Independent Research Programs
Cerebrovascular Disease and its Consequences in American Indians Study
Also known as the Strong Heart Stroke Study. Role: Project Lead, Co-Principal Investigator
The Strong Heart Study is the largest longitudinal epidemiologic study of American Indians ever conducted with more than 4,500 American Indian adults aged 35-74 from 13 communities in the Northern Plains, the Southern Plains, and the Southwest in 1989-1991 and later in 2001, expansion of the cohort to an additional 3,700 family members age 15 and older. SHS website: https://strongheartstudy.org/.
The Cerebrovascular Disease and its Consequences in American Indians (CDCAI) Study is an ancillary study within the SHS, with two examination time points among surviving participants: 2010-2013 (N=818) and 2017-2019 (N=403). The goal of the CDCAI Study was to characterize the burden, risk factors, and manifestations of vascular brain injury on cranial MRI in American Indians aged 65-95 from communities and tribes in the Northern Plains, Southern Plains, and Southwestern United States. In addition to cranial MRI, participants underwent medical interview, clinical examination, neurocognitive testing, physical evaluation, electrocardiogram, provided blood and urine, and self-administered questionnaires.
Partners: Missouri Breaks Industries Research Inc. (MBIRI), MedStar Health Research Institute (MHRI), University of Oklahoma Health Science Center (OUHSC), Strong Heart Study
Funding Sponsors: Federal - National Institutes of Health, National Institute on Aging (NIA)
Incident Vascular Brain Injury, Probable Alzheimer’s Disease, and Cognitive Change in Elderly American Indians
Role: Principal Investigator Grant Start: 07/01/2018, Grant End: 03/31/2023
American Indian people bear a disproportionate burden of cardiovascular risk factors, which may cause damage to the brain and result in cognitive impairment. However, little is known about cognitive impairment and dementia in this group. We will establish the frequency, risk factors, and outcomes related to new onset of these conditions among American Indian people of the United States. This program will report the first estimates of prevalent and incident Alzheimer’s disease; establish the first descriptive estimates of cognitive performance and cognitive impairment; evaluate normative and diagnostic standards for standard cognitive tests; and conduct machine learning to empirically identify neuroimaging and biomarker profiles that uniquely characterize cognitive status–in a large, population-based cohort of American Indian people. This is the first study to collect and report cognition data in a large, longitudinal population-based study of American Indian people.
Funding Sponsors: National Institute on Aging (NIA)
American Indian and Alaska Native Health Disparities, Alzheimer’s Disease Center of Excellence (ADCOE) Research Project 1 (RP1): Longitudinal Study of MRI, Clinical, and Genetic Biomarkers of Cognitive Impairment and Alzheimer’s Disease in Elderly American Indians
Role: Project Lead, Project PI Grant Start: 09/22/2017, Grant End: 04/30/2022 (Plus 2-year NCE)
This study, Research Project 1 of the American Indian and Alaska Native Health Disparities, Alzheimer’s Disease Center of Excellence, represents a major innovation within the first large, longitudinal, population-based cohort study of Alzheimer’s disease in American Indian people, by conducting complex image processing, in order to produce and analyze detailed 3D brain maps and estimates of regional brain structures. This study will use data from the Strong Heart Study (SHS) and the ancillary Cerebrovascular Disease and its Consequences in American Indians (CDCAI) study to evaluate cognitive function, AD risk factors, and MRI-defined biomarkers of AD in elderly AIs.
Partners: Colorado School of Public Health, Strong Heart Study, Banner Alzheimer's Institute
Bayesian Statistical Learning for Robust and Generalizable Causal Inferences in Alzheimer’s Disease and Related Disorders Research
Role: Co-Investigator Grant Start: 02/15/2023, Grant End: 01/31/2028
This project aims to develop advanced statistical models for causal inference based on Bayesian joint approaches and computationally efficient coding packages to integrate existing longitudinal data in order to account for biases inherent in observational data from life-course epidemiology studies. The proposed approaches will enable causal inference on joint exposure effects and mediation analysis to inform policy for environmental exposures in mid-life in order to prevent late-life outcomes, such as Alzheimer’s disease and related dementias.
Partners: Strong Heart Study, Columbia University
Funding Sponsors: National Institutes of Health (NIH), National Institute on Aging (NIA)
Psychological risk factors, quality of life, community, and brain aging in American Indians: The Strong Heart Study
Role: Principal Investigator Grant Start: 06/01/2021, Grant End: 05/31/2026
American Indian adults have a high burden of psychological risk factors and related sequelae, but little is known about their relation to Alzheimer’s disease. This project aims to collect psychological risk features as well as cognitive test performance data in 3,000 aging American Indian adults, in order to: test longitudinal relationships among stress, depression, substance use, quality of life, community connectedness, and cognition, and also to establish the first normative psychometric standards specific to American Indian adults using the NIH Toolbox Cognition Battery.
Partners: Missouri Breaks Industries Research Inc. (MBIRI), MedStar Health Research Institute (MHRI), University of Oklahoma Health Science Center (OUHSC), Strong Heart Study
Federal - National Institutes of Health, National Institute on Aging (NIA)
Resilience, cultural alignment, and social support in brain aging (Resilience in SHS)
Role: Principal Investigator Grant Start: 09/01/2020, Grant End: 05/31/2025
American Indian people have a unique history and ongoing experience of trauma and disparities in environmental and socioeconomic conditions, which amplify daily stresses and contribute to health risks. Despite these adverse circumstances, remarkable resilience has been described in American Indian populations. It remains an open question whether neurodegenerative conditions such as Alzheimer’s disease and related dementias (ADRD) can result from chronic stress, or whether individual psychosocial characteristics such as resilience can mediate such risk. Our Specific Aims are to: describe associations of individual resilience among American Indian adults with identity and self-regard, social support, and cultural alignment, by age and sex; evaluate resilience, social support, and cultural features in relation to ADRD; and use machine learning to develop explanatory models of resilience and dementia.
Partners: Missouri Breaks Industries Research Inc. (MBIRI), MedStar Health Research Institute (MHRI), University of Oklahoma Health Science Center (OUHSC), Strong Heart Study
Federal - National Institutes of Health, National Institute on Aging (NIA)
Biological Heterogeneity in Alzheimer’s Disease and Related Dementias
National Alzheimer’s Coordinating Center Alzheimer’s Disease Research Center at University of Washington, Co-Leadership of Data, Methods, and Statistics Core; Co-Investigator; Founder of Resilience Working Group; Member of ATN Biomarkers Committee; Founding member of Native Research and Resource Core.
Federal- National Institutes of Health, National Institute on Aging (NIA)
Role: Co-Lead, Data Methods and Statistics Core Grant start: 6/1/2020-4/30/2025
Pending Research Programs
Cognitively Healthy Nonagenarians in the Cross Cohort Collaboration (CCC)
Role: Multiple Principal Investigator Grant start: in review (2024-2029)
Half of all persons who will develop dementia during their life, do so above the age of 85 years. However, dementia in this older age group is poorly understood. We plan to combine information from 13 longitudinal studies that followed over 100,000 persons from mid to late life to understand why some develop dementia while others remain cognitively normal in their nineties. We will measure and use plasma protein markers to understand how various factors that change the risk may be acting.
Partners: University of Texas Health Sciences Center, Duke University, Boston Children’s Hospital, University of Mississippi, MedStar Health Research Institute, University of Washington, Strong Heart Study
Federal Funding: National Institutes of Health
