Notice of Special Interest: Health Disparities and Alzheimer's Disease
Notice Number:
NOT-AG-21-033

Key Dates

Release Date:

December 28, 2021

First Available Due Date:
March 11, 2022
Expiration Date:
November 13, 2024

Related Announcements

PAR-22-093, Research on Current Topics in Alzheimer's Disease and Its Related Dementias (R01 Clinical Trial Optional)

PAR-22-094, Research on Current Topics in Alzheimer's Disease and Its Related Dementias (R21 Clinical Trial Not Allowed)

Issued by

National Institute on Aging (NIA)

All applications to this funding opportunity announcement should fall within the mission of the Institutes/Centers. The following NIH Offices may co-fund applications assigned to those Institutes/Centers.

Office of Research on Women's Health (ORWH)

Purpose

Background

The need to diversify Alzheimer’s disease (AD) and Alzheimer’s disease-related dementias (ADRD) research cohorts and improve methods and tools for conducting health disparities research related to AD/ADRD has been emphasized by the National Alzheimer’s Project Act; the Alzheimer’s Research Summits (2012, 2015, and 2021); the National Research Summit on Care, Services, and Supports for Persons with Dementia and their Caregivers (2017 and 2020); and the Alzheimer’s Disease-Related Dementia Summits (2013, 2016, and 2019). To achieve such diversity, projects are needed that will increase enrollment of underrepresented populations, expand the use of existing cohorts, and create robust estimates of AD/ADRD in diverse populations. Improvements are also needed in research tools, research methods, and design and recruitment practices. The National Institute on Aging (NIA) is committed to diverse representation in all research studies, including clinical trials.

Research that assesses health disparities in aging and AD/ADRD is of variable quality, and a limited number of studies focus on elucidating causal mechanisms. Inconsistent results across studies, insufficient numbers of participants from medically underserved populations, and inadequately powered studies represent additional challenges to identifying and eliminating factors related to disparities. In addition, most studies recently used to estimate AD/ADRD prevalence rely on cross-sectional rather than longitudinal measurement, when the latter more convincingly demonstrates cognitive and functional decline.

There is a need to improve the rigor of scientific investigations of AD/ADRD that consider health disparities. NIA’s Health Disparities Framework describes factors across multiple levels (i.e., environmental, sociocultural, behavioral, and biological) that impact health disparities. These factors operate through individual, interpersonal, community, and social processes and over the life course. Race, ethnicity, socioeconomic status, and sex/gender may be multifactorial in their influence on AD/ADRD and cognitive impairment and decline. To optimize inclusion of diverse populations, it is important that research projects address the nuances of cultural context across participants, including the various levels at which decision making occurs (e.g., patients, caregivers, clinicians, groups, healthcare systems and/or communities which mediate the goal of achieving health equity). Studies incorporating geographic, neighborhood, education, environmental, biological, social, behavioral, lifestyle, and genetic factors need to be conducted with study populations that have robust demographic diversity. Also, there is a need for studies to investigate determinants of population-level differences in AD/ADRD.

When cohorts are diverse, new mechanisms that link environmental, sociocultural, behavioral, and biological factors can be identified. Health disparities populations, as defined by Public Law 106-525, Minority Health and Health Disparities Research and Education Act of 2000, include the following populations:

  • Blacks/African Americans
  • Hispanics/Latinos
  • American Indians/Alaskan Natives
  • Asian Americans
  • Native Hawaiians and Other Pacific Islanders

Additional populations may include the following:

  • Socioeconomically Disadvantaged Populations
  • Rural Populations
  • Populations Living with a Physical, Developmental, or Intellectual Disability
  • Sex and Gender Minorities

Objectives

This Notice of Special Interest (NOSI) encourages applications that examine mediators and moderators of disparities in AD/ADRD, using diverse cohorts of subjects. Projects of interest include, but are not limited to, those addressing the following topics:

