in Younger and Older African Americans and Whites Different CSF Total Tau and Phosphorylated Tau, but not Aβ, in Younger and Older African Americans and Whites Whitney Wharton, PhD Associate Professor, Nursing & Neurology Emory University

Funding, Disclosures No Disclosures Funding NIA K01, R01, Admin Supp to Address Health Disparities NINR Alzheimer’s Association PTC VA Emory ADRC and School of Nursing

Early Detection MCI Mild AD Moderate AD Severe AD Increasing Age Normal Cognition MCI Worse Cognitive Abilities  better Mild AD Moderate AD Start Treatment HERE Severe AD 95 Years Increasing Age

Shifting the curve What factors can we identify that…. Are linked to cognitive decline Are linked to AD pathology (plaques and tangles) Occur during midlife Treatable / reversible

Who is most at risk for AD? African Americans Women Middle Age Increased Vascular risk Family History Caregivers To Help the Most People Possible, We Must Target Those Most at Risk!!

The meta-analysis showed that the AD rate for AAs was 64% higher than for Whites (RR = 1.64 (95% CI 1.35-2.00)), with no evidence of heterogeneity. We estimated the current US AD prevalence for ages 65–90 to be 5.5% for Whites, and 8.6% for AAs (prevalence ratio 1.56) African Americans have increased incidence AND prevalence

Prevention Study for High Risk Individuals: ASCEND Observational, NIA funded N=80, 2 yrs, annual visits, 45-65yrs, parental history of AD Determine the extent to which change in peripheral vascular function may influence 1) Aβ, tau in CSF 2) CSF and blood inflammation 3) cognition EndoPAT, FMD, PWV, plasma RAS and ambulatory blood pressure CSF, MRI, blood, cognitive testing, inflammatory markers, extensive Qs (sleep, exercise, nutrition, stress, discrimination, sexual and reproductive history)

Demographics and Clinical

AD Biomarkers in CSF

Race differences in CSF p-tau and t-tau, but not Aβ Race modified the relationship between t-tau & IL-9 (p=0.018), and p-tau and IL-9 (p<0.001)

Take Away This is the 3rd study to show reduced p and t tau, but not Aβ, in African Americans vs Whites First study to show changes in middle age, healthy cohort 3 studies, different labs and platforms