Impact of Environmental Stressors on Ischemic Stroke Outcome Inequities in Alzheimers Disease and Related Dementias

Persons with Alzheimer’s disease (AD) and AD-related dementia (AD/ADRD) are vulnerable to heat-illness,

particularly in socioeconomically disadvantaged neighborhoods, due to limited resources to combat heat

exposure. High temperature is a risk factor for acute ischemic stroke (AIS), and is associated with worse stroke

morbidity and mortality. The problem is that both environmental heat and socioeconomic stressors

independently impact persons with AD/ADRD and also are associated with worse stroke outcomes. Yet, no

extant studies have evaluated the combined impact of environmental heat and socioeconomic stressors (i.e.,

heat vulnerability) on stroke outcomes in persons with AD/ADRD. The objective of this proposal is to evaluate

the role of the heat vulnerability index (HVI) on stroke functional outcomes in persons with AD/ADRD. HVI was

developed by the New York State and City Departments of Health as a combined metric integrating

environmental and socioeconomic factors to identify neighborhoods with higher risk of heat-related deaths. We

hypothesize that persons with AD/ADRD in high-HVI neighborhoods suffer higher rates of AIS, worse stroke

severity (National Institutes of Health Stroke Scale - NIHSS≥6, Alberta Stroke Program Early CT Score -

ASPECTS