{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T22:53:53Z","timestamp":1789512833069,"version":"build-2803163510"},"reference-count":52,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2024,5,15]],"date-time":"2024-05-15T00:00:00Z","timestamp":1715731200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R01HL093086"],"award-info":[{"award-number":["R01HL093086"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["P50AG005136"],"award-info":[{"award-number":["P50AG005136"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["K01AG057821"],"award-info":[{"award-number":["K01AG057821"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["75N92019D00027"],"award-info":[{"award-number":["75N92019D00027"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["75N92019D00028"],"award-info":[{"award-number":["75N92019D00028"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["75N92019D00029"],"award-info":[{"award-number":["75N92019D00029"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["75N92019D00030"],"award-info":[{"award-number":["75N92019D00030"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R01HL109315"],"award-info":[{"award-number":["R01HL109315"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R01HL109301"],"award-info":[{"award-number":["R01HL109301"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R01HL109284"],"award-info":[{"award-number":["R01HL109284"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R01HL109282"],"award-info":[{"award-number":["R01HL109282"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R01HL109319"],"award-info":[{"award-number":["R01HL109319"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["U01HL41642"],"award-info":[{"award-number":["U01HL41642"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["U01HL41652"],"award-info":[{"award-number":["U01HL41652"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["U01HL41654"],"award-info":[{"award-number":["U01HL41654"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["U01HL65520"],"award-info":[{"award-number":["U01HL65520"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["U01HL65521"],"award-info":[{"award-number":["U01HL65521"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["alz-journals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Alzheimer's &amp;amp; Dementia"],"published-print":{"date-parts":[[2024,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>INTRODUCTION<\/jats:title>\n                    <jats:p>Accurate epidemiologic estimates for dementia are lacking for American Indians, despite substantive social and health disparities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>The Strong Heart Study, a population\u2010based cohort of 11 American Indian tribes, conducted detailed cognitive testing and examinations over two visits approximately 7 years apart. An expert panel reviewed case materials for consensus adjudication of cognitive status (intact; mild cognitive impairment [MCI]; dementia; other impaired\/not MCI) and probable etiology (Alzheimer's disease [AD], vascular bain injury [VBI], traumatic brain injury [TBI], other).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>\n                      American Indians aged 70\u201395 years had 54% cognitive impairment including 10% dementia. VBI and AD were primary etiology approximately equal proportions (&gt;40%). Apolipoprotein (APO) E\u03b54 carriers were more common among those with dementia (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.040). Plasma pTau, glial fibrillary acidic protein (GFAP), and neurofilament light chain (NfL) were higher among those with cognitive impairment, but not amyloid beta (A\u03b2). Cognitive intact had mean 3MSE 92.2 (SD 6.4) and mean Montreal Cognitive Assessment (MoCA) score of 21.3 (SD 3.2).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>DISCUSSION<\/jats:title>\n                    <jats:p>This is the first population\u2010based study to estimate the prevalence of vascular and Alzheimer's dementias in a population\u2010based study of American Indians.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Highlights<\/jats:title>\n                    <jats:p>\n                      <jats:list list-type=\"bullet\">\n                        <jats:list-item>\n                          <jats:p>The Strong Heart Study is a population\u2010based cohort of American Indian tribes, conducted over 30+ years and three US geographic regions (Northern Plains, Southern Plains, Southwest).<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>Our teams conducted detailed cognitive testing, neurological examination, and brain imaging over two visits approximately 7 years apart. An expert panel reviewed collected materials for consensus\u2010based adjudication of cognitive status (intact; MCI; dementia; other impaired\/not MCI) and probable underlying etiology (AD; VBI; TBI; other).<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>In this cohort of American Indians aged 70\u201395, 54% were adjudicated with cognitive impairment, including approximately 35% MCI and 10% dementia. These data expand on prior reports from studies using electronic health records, which had suggested prevalence, and incidence of dementia in American Indians to be more comparable to the majority population or non\u2010Hispanic White individuals, perhaps due to latent case undercounts in clinical settings.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>Vascular and neurodegenerative injuries were approximately equally responsible for cognitive impairment, suggesting that reduction of cardiovascular disease is needed for primary prevention.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>Traumatic injury was more prevalent than in other populations, and common among those in the \u201cother\/not MCI\u201d cognitive impairment category.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>Mean scores for common dementia screening instruments\u2014even among those adjudicated as unimpaired\u2014were relatively low compared to other populations (mean unimpaired 3MSE 92.2, SD 6.4; mean unimpaired MoCA 21.3, SD 3.2), suggesting the need for cultural and environmental adaptation of common screening and evaluation instruments.