PHILADELPHIA—Black adults are more likely than other groups to develop Alzheimer’s disease or related disorders but are poorly represented in Alzheimer’s disease research, including recent clinical trials. This health disparity illustrates how Black individuals can benefit from advances in the field if they had access.
This week, the Pennsylvania Department of Health’s Commonwealth Universal Research Enhancement (CURE) program announced it will award a $3.5 million grant to Penn Medicine researchers and community partners to address the underrepresentation of Black adults in Alzheimer’s Disease research. The grant supports the Aging Brain Cohort Dedicated to Diversity (ABCD2) study, a research and training initiative led by David Wolk, MD, a professor of Neurology in the Perelman School of Medicine at the University of Pennsylvania. Wolk is also the incoming director of the Alzheimer’s Disease Research Center, and co-director of the Penn Memory Center.
In the past, diagnosis of Alzheimer’s disease could only definitively be made using an autopsy. Today, there are tools to visualize its pathological markers, the amyloid plaques and tau-based tangles. The goal of ABCD2 is to create one of the largest neuroimaging cohorts of Black individuals to date, in addition to training underrepresented minorities in the science and clinical care of Alzheimer’s disease.
The research will enhance understandings of the relationships between measures of disease and cognitive decline, and the transition from normal aging to the earliest stages of Alzheimer’s disease, before disability. Determining these relationships and the role of additional risk factors, like vascular disease, genetics, and sociodemographic factors, will benefit Pennsylvanians with advances in risk prediction and prevention studies.
“There has been an Alzheimer’s disease research revolution in the past few years. We can now detect pathology prior to the development of cognitive symptoms, and the field is moving towards targeting individuals with preclinical AD to slow or prevent the emergence of cognitive symptoms,” said Wolk. “Unfortunately, much of what we know about these markers of disease and risk come from studies that are almost entirely composed of white individuals. Thus, the degree to which findings generalize to Black individuals in the context of potential differing co-morbidities and other social determinants of health is unknown and critical for this population to benefit from these advances.”
As part of the neuroimaging effort, the researchers are looking to determine not only the relationship between molecular positron emission tomography (PET) measures of Alzheimer’s disease with measures of brain change and cognition, but also the degree to which these relationships are impacted by additional risk factors such as poverty and the quality of education, vascular disease, and genetics. By determining these relationships and the role of these modulating factors, the team aims to develop advances in risk prediction to be incorporated in prevention studies.
Researchers are also emphasizing training the next generation of investigators and clinicians. Building a diverse workforce will mitigate future disparities in care and research. A training program for underrepresented minorities aims to create a clinical and research workforce that is more representative of the Pennsylvania.
The ABCD2 study includes collaborations with investigators at Temple University and University of the Sciences and community partners, including Alpha Kappa Alpha Sorority’s Omega Omega chapter, Alpha Phi Alpha Fraternity, and the Enon Tabernacle Baptist Church. Community partners will support the design, recruitment, training, and dissemination of the study.
“Our hope is that ABCD2 will create a foundation to improve diversity in Alzheimer’s disease research and clinical trials. This effort will be strengthened by the training of clinicians and researchers through the complementary training plan,” said Jason Karlawish, MD, a professor of Medicine, Medical Ethics & Health Policy, and Neurology at Penn. Karlawish is also co-director of the Penn Memory Center and a co-leader for the ABCD2 training effort. “This is truly a collaborative effort across universities and community partners. This is an ambitious project, and our team and partners have the infrastructure in place and experience to meet this challenge.”