All ETDs from UAB

Advisory Committee Chair

Virginia J Howard

Advisory Committee Members

Emily B Levitan

David S Geldmacher

Gary R Cutter

Kimberly Martin

Document Type

Dissertation

Date of Award

2019

Degree Name by School

Doctor of Philosophy (PhD) School of Public Health

Abstract

Several large cohort studies have found associations between residence in the Stroke Belt and cognitive impairment as well as dementia mortality; however, the rela-tionship between residence in the Stroke Belt and buildup of amyloid has not been estab-lished. The current project assessed the association between residence in the Stroke Belt and amyloid burden, amyloid accumulation, or white matter hyperintensities (WMH) in a large, national cohort of older US residents. The first study used linear regression models to examine the relationship between geographic residence and Centiloid values. Residence in the Stroke Belt at the time of baseline amyloid PET assessment was associated with statistically higher Centiloid values compared to Non-Belt residence (full model difference in amyloid values between Stroke Belt v. Non-Belt Centiloid Scale 7.70, 95% Confidence Interval 1.96-13.44, p-value 0.0086). The second study used generalized estimating equation models to examine the relationship between residence in the Stroke Belt and amyloid accumulation over time. The tests detected significant differences in rate of amyloid accumulation between the two regions over time (p-value < 0.0001) for each model’s interaction term. Residence in the Stroke Belt was associated with elevated baseline levels of amyloid while Non-Belt residence was associated with a higher rate of amyloid accumulation in older adults. The third study used linear regression models to examine the relationship between geographic residence and log transformed WMH volumes in cubic centimeters. In the full model, the geometric mean of WMH volumes was 32% higher for individuals who lived in the Stroke Belt compared to individuals living in Non-Belt areas of the US (p-value: 0.0027). These results indicated that residence in the Stroke Belt was associated with dif-ferences in WMH volumes for older adults.

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