ABSTRACT As our population ages, the global crisis related to Alzheimer disease (AD) and related dementias (ADRD) increases and yet provides the opportunity for the development of research strategies that support the needs of our aging community. In Missouri, the projected total number of people 65 and older living with ADRD will increase from 120,000 in 2020 to 130,000 by 2025. Health disparities in ADRD begin with acknowledging the impact of social determinants of health, structural vulnerability, and systematic discrimination. Ethnoracial factors, classism, systemic and systematic racism, ageism, historical mistrust of scientists, and suspicion of the healthcare system all are factors linked to reduced recruitment, enrollment, and retention in ADRD research. The main objective of this study is to establish a novel approach to recruiting, enrolling, and retaining under- resourced communities into an ADRD research registry named COEQUAL (Creating Opportunities to Increase Health Equity and Equality for Persons at Risk for Alzheimer Disease and Related Dementias). We propose using a community and patient engaged research framework (CPER) to develop and test the feasibility of a high- yield recruitment process to create a research registry for recruitment, enrollment, and retention of under- resourced participants into ADRD research. The study team consists of diverse researchers, community members, and family and patient advocates partnered with Washington University School of Medicine Knight Alzheimer’s Disease Research Center (Knight ADRC) in St. Louis, Missouri. We hypothesize that the creation of a culturally appropriate research registry will aid in the recruitment, enrollment, and retention of diverse participants into ADRD research, as well as those who are more representative of the medical comorbidities experienced by community-living older adults. The Specific Aims are to: 1. Identify and enhance current practices and resources to promote high-yield recruitment, enrollment, and retention of underrepresented participants into ADRD research. 2. Determine if NIA ADORE (Alzheimer's & Dementia Outreach, Recruitment & Engagement Resources) materials are accurate, accessible, and actionable for meeting best practices to increase recruitment, enrollment, and retention for under-resourced participants in ADRD research. 3. Establish and implement the COEQUAL research registry in the St. Louis area to increase the recruitment, enrollment, and retention of n=2000 under-resourced participants who are cognitively unimpaired and impaired into ADRD research. This study provides a systematic process for the enrollment of under-resourced participants into ADRD studies. Our goal is to build a sustainable research registry that expands the existing success and efforts of the Knight ADRC to increase diversity, equity, and inclusion in ADRD research.

PROJECT NARRATIVE The lack of cultural diversity in biomedical research exacerbates health disparities and increases biases experienced by these communities. This ultimately fuels the lack of generalizability of medical and behavioral interventions related to Alzheimer Disease and Related Dementias (ADRD). This project aims to establish a novel approach by creating and evaluating a research registry to recruit, enroll, and retain under-resourced diverse communities into an ADRD.