  • Alzheimer’s disease and related dementias risk and diversity. Robust estimates of AD/ADRD are needed in diverse populations. Research is encouraged on the recruitment and retention of cohorts that include diverse subjects to conduct standardized diagnostic evaluations. Research is needed to understand the demographic diversity of dementia risk that goes beyond description to identify factors driving health disparities.
  • Effect of educational attainment on dementia risk. While the large growth in the number of older adults in the coming decades will lead to an increase in dementia cases in countries around the world, a number of recent studies have suggested that the age-specific risk of dementia has actually decreased in some high-income countries over the last 20 years, possibly due to increasing levels of education. Research is needed to understand the mechanisms by which education contributes to declines in the age-specific risk of dementia, whether this trend will continue in the face of rising levels of obesity and diabetes, and whether there has been a similar or opposite trend in demographically diverse populations.
  • Diversity and cognitive change over time. In addition to race/ethnicity, multiple factors need to be considered when studying the status of cognitive change over time. Analyses of the relationship of race, education, comorbidities, geographic location, and additional demographic diversity and their effects on dementia risk and cognitive resilience using existing data are encouraged.
  • Diagnosis and assessment procedures. Procedures for cognitive assessment need to be evaluated in concert with environmental, sociocultural, behavioral, biological, and genetic factors. Research is encouraged on disparities in cognitive testing procedures, clinic participation rates, and validity of other assessment procedures.
  • Neuroimaging, neuropathology and the biology of AD/ADRD. Neuroimaging and post-mortem evaluations need to be increased in underrepresented populations. Studies that investigate factors (e.g., behavioral, environmental, biological) that contribute to the demographic diversity on biology and neuropathology in the development of AD/ADRD are encouraged. . This includes 1) determinants of brain anatomy and cognitive ability; 2) neuropathological identification of disease; and 3) identification of biologic markers.
  • Analyses of behavioral, social, and biological pathways that create and sustain AD/ADRD disparities. Investigators are encouraged to focus on linking biological indicators with behavioral, sociocultural, or environmental factors in order to better understand disparities in AD/ADRD. Behavioral and social indicators of interest include, but are not limited to: stress processes, socioemotional function, cognitive stimulation, health behaviors (e.g., sleep, substance use, physical activity, etc.), social connectedness, discrimination, stigma, structural racism, and environmental and occupational exposures. Biological indicators of interest include, but are not limited to: physiological indicators, genetic stability, cellular function and communication, mitochondrial dysfunction, cellular senescence, cellular stress response, intercellular communication, and epigenetic alteration and telomere attrition.
  • Strategies for recruitment and retention. Research using novel recruitment and retention strategies (including those described in the gaps and opportunities identified by Summits) is also encouraged in order to overcome logistical barriers specific to AD/ADRD research and disparities in clinical research and clinical trial participation. For more information regarding this need, see the National Strategy for Recruitment and Participation in Alzheimer's Disease Clinical Research.

Application and Submission Information

This notice applies to due dates on or after March 11, 2022 and subsequent receipt dates through November 13, 2024.

Submit applications for this initiative using one of the following funding opportunity announcements (FOAs) or any reissues of these announcement through the expiration date of this notice.

  • PAR-22-093, Research on Current Topics in Alzheimer's Disease and Its Related Dementias (R01 Clinical Trial Optional)
  • PAR-22-094, Research on Current Topics in Alzheimer's Disease and Its Related Dementias (R21 Clinical Trial Not Allowed)

All instructions in the SF424 (R&R) Application Guide and the funding opportunity announcement used for submission must be followed, with the following additions:

  • For funding consideration, applicants must include “NOT-AG-21-033” (without quotation marks) in the Agency Routing Identifier field (box 4B) of the SF424 R&R form. Applications without this information in box 4B will not be considered for this initiative.

Applications nonresponsive to terms of this NOSI will not be considered for the NOSI initiative.

Inquiries

Please direct all inquiries to the contacts in Section VII of the listed funding opportunity announcements with the following additions/substitutions:

Damali Martin, Ph.D.
National Institute on Aging (NIA)
Division of Neuroscience
Telephone: 301-402-8310
Email: martinda@mail.nih.gov

Frank Bandiera, Ph.D.
National Institute on Aging (NIA)
Division of Behavioral and Social Research
Telephone: 301-496-3136
Email: frank.bandiera@nih.gov