DESCRIPTION (provided by applicant): The primary aim of this R21 exploratory/developmental grant proposal is to extend the clinical research infrastructure of the University of Kansas' Alzheimer and Memory Program (KU AMP) to the Costa Rican healthcare system and build Costa Rican clinical research expertise for the assessment and treatment of Alzheimer's disease (AD). Rates of AD prevalence will increase fastest in developing nations due to increased incidence (earlier detection) and increased duration of survival with disease. A coordinated international team of researchers will implement a comprehensive and empirically rigorous measurement strategy for the assessment of the environmental versus organismic determinants of healthy aging and dementia in Latin Americans. By training University of Costa Rica faculty at KU AMP, a large US federally funded research facility, we will develop the needed Latin American expertise to sustain a prospective memory and aging study in Costa Rica. We supplement this experiential training with a proven didactic program on clinical research methods and data analysis at the University of Kansas. Our long term goal is to foster the partnership between KU AMP and analogous University of Costa Rica research centers to develop a sustainable longitudinal study of Costa Rican Alzheimer and Memory Program (UCR AMP). In the short term we propose a pilot project training in best practices for clinical research that will assess 300 older adult Costa Ricans in the national hospital for geriatrics in San Jose and in two rural hospitals. Specifically, we examine a mortality advantage found in Costa Rican epidemiological data that indicates lifestyle and environmental factors protect lower and low-middle class rural population sectors against age-related neurocognitive and physical decline. We hypothesize that lifestyle factors (traditional versus modern) afford greater cardiovascular health which is the protective factor in healthy brain aging. Between-group contrasts of urban versus rural CR elders will reveal significant moderating lifestyle factors of healthy versus unhealthy aging, and these factors will interact with measures of cardiovascular health. Our research investigates the critical interaction of cardiovascular risk factors with lifestyle factor in a unique and understudied population of Latin Americans. This pilot project will also harmonize its assessment instrumentation with existing US longitudinal studies of Latin American health and aging so that findings from several international sites can be compared. As this project matures it will serve as the foundation for a center of Hispanic American research methods.

Low- and middle-income nations will experience an unprecedented growth of the elderly population and subsequent increase in age-related neurological disorders that requires effective strategies for promoting healthy brain aging and the prevention of Alzheimer's disease. Alzheimer's disease destroys the active, productive lives of its victims and devastates their families, financially and emotionally. It is estimated to affec millions of older people throughout the world. Worldwide prevalence and incidence of Alzheimer's disease will increase as life expectancy increases across the globe. One-in-ten individuals over 75 have at least moderate cognitive impairment with the prevalence of cognitive impairment doubling every 5 years thereafter.