<\/jats:p>\n                        <\/jats:list-item>\n                      <\/jats:list>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/alz.13849","type":"journal-article","created":{"date-parts":[[2024,5,15]],"date-time":"2024-05-15T07:00:40Z","timestamp":1715756440000},"page":"4174-4184","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":34,"title":["Epidemiology and prevalence of dementia and Alzheimer's disease in American Indians: Data from the Strong Heart Study"],"prefix":"10.1002","volume":"20","author":[{"given":"Astrid M.","family":"Suchy\u2010Dicey","sequence":"first","affiliation":[{"name":"Huntington Medical Research Institutes  Pasadena California USA"},{"name":"Washington State University Elson S Floyd College of Medicine  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kimiko","family":"Domoto\u2010Reilly","sequence":"additional","affiliation":[{"name":"University of Washington School of Medicine  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lonnie","family":"Nelson","sequence":"additional","affiliation":[{"name":"Washington State University College of Nursing  Spokane Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suman","family":"Jayadev","sequence":"additional","affiliation":[{"name":"University of Washington School of Medicine  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dedra S.","family":"Buchwald","sequence":"additional","affiliation":[{"name":"Washington State University Elson S Floyd College of Medicine  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas J.","family":"Grabowski","sequence":"additional","affiliation":[{"name":"University of Washington School of Medicine  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristoffer","family":"Rhoads","sequence":"additional","affiliation":[{"name":"University of Washington School of Medicine  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,5,15]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/alz.13016"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.3233\/JAD-191092"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)30367-6"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.3233\/JAD-200704"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/alz.13458"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00127-022-02237-7"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000201261"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jalz.2018.06.3063"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jalz.2015.12.007"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1017\/S1355617719001073"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1037\/neu0000574"},{"key":"e_1_2_11_13_1","first-page":"217","article-title":"Ecology of health care: the need to address low utilization in American Indians\/Alaska Natives","volume":"89","author":"Duwe EA","year":"2014","journal-title":"Am Fam Physician"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1177\/0898264312444309"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1017\/S1041610215000861"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-014-3102-8"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0040-1718756"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2023.36383"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jalz.2007.10.012"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1064-7481(12)61668-6"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.wad.0000190806.13126.55"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1159\/000443277"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000201261"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jalz.2011.03.008"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jalz.2011.03.005"},{"key":"e_1_2_11_26_1","first-page":"270","article-title":"The National Alzheimer's Coordinating Center (NACC) database: an Alzheimer disease database","volume":"18","author":"Beekly DL","year":"2004","journal-title":"Alzheimer Dis Assoc Disord"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.108.772285"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.1002\/sim.4509"},{"key":"e_1_2_11_29_1","doi-asserted-by":"publisher","DOI":"10.1177\/10731911231180127"},{"key":"e_1_2_11_30_1","doi-asserted-by":"publisher","DOI":"10.1159\/000067110"},{"key":"e_1_2_11_31_1","doi-asserted-by":"publisher","DOI":"10.3233\/JAD-201370"},{"key":"e_1_2_11_32_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2022.3543"},{"key":"e_1_2_11_33_1","volume-title":"What is Dementia? Types of Dementia","author":"Association As","year":"2023"},{"key":"e_1_2_11_34_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12916-014-0206-2"},{"key":"e_1_2_11_35_1","doi-asserted-by":"publisher","DOI":"10.1212\/01.wnl.0000271090.28148.24"},{"key":"e_1_2_11_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jstrokecerebrovasdis.2022.106467"},{"key":"e_1_2_11_37_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11357-019-00055-5"},{"key":"e_1_2_11_38_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.99.18.2389"},{"key":"e_1_2_11_39_1","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.119.012289"},{"key":"e_1_2_11_40_1","doi-asserted-by":"publisher","DOI":"10.1159\/000496343"},{"key":"e_1_2_11_41_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCRESAHA.116.309115"},{"key":"e_1_2_11_42_1","doi-asserted-by":"publisher","DOI":"10.1080\/13854040590945346"},{"key":"e_1_2_11_43_1","doi-asserted-by":"publisher","DOI":"10.1037\/a0023222"},{"key":"e_1_2_11_44_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11065-008-9067-9"},{"key":"e_1_2_11_45_1","doi-asserted-by":"publisher","DOI":"10.1017\/S1041610216001976"},{"key":"e_1_2_11_46_1","doi-asserted-by":"publisher","DOI":"10.1080\/23279095.2021.1952588"},{"key":"e_1_2_11_47_1","doi-asserted-by":"publisher","DOI":"10.1017\/S1355617723011438"},{"key":"e_1_2_11_48_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0b013e31826e26b7"},{"key":"e_1_2_11_49_1","doi-asserted-by":"publisher","DOI":"10.3233\/JAD-200778"},{"key":"e_1_2_11_50_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.dadm.2018.09.003"},{"key":"e_1_2_11_51_1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6846a2"},{"key":"e_1_2_11_52_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsr.2019.09.017"},{"key":"e_1_2_11_53_1","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwx368"}],"container-title":["Alzheimer's &amp; Dementia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/alz-journals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/alz.13849","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T18:01:30Z","timestamp":1759946490000},"score":1,"resource":{"primary":{"URL":"https:\/\/alz-journals.onlinelibrary.wiley.com\/doi\/10.1002\/alz.13849"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,5,15]]},"references-count":52,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2024,6]]}},"alternative-id":["10.1002\/alz.13849"],"URL":"https:\/\/doi.org\/10.1002\/alz.13849","archive":["Portico"],"relation":{},"ISSN":["1552-5260","1552-5279"],"issn-type":[{"value":"1552-5260","type":"print"},{"value":"1552-5279","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,5,15]]},"assertion":[{"value":"2024-01-19","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-03-28","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-05-15","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}