The Baakalaaxdeete (To have good memory) Study of Risk and Protective Factors for ADRD among American Indians Across the Life Span

More than 6 million individuals in the U.S. live with Alzheimer’s disease and related dementia (ADRD), and this number is projected to increase to more than 15 million by 2060.

Approximately 35% of American Indian/Alaska Natives (AI/AN) and 30% of Whites over the age of 65 are predicted to be diagnosed with ADRD over the next 25 years.  AI/AN’s have a high prevalence of midlife modifiable risk factors such as diabetes, hearing loss, traumatic brain injury, hypertension, alcohol, obesity, smoking, and depression.

Despite the high incidence (21%) of early cognitive decline—a precursor to dementia in AI/AN older adults—more than one-third of AI/AN (35%) have reported a low concern about developing dementia. Also, research on the association between early and midlife conditions and cognition at an older age in the AI/AN population is not well established.

Understanding the extent to which early and midlife conditions influence cognitive aging through midlife health behavior and modifiable risk factors is essential to improving the early detection of ADRD in the AI/AN population.

Several risk prediction models and indices for dementia have been developed and validated in White or non-AI/AN populations and used in clinical practice for early detection to start early intervention. However, those existing risk prediction models have not been designed or validated specifically for AI/AN older adults.

Additionally, past dementia risk prediction models have been criticized for not capturing protective factors such as cultural values, spirituality, and family cohesion and certain behavioral practices pertinent to AI/AN due to over-reliance on quantitative data and poor internal and external validations in the AI/AN population. Therefore, the clinical utility of these prediction models in the AI/AN adults is significantly limited.

We propose to mitigate both conditions by developing a culturally sensitive AI/AN risk prediction model.

We will conduct a longitudinal analysis of data from the National Health and Aging Trends Study (NHATS) linked with Medicare enrollment data to develop an American Indian Dementia index (AIDi). That index will be supplemented and culturally validated using the RARE (Rapid Assessment, Response and Evaluation) methodology to identify protective and risk factors, cultural attributes, and community-based perceptions of ADRD that impact early intervention efforts.

The long-term goal of this study is to improve early detection of dementia in AI/AN, an important step toward enhancing preventive care in a vulnerable population.

Our goals through the study are:

• Develop and validate AIDi for American Indians aged 65 and older, using the NHATS and Medicare-linked data from 2011-2020.
• Determine the community perceptions of the unique protective and risk factors, needs, assets, and resources of tribal community members regarding ADRD and healthy brain initiatives using the RARE approach to culturally validate the AIDi, and to provide community engaged cultural models for later program development.

The long-term goal of this study is to develop culture-based, multi-system healthy brain initiatives for AI/AN adults and families that recognize the unique needs and assets of these populations.

Study title: The Baakalaaxdeete (To have good memory) Study of Risk and Protective Factors for ADRD among American Indians Across the Life Span

Specific Aims

Funding: The study is funded by NIMHD/NIH U54MD012388-04S1
IRB project number:

About the investigators

The Southwest Health Equity Research Collaborative is a grant-funded initiative of the Center for Health Equity Research at Northern Arizona University. SHERC is supported by the National Institute on Minority Health and Health Disparities of the National Institutes of Health under Award Number U54MD012388-04S1.

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