African Americans Fighting Alzheimer’s in Midlife aims to understand mid-life risk factors that specifically impact the African American community at risk for Alzheimer’s disease, according to the Wisconsin Registry for Alzheimer’s Prevention website. A team of AA-FAIM has published new findings presenting a blood test that will hopefully predict cognitive changes due to the neurodegenerative disease in Black adults.
AA-FAIM is a sub-study of the WRAP, one of the largest and longest-running studies observing risk factors in individuals. Risk factors of interest include cardiovascular disease, neighborhood disadvantage, mood and discrimination-related stress, according to WRAP.
Beyond providing cognitive and biomarker tests, AA-FAIM emphasizes the inclusion of African Americans in biomarker research, recruiting African Americans into these parent studies and relying on recruiting portals and institutional review boards, according to senior author of the paper and School of Medicine and Public Health associate professor Carey Gleason.
“Rather than reinvent the wheel, we work together,” Gleason said.
Gleason advocates for the inclusion of underrepresented individuals in the Alzheimer’s disease core at the University of Wisconsin and addresses the disparities in Alzheimer’s research, striving for a more inclusive approach to studying the disease.
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Gleason highlights the current limitations in Alzheimer’s testing, noting that most assessments involve costly PET scans, which are not universally accessible at medical locations. The significant biomarkers for Alzheimer’s, such as proteins like tau tangles and beta-amyloid plaques, are predominantly tested in large research centers only, including university research centers, Gleason said.
Only one blood test is currently FDA-approved for Alzheimer’s, Gleason said, underlining the need for more accessible and widely available diagnostic options.
Despite these challenges, Gleason’s work underscores the importance of broadening access to Alzheimer’s diagnostics and research, aiming for a more inclusive and equitable landscape in the study of this neurodegenerative disease.
According to Gleason, the largest population that participates in these studies is highly resourced and provides a very different risk profile than those from marginalized backgrounds. It is a mistake to assume the risk profiles of populations that do not face food insecurity and other salient issues in underprivileged areas are the same.
“[The] goal is to have equity across all clinical and research work,” neuropsychologist and assistant professor at UW Barbara Fischer said.
Fischer said racialized minorities are rarely the subjects of early disease studies. These groups tend to seek help once the disease has progressed and at that point, there is less — if anything — researchers and doctors can do to treat the patient. To reform this pattern requires changes in the way cognitive abilities are tested.
AA-FAIM used tests that ignored the usual method of comparing patients against the norm. According to Fischer, AA-FAIM used intra-individual cognitive variability tests and found IICV measure was highly correlated with patients’ cognitive abilities. In other words, the IICV is a good test that doesn’t rely on norms.
According to Gleason and Fischer, the program provides a significant emphasis on engaging racialized communities. It is crucial, however, to approach this inclusion in a manner that respects these communities’ history of mistreatment. The current power structure in clinical research leads to outcomes where researches benefit regardless but subjects are at risk of loss. A strategic shift is required to alter this dynamic.
Specifically, the main challenge is increasing the number of participants in Alzheimer’s research. To achieve this, AA-FAIM is working to make the recruitment process convenient for potential members, even conducting interviews within the community itself, Gleason said. This approach addresses concerns such as distrust of clinical research among racialized minorities stemming from small and under-representative sample sizes.
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The tests that are available today to observe tau tangles and plaque buildup do not use blood plasma in readings. The development of tests that use plasma as the medium can make research much more accessible and less invasive, Fischer said. These procedures would be able to be done at simple routine checkups.
“[Plasma tests] give people quick access to research and clinical tests,” Fischer said.
AA-FAIM introduces a novel approach to cognitive testing, utilizing intra-individual cognitive variability tests that do not rely on traditional norm comparisons, according to Fischer. This method, championed by AA-FAIM, provides a more inclusive and accurate measure of cognitive abilities, challenging existing patterns in disease studies.
Looking ahead, the emphasis on developing plasma-based tests for observing tau tangles and plaque buildup signifies a potential breakthrough in Alzheimer’s research. Tests of this type are transformative for detecting Alzheimer’s disease in Black adults, providing quick access to both research and clinical diagnostics during routine checkups, Fischer said.
AA-FAIM’s multifaceted efforts mark a significant stride toward a more inclusive, accessible and equitable landscape in Alzheimer’s research and diagnostics.
