alabama, future studies should include diversity of race, ethnicity, and region to better treat all individuals affected by ADRD.
Is Alzheimer's The Worst Disease
ADRD continues to be a global health crisis for all individuals affected, including patients with ADRD, individuals at risk, and caregivers such as friends and family. For more than a century, ADRD research has made significant efforts to cure, treat, or prevent ADRD. However, there is a distinct lack of research focused on regional, racial, and ethnic disparities in ADRD, particularly in southern, rural, and poor states like Alabama. It is estimated that more than 94,000 people in Alabama have AD (Alzheimer’s Association, 2022) and AD is the sixth leading cause of death for people in Alabama (Alabama, 2021). African Americans are more likely to develop AD than white Americans (Blum et al., 2018; Alzheimer’s Association, 2022). According to the 2021 US Census, African Americans make up 13.4% of the US population, but in Alabama, 26.8% of the more than 5 million people are African American (Census , 2022), which represent a greater risk and present a greater prevalence of ADRD. in Alabama. . Additionally, more than one million Alabamians live in rural areas, where health disparities are even greater (Rural Health Information Hub, 2022). This combination of high-risk populations represents an urgent need for research for ADRD in Alabama and other regions with similar demographics.
Virtual Connectomic Datasets In Alzheimer’s Disease And Aging Using Whole Brain Network Dynamics Modelling
The neuropathologies found in the postmortem brains of ADRD patients are complex and multifactorial. A number of amyloid isotypes accumulate in the brains of these patients, including amyloid plaques (Aβ), tau neurofibrillary tangles (NFTs), α-synuclein pathologies, Lewy bodies, DNA, and transactive RNA. ., 2019; Robinson et al., 2021; Uemura et al., 2022). These neuropathologies are often associated with neurovascular abnormalities including large macroscopic, lacunar and microscopic infarcts, hemorrhage and vascular pathologies such as cerebral amyloid angiopathy, intracranial atherosclerosis and arteriolosclerosis. For example, in the Religious Order Study and the Rush Memory and Aging Project cohort, ~87% of individuals with a probable diagnosis of AD had abnormal vascular neuropathologies. About 74% of these subjects also had traditional AD and/or other neurodegenerative neuropathologies (Kapasi et al., 2017). This work and others described below support that neurovascular dysfunction is more common than not in ADRD.
Neurovascular dysfunction in ADRD can be partially attributed to cardiovascular deficits (Shabir et al., 2018). Neurovascular disconnection, an early event in AD, leads to dysregulation of cerebral blood flow (CBF) and NCE and is a major contributor to AD progression (Iadecola, 2004, 2013; Zlokovic, 2011; Montagne et al. al., 2015; Sweeney). et al., 2015, 2019; Zhao et al., 2015; Arvanitakis et al., 2016; Iturria-Medina et al., 2016; Nelson et al., 2016; Kisler et al., 2017a; Nation et al. , 2019). Breakdown of the blood-brain barrier (BBB), as well as pericyte injury and loss, are also hallmark findings in AD, leading to chronic neuroinflammation, gliosis, Aβ deposition, and tau hyperphosphorylation (Collins-Praino and Corrigan, 2017 ; Perea et al. ., 2018). The above clinical findings in AD can be partially mitigated by education and awareness of several extrinsic vascular risk factors associated with AD. The most common genetic risk factor for AD is the port apolipoprotein ε4 (APOE4) (Mahley et al., 2006). Studies suggest that APOE4 mice (Bell et al., 2012) and humans (Montagne et al., 2020a) have increased BBB degradation consistent with cognitive decline. In addition, APOE functions for the transport of lipids (for example, cholesterol) in the blood (Di Battista et al., 2016). Previous studies suggest that APOE4 transport disrupts the ability of brain cells to metabolize lipids ( Dupuy et al., 2001 ; Huang and Mahley, 2014 ). Metabolism deficits may account for the intestinal dysbiosis seen in AD cases, contributing to elevated levels of pro-inflammatory cytokines and systemic inflammation (Al Bander et al., 2020). In addition, systemic infections, such as pneumonia, lead to the formation of peripheral amyloid (eg, Aβ and tau) and occasional dementia that may ultimately contribute to ADRD (Nelson, 2022). Stress and anxiety also contribute to the progression of AD through consequences in subsequent behavioral and physiological changes (Dimsdale, 2008). Diet and lifestyle differences have also been identified as a risk factor for AD. The use of alcohol and recreational drugs has been linked to the diagnosis of ADRD and cognitive impairment. These identified risk factors contribute not only to the progression of AD, but also of cardiovascular and pulmonary diseases. For this reason, cardiovascular and pulmonary diseases have been linked to dementia due to disruption of the BBB and neuroinflammation. However, it is important to note that the vascular risk factors found in middle age can be temporarily disconnected from cognitive dysfunction, suggesting that aging is a contributing factor to neurovascular dysfunction in ADRD.
Although there is no cure for ADRD, several medications can be prescribed to temporarily relieve symptoms by reducing hypertension, protecting the neurovasculature, or correcting intestinal dysbiosis (Ahmed, 2005; Stirban et al., 2006; Raj et al., 2018; Williamson et al., 2019; Nasrallah et al., 2021). Non-pharmaceutical treatments may also be viable options to slow cognitive decline in AD patients, also usually by correcting gut dysbiosis. Physical activity has been shown to reduce the risk of AD and slow cognitive decline, even in APOE4 carriers (Allard et al., 2017). However, the South has the highest prevalence of physical inactivity in the United States (Centers for Disease Control and Prevention, 2021). Treatment of mood disorders has also been shown to protect blood vessel health by preventing unhealthy behaviors such as smoking and physical inactivity (Abed et al., 2014). Other non-pharmaceutical and alternative treatments for AD, such as hormone replacement therapy and oxygen therapy, have also been proposed to treat patients with AD, but their effectiveness is still unclear (Smith et al., 2010; Harch and Fogarty, 2018; Guo). et al., 2020; Song et al., 2020; Shapira et al., 2021; Somaa, 2021).
Each individual has unique social determinants of health profile, and many people living in Alabama face differences in health and health care. The social determinants of health are defined as “the environmental conditions in which people are born, live, learn, work, play, worship and age and which affect a wide range of health outcomes and risks, functioning and quality of life”. “. , 2022. Health inequalities are usually reflected in disadvantaged groups. Individuals and groups can be disadvantaged because of their race or ethnicity, gender, sexual identity, age, disability, SES, cognitive abilities and geography (Foundation Health Measures Archive, 2020). In most of the United States and specifically in Alabama, SES and race/ethnicity are the disadvantaged areas that have the greatest impact on health inequalities (Arrieta et et al., 2008).
Q&a With The Authors Of ‘american Dementia: Brain Health In An Unhealthy Society’
While there are many possible treatments to slow cognitive decline and the progression of vascular dysfunction in AD, many social and structural determinants of health in Alabama make it difficult to access these treatments or even to diagnose ADRD. Many regions in Alabama have a low SES, which poses the challenge of adopting healthy eating and exercise habits that can prevent or delay the onset of ADRD. The diagnosis of dementia is usually earlier in people with a high SES, when interventions can have an effect, than in people with a low SES (Cha et al., 2021; Petersen et al., 2021). Many areas in Alabama, both urban and rural, have limited access to health care and healthy food, making it more difficult
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