Investigating financial wellbeing, biological aging, and risk of Alzheimers disease and related dementias in a life course synthetic cohort

Project Summary/Abstract The number of Americans aged 65+ living with Alzheimer’s disease and related dementias (ADRD) is projected to double in the next 30-40 years, particularly for minoritized groups, widening existing disparities in ADRD. Poor financial wellbeing is a major source of stress, and the cumulative impacts of financial strain may harm cognition. Life course experiences of financial strain are common, especially for adults from minoritized groups (e.g., Black Americans) who often also face greater ADRD burden. Given the pervasiveness of life course financial stressors in the U.S. and growing financial disparities for groups inequitably burdened by ADRD, there is a critical need to examine how and when poor financial wellbeing harms cognition and contributes to ADRD risk and disparities over the life course. The central hypothesis of this application is that poor financial wellbeing across the life course, particularly starting in early life, increases risk of cognitive decline and ADRD. Stress likely plays a role, as financial hardship causes stress which may accelerate biological aging and, in turn, lead to cognitive decline. Interventions to improve financial wellbeing would likely reduce ADRD burden, but what such interventions should be and when they should occur is unclear. Previous research has lacked the longitudinal data ideally suited to answer these questions. Leveraging three datasets that, together, span the life course, the scientific objective of this study is to (Aim 1) build a synthetic cohort to examine (Aim 2) the life course relationship between financial wellbeing and ADRD outcomes and disparities, (Aim 3) its potential mechanism via biological aging, and (Aim 4) the components and timing of hypothetical interventions to reduce ADRD burden and disparities associated with poor financial wellbeing. The proposed work will use data from the National Longitudinal Study of Adolescent to Adult Health (ages: 12-43), Coronary Artery Risk Development in Young Adults (ages: 18-60), and the Health and Retirement Study (ages: 50-100+). The research addresses NIA strategic directions to better understand social determinants of ADRD across the life span and their mechanisms. Understanding how and when financial wellbeing most impacts cognition could inform actionable strategies to reduce ADRD burden, especially among financially disadvantaged groups. Complementing this research plan is a training plan that builds on the applicant’s background and prior training in life course epidemiology and foundational causal inference theory and includes new training in 1) applied data fusion and advanced causal inference techniques, 2) financial wellbeing and social policy, 3) neuroscience and measurement of ADRD, and 4) biological aging. The strong mentorship team and research and training plans will prepare the applicant for a successful independent research career investigating the life course timing and pathways via which socioeconomic stressors harm cognition and impact ADRD risk.