# Understanding Cohort Effects on Stroke, VCID, and Cognition After Major Epidemiologic Transitions

> **NIH NIH RF1** · UNIVERSITY OF ALABAMA AT BIRMINGHAM · 2024 · $16,244,011

## Abstract

PROJECT SUMMARY/ABSTRACT
Stroke mortality has always been higher for Black Americans and for those living in the American Southeast, aka
the Stroke Belt. The REGARDS study has been examining racial and geographic differences in stroke incidence
and cognitive function (including cognitive impairment, cognitive decline and dementia) since 2003. This cohort
of 30,239 people from across the lower 48 United States has been active for more than 20 years with a 97%
annual retention rate and has generated >700 publications creating a truly unique scientific resource. Leveraging
the rich, expansive data collected by REGARDS will be critical to understand major societal changes and
epidemiologic transitions including: rise in obesity, COVID-19, and widening disparities due to social structures.
Even before the COVID-19 pandemic, America experienced an inflection point when the long-persisting
improvement in life expectancy stagnated and began reversing. Life expectancy has been declining since 2014
in part driven by increased stroke mortality. This alarming trend places the US as discordant from most developed
nations as most have continued to experience increasing life expectancy. The REGARDS study is ideal for
understanding how racial disparities in stroke and stroke risk factors such as cognitive decline, biomarkers of
brain injury, social determinants of health, diet, and blood pressure are contributing to wider declines in life
expectancy in the US. Through this new round of funding, we propose to create the REGARDS-2 cohort
consisting of 8000 participants followed since baseline (2003-07, born between born 1908-1960) and 12000 new
younger participants aged 45-64 (born between 1961 and 1980). Aim 1 examines the role of secular changes in
stroke and dementia risk factors comparing 15,326 individuals who were 45-64 in 2003-2007 (middle aged Baby
Boomer Generation) with 12,000 individuals who are 45-64 in 2024-2027 (middle aged Generation X). We will
further explore how changes in risk factors in middle aged adults are driving increases in stroke incidence and
Alzheimer’s Disease and Related Dementia (ADRD). For Aim 2, we will build on the large biomarker repository
to examine whether emerging ADRD blood-based biomarkers are associated with incident ADRD and stroke.
To support bi-directional communication with the REGARDS research community and the REGARDS participant
community, we propose an Infrastructure Aim to establish a participant advisory board and structured mentoring
for scientists, particularly those from backgrounds under-represented in research, interested in working in health
disparities in stroke and dementia. The REGARDS study has been and will continue to be a strong platform for
developing future scientists interested in understanding and addressing health disparities in Black and White
Americans.

## Key facts

- **NIH application ID:** 10984538
- **Project number:** 2RF1NS041588-22A1
- **Recipient organization:** UNIVERSITY OF ALABAMA AT BIRMINGHAM
- **Principal Investigator:** MARY CUSHMAN
- **Activity code:** RF1 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $16,244,011
- **Award type:** 2
- **Project period:** 2001-09-24 → 2026-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10984538

## Citation

> US National Institutes of Health, RePORTER application 10984538, Understanding Cohort Effects on Stroke, VCID, and Cognition After Major Epidemiologic Transitions (2RF1NS041588-22A1). Retrieved via AI Analytics 2026-06-08 from https://api.ai-analytics.org/grant/nih/10984538. Licensed CC0.

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