OVERALL: ABSTRACT American Indians/Alaska Natives (AI/ANs) and Native Hawaiians and Pacific Islanders (NHPIs) are increasingly concerned about Alzheimer’s disease and related dementias, as these conditions will soon have a major impact on their communities. Although AI/ANs and NHPIs share a high prevalence of ADRD risk factors, including hypertension and type 2 diabetes, their life expectancies have improved by as much as 30 years over the last 5 decades, resulting in a tripling of their populations’ share of people ages 65+. Unfortunately, the healthcare systems that serve AI/ANs and NHPIs are unprepared for the clinical, social, and economic, burdens associated with ADRD. The Natives Engaged in Alzheimer’s Research Center will be the only P01 to include AI/ANs or Native Hawaiians since the National Institute on Aging started cataloging P01s in 1984. Based at Washington State University, with collaborators at the University of Miami, Brigham Young University, and several other major universities, as well as with AI/AN and NHPI community partners, we will create an innovative program to understand, intervene on, and mitigate ADRD-related health disparities experienced by our priority populations. Our 3 Research Projects will be supported by Administrative, Research Methods, Recruitment and Engagement, and Biospecimen Cores. The Center will also feature a network of 8 Satellite Centers led by Native researchers that encompass areas where 90% of AI/ANs and NHPIs reside. These Satellite Centers will ensure that our work and our dissemination efforts are national in scope and help to create research-ready cohorts. The Center will unite scholars across social, clinical, and behavioral sciences. Notably, 12 AI/AN or NH/PI professionals have committed to participate as Investigators or Consultants. Thus, our Specific Aims are to: 1) In a group- randomized trial, test the effectiveness of a culturally informed provider training and “dementia-friendly clinic” intervention for detection and appropriate management of AI/AN patients with ADRD and mild cognitive impairment in at least 20 urban and rural clinics serving AI/ANs; 2) In a group-randomized controlled trial, test the effectiveness of a Hula intervention for preventing cognitive decline in NHPI elders with subjective cognitive impairments or mild cognitive impairment in the Hawaiian Islands; 3) In an observational study, screen AIs in 2 remote reservation communities for obstructive sleep apnea and cognitive impairment, then conduct a randomized controlled trial to test an intervention to improve adherence to sleep apnea treatment for improving or preserving cognitive function; 4) Genotype DNA from saliva samples, catalog the frequency of genetic markers for ADRD risk, and calculate polygenic risk scores for ADRD using biospecimens from 2,700+ AI/ANs and NHPIs; and 5) Create an innovative P01 to understand, intervene on, and mitigate ADRD disparities in AI/ANs and NHPIs. Our leadership, resources, and experience offer an unprecedented opportunity to address the National Institute on Aging’s research priorities for underrepresented minorities, as articulated in the National Plan to Address Alzheimer's Disease, and to respond directly to its interest in diversifying the scientific workforce.

OVERALL: PUBLIC HEALTH NARRATIVE American Indians, Alaska Natives, Native Hawaiians, and Pacific Islanders are increasingly concerned about Alzheimer’s disease, dementia, and cognitive impairment. These conditions will soon have a major impact on their communities because the life expectancies for these groups have improved over the last 50 years by as much as 30 years, resulting in a large increase in the number of older adults. Unfortunately, the healthcare systems that serve these populations are unprepared for the clinical, economic, and social burdens associated with Alzheimer’s disease, dementia, and cognitive impairment. Our goal is to reduce disparities related to these conditions by testing various sustainable and culturally-appropriate interventions. The leadership, resources, and experience of our team can help address the National Institute on Aging’s research priorities for underrepresented minorities and respond to its interest in diversifying the scientific workforce.