Abstract
Alzheimer's Disease Biomarkers and Economic Status in a Nationally Representative US Sample
Jack Chapel, PhD, Assistant Professor, University of Southern California
Alzheimer's disease (AD) and related dementias impose large economic burdens on individuals and families, with well-documented socioeconomic disparities in risk. Emerging blood-based biomarker tests open new avenues to understand the bidirectional relationships between AD and economic status, and to anticipate and mitigate associated economic risks. This pilot leverages newly released blood-based biomarker data (Aβ42/Aβ40, pTau181, GFAP, NfL) from the 2016 Health and Retirement Study (HRS) Venous Blood Study, assayed for approximately 4,500 respondents and linked to HRS's rich economic, cognitive, and genetic data (e.g., APOE ε4), to provide a nationally representative examination of how economic circumstances relate to neuropathological biomarkers. Specifically, the pilot will: (1) describe disparities in biomarker-defined ADRD risk across economic status (e.g., education, income, wealth) and sociodemographic groups, testing whether the socioeconomic gradients documented for clinical dementia extend to the biological markers that precede it; (2) examine AD and neurodegenerative biomarkers as potential mediators of the well-documented association between economic status and cognitive function, estimating the share statistically accounted for by measured pathology versus other pathways; and (3) evaluate planning and financial preparedness among those at elevated biomarker-defined risk. HRS's oversampling of Black and Hispanic respondents enables examination of disparities not feasible in clinical cohorts. Findings will establish a foundational evidence base on the economic antecedents of preclinical AD, generate preliminary data for future NIA proposals (R01/R03), and inform potential strategies to pair screening with early financial planning to protect economic security for those at risk before cognitive symptoms emerge.