“Dementia Determinants in Caribbean and U.S. Hispanic Populations” This proposal in response to PAR-17-470 will significantly expand knowledge regarding determinants and consequences in Caribbean-origin populations of Alzheimer's Disease and its related Dementias (AD/ADRD). We build on the 10/66 Dementia Research Group’s internationally harmonized surveys in capital city metro areas of Puerto Rico, Dominican Republic, and Cuba; these three islands/countries are the origin of the vast majority of Caribbean immigrants to the U.S. We will compare these data with the U.S. Health and Retirement Study, and particularly its Healthy Cognitive Aging Project (HCAP) sub-study which was designed for such international comparisons of cognitive function and likely risk for AD/ADRD. 10/66 data indicate a remarkably high dementia prevalence of 10-12% among adults ages 65+ in these three Caribbean sites, whose similar histories but richly varying societal structures over the past century offer great promise for better understanding AD/ADRD in Caribbean-origin immigrant populations. Our international collaborative team will focus on three specific aims: (1) Collect new baseline survey data in non-metro Puerto Rico and Dominican Republic that parallel existing 10/66 samples from capital city areas, to better capture the variation in lifecourse exposures to AD/ADRD risk factors in these sending islands/countries. (2) Analyze dementia relationships with hypothesized lifecourse socioeconomic determinants of AD/ADRD across contexts, exploiting comparisons across vastly heterogeneous life circumstances to both understand drivers of AD/ADRD prevalence and to simulate how AD/ADRD prevalence could plausibly be different under altered social circumstances. (3) Analyze the comparative societal costs of AD/ADRD (including both formal and informal care) to simulate how these costs could plausibly be different under altered societal arrangements.

Narrative/Statement of Public Health Relevance “Dementia Determinants in Caribbean and U.S. Hispanics” will add data from non-metro populations to previously collected surveys of the 65+ capital city metro populations in the Hispanic Caribbean island/countries of Puerto Rico and Dominican Republic. These data will enable comprehensive analysis of the relationship of dementia with lifecourse socioeconomic determinants and consequences across highly varied contexts. The study will compare findings to representative data for U.S. populations of Hispanic Caribbean origin to understand the key drivers of dementia as well as the resulting formal and informal care costs, then simulate how prevalence and costs could be different under altered social arrangements.