# URBAn Native Elders (URBANE): Risk and Protective Factors for Alzheimer's and Related Dementias

> **NIH NIH R01** · WASHINGTON STATE UNIVERSITY · 2020 · $2,220,051

## Abstract

ABSTRACT: Alzheimer’s disease and related disorders (ADRD) is a growing public health concern for American
Indian and Alaska Native (AI/ANs) people, but AI/ANs are profoundly underrepresented in ADRD research. For
example, the National Alzheimer’s Coordinating Center database, an important resource for influential ADRD
studies, includes just 162 AI/ANs out of 31,000 adults (0.5%). This is a troubling exclusion, since AI/ANs have high
burdens of many ADRD risk factors, including hypertension, type 2 diabetes, traumatic brain injury, vascular brain
injury (VBI), and stroke. The Cerebrovascular Disease and its Consequences in American Indians (CDCAI) study,
conducted by our research group, is the only prospective cohort study with longitudinal data for rigorous evaluation
of cognitive function, ADRD, and VBI in any US Native population. In its first wave of exams, CDCAI collected data
on 818 elderly AI/ANs living on reservations in 3 primarily rural, geographic regions; the second wave of exams is
underway. CDCAI is yielding seminal findings on ADRD risk factors and biomarkers in AI/ANs; 33% of the sample
showed evidence of VBI, with men even higher. Yet the cohort is not representative of the national AI/AN population
because 72% of AI/ANs now reside in urban areas. Urban A/ANs represent an “invisible tribe” that is largely absent
from health research. One likely explanation is that urban environments feature distinctive risk and protective
profiles, including lifestyle factors that exacerbate age-related cognitive decline, and protective factors such as
better access to acute and specialty care and higher levels of education. Accordingly, we propose a novel study,
URBan Native Elders (URBANE), to replicate CDCAI in a large cohort of urban AI/ANs with broad geographic
representation. We will recruit 1,200 men and women ages 55 and older in 5 geographically diverse metropolitan
areas with large AI/AN populations. Data collection will include MRI for all participants, and genetic testing for
alleles associated with ADRD in the all-races population. We will expand CDCAI protocols to reflect state-of-the-
art imaging and neuropsychological assessments. We will use protocols established by the CDCAI to estimate
probable ADRD based on a single exam. The resulting analyses will establish the baseline prevalence of cognitive
impairment, probable ADRD, and VBI and their associations with clinical, genetic, neuroimaging, behavioral, and
lifestyle risk and protective factors. Of importance, this cross-sectional study will lay the foundation for future
longitudinal research on ADRD. Our Specific Aims are to: Quantify the extent of probable ADRD and VBI as
defined by brain MRI, and determine their associations with cognitive functioning in a diverse sample of urban
AI/AN elders. 2) Evaluate associations between conventional risk factors and probable ADRD, and evaluate
potential mediation of selected risk factors by VBI. 3) In an exploratory analysis, evaluate p...

## Key facts

- **NIH application ID:** 9990644
- **Project number:** 5R01AG064493-02
- **Recipient organization:** WASHINGTON STATE UNIVERSITY
- **Principal Investigator:** Lonnie A. Nelson
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $2,220,051
- **Award type:** 5
- **Project period:** 2019-09-01 → 2024-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9990644

## Citation

> US National Institutes of Health, RePORTER application 9990644, URBAn Native Elders (URBANE): Risk and Protective Factors for Alzheimer's and Related Dementias (5R01AG064493-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/9990644. Licensed CC0.

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