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Racial differences in brain health at midlife and the potential mediating role of cardiorespiratory fitness and cardiometabolic risk

Jorgensen, Dana R (2018) Racial differences in brain health at midlife and the potential mediating role of cardiorespiratory fitness and cardiometabolic risk. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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Blacks are at a higher risk for adverse brain-related outcomes, including stroke and dementia. Due to associations of vascular risk factors with brain health, differences in brain health may result from a greater burden of vascular risk factors in blacks, especially in midlife. However, relationships between vascular risk factors and midlife racial disparities in brain health have been underexplored. The overall objective of this dissertation is to improve our understanding of racial disparities in brain health outcomes and test for potential mediators of any observed racial differences. This objective was addressed through three studies. Since cerebral small vessel disease is a major cause of both stroke and dementia, our first study aimed to examine whether blacks exhibit more subclinical markers of cerebral small vessel disease than whites. We found that blacks appear to be at a greater risk for developing white matter hyperintensities, but relationships with other markers of brain health remain unclear. Major limitations in the current literature include: 1) a lack of representation by younger age groups, 2) limited geographic representation, 3) few study samples, and 4) the lack of reporting diverse markers for brain health. The second study investigated racial differences in brain health among a middle-aged population. After adjustment for demographics, blacks exhibited significantly lower gray matter volume, smaller hippocampus, less cortical surface area, and a thinner cerebral cortex than whites (all p’s<0.05). No differences in cerebral blood flow were found. The third study examined whether cardiorespiratory fitness (CRF) and/or cardiometabolic risk (CMR) mediate the relationship between race and brain health. We found that CRF and CMR partially mediated the association of race with cortical surface area and gray matter volume. Overall, the findings of these three complementary studies are of public health relevance given by revealing that brain health disparities exist in an otherwise healthy midlife population and by examining potential mediators for these disparities. Future work is needed to better understand these disparities. Researchers should investigate other potential pathways, examine younger populations and observe changes in brain health overtime.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Jorgensen, Dana Rdrj19@pitt.edudrj190000-0002-9594-9918
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairRosano, Ccar2350@pitt.eduCAR2350
Committee MemberGianaros, PJgianaros@pitt.eduGIANAROS0000-0003-2313-5277
Committee MemberSekikawa, Aakira@pitt.eduAKIRA
Committee MemberBrooks, Maria M.mbrooks@pitt.eduMBROOKS
Committee MemberMarsland, Anna Lmarsland@pitt.eduMARSLAND
Date: 28 June 2018
Date Type: Publication
Defense Date: 6 April 2018
Approval Date: 28 June 2018
Submission Date: 28 March 2018
Access Restriction: 3 year -- Restrict access to University of Pittsburgh for a period of 3 years.
Number of Pages: 135
Institution: University of Pittsburgh
Schools and Programs: School of Public Health > Epidemiology
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: Brain health, Race, cerebral small vessel disease, stroke, disparities, cardiorespiratory fitness, cardiometabolic risk
Date Deposited: 28 Jun 2018 20:33
Last Modified: 28 Jun 2021 05:15


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