Characterizing risk and protective factors for Alzheimer's disease and related dementias in American Samoa

Funding

Given the scarcity of meaningful data and recognizing their elevated risk, the National Institutes of Minority Health and Health Disparities (NIMHD) funded our Indigenous Samoan Partnership to Initiate Research Excellence (INSPIRE) program, a five-year, multi-pronged effort (2016–2021). INSPIRE aimed to build research capacity in American Samoa, explore functional health literacy, and investigate the neurocognitive status of Samoan adults aged 50 and older using the Kimberley Indigenous Cognitive Assessment Tool (KICA). INSPIRE results indicated a high prevalence of ADRD and inadequate functional health literacy in American Samoa. Specifically, 17 % of our INSPIRE sample of Samoan adults aged 50 and above (n = 230) scored within the possible dementia range, indicating a notable prevalence of ADRD within this population. Additionally, a larger, separate INSPIRE sample focused on examining the health literacy of approximately 713 Samoan adults aged 45 years and older revealed that 75.5 % of participants had either “marginal” or “inadequate” health literacy, meaning they would have difficulty reading and interpreting health materials (Tofaeono et al., 2024). These results demonstrate a pressing need to better understand and address cognitive health in American Samoa through the lens of social determinants of health and culturally and linguistically grounded approaches (Tofaeono et al., 2020).In addition to ADRD prevalence data, there is a great need for culturally grounded screening measures, determination of ADRD risk and protective factors, and provision of holistic care that targets individuals at risk for ADRD, individuals with ADRD, and their family members. The current paper is an INSPIRE secondary data analysis supported by the Native Alzheimer's Disease Resource Center for Minority Aging Research (NAD-RCMAR) which is funded by the National Institute on Aging. We seek to address gaps and begin to offer programmatic solutions by enhancing understanding of potentially modifiable risk and protective factors for Samoan individuals and communities. The 2024 update to the standing Lancet Commission on dementia prevention indicates that 45 % of dementia cases worldwide could potentially be prevented or delayed by addressing fourteen modifiable factors (Livingston et al., 2024). Specifically, we have chosen current study indicators that align with the Lancet Commission's 2020; () report of potentially modifiable risk factors for dementia (Livingston et al., 2020). The current study examines the relationships among cognitive functioning, emotional well-being, education, and smoking and alcohol use in a sample of American Samoa residents aged 50 and older. This study has the potential to enhance knowledge of ADRD among Samoan populations, as it is the first to examine behavioral risk and protective factors through a culturally grounded framework. More broadly, dissemination of these findings will inform and build capacity to support ADRD prevention, intervention and research in American Samoa. Our results provide a starting point to better understand critical health issues within Samoan populations and support future efforts to reduce the risk of ADRD from a culturally informed perspective.This analysis was supported by the Native Alzheimer's Disease Resource Center for Minority Aging Research (NAD-RCMAR) which is funded by the National Institute on Aging (Grant P30AG059295-05). Data collection was supported by a grant from the National Institute of Minority Health and Health Disparities (U24MD011202-3S; MPI: V. Tofaeono). This analysis was supported by the Native Alzheimer's Disease Resource Center for Minority Aging Research (NAD-RCMAR) which is funded by the National Institute on Aging (Grant P30AG059295-05 ). Data collection was supported by a grant from the National Institute of Minority Health and Health Disparities ( U24MD011202-3S ; MPI: V. Tofaeono).