# Reducing Disparities in Dementia and VCID Outcomes in a Multicultural Rural Population

> **NIH NIH R01** · UNIVERSITY OF MIAMI SCHOOL OF MEDICINE · 2023 · $1,143,639

## Abstract

ABSTRACT
Alzheimer's disease and related dementias (ADRD) affect millions of Americans. Persons living in rural areas face
increased prevalence (OR=1.1) and incidence (OR=1.2) of ADRD compared to urban/suburban dwellers with
increased disparities affecting health outcomes. Underlying factors that may increase ADRD risk and disparities in
health outcomes include: poverty; low education; poor health literacy; poor nutrition; tobacco, alcohol and substance
abuse; limited access to care (specialists, diagnostic testing); migrant or marginal immigration status; and non- and
underinsurance. In addition to rurality, race and ethnicity may play a role in ADRD. African Americans are 2 times
as likely and Hispanics are 1.5 times more likely than Whites to develop ADRD that may be due to different risk
profiles, particularly vascular risks. These social, biologic, and genetic determinants increase risk for multiple chronic
conditions associated with vascular contributions to cognitive impairment and dementia (VCID). We propose to
study health disparities associated with ADRD and more specifically VCID in culturally heterogeneous older adults
living in a rural setting compared with older adults living in an urban/suburban setting. Comparison populations
reside either in the (a) western rural portion of Palm Beach County, FL (locally referred to as “the Glades”) or (b) the
more metropolitan and affluent coastal portion of Palm Beach County (locally referred to as “the Coast”). The overall
HYPOTHESIS is that rurality, combined with low SES, cultural characteristics, vascular risk factors, environment
and lifestyle factors, and genetic traits synergistically increase the risk for ADRD and in particular VCID. These same
factors contribute to disparities in health outcomes for rural populations compared to similar groups of older adults
from urban/suburban communities. We propose these SPECIFIC AIMS: (1) Conduct a cross-sectional, population-
based study of the Glades with phenotype and genotype of participants to determine the prevalence of ADRD/VCID;
(2) Conduct a longitudinal study of individuals randomly selected from Aim 1 and compare to an age- and
racial/ethnicity-matched sample of suburban/urban older adults recruited for longitudinal follow-up; (3) Evaluate
cross-sectional relationships at baseline, 18mos, and 36mos between clinical, functional, psychosocial, genetic,
and biomarker variables and cognitive performance for the cohort as a whole, and stratified by relevant biological
variables; and (4) Model baseline and longitudinal clinical, functional, psychosocial, behavioral, genetic, and
biomarker variables to predict cognitive impairment and rate of progression from normal cognition to MCI, and
MCI to ADRD/VCID for the cohort as a whole, and stratified by relevant biological variables. Our short-term
goals are to determine prevalence and profile of transition from normal aging to ADRD/VCID, in a rural population
compared to urban/suburban settings; i...

## Key facts

- **NIH application ID:** 10690482
- **Project number:** 5R01NS101483-06
- **Recipient organization:** UNIVERSITY OF MIAMI SCHOOL OF MEDICINE
- **Principal Investigator:** James E Galvin
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2023
- **Award amount:** $1,143,639
- **Award type:** 5
- **Project period:** 2020-03-06 → 2026-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10690482

## Citation

> US National Institutes of Health, RePORTER application 10690482, Reducing Disparities in Dementia and VCID Outcomes in a Multicultural Rural Population (5R01NS101483-06). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10690482. Licensed CC0.

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