Brain CHEC-AC (Brain and Cognitive Health Equity Campaign for Allegheny County)

ABSTRACT Despite being at nearly twice the risk of developing Alzheimer’s or a related dementia (ADRD), Americans identifying as Black or African American are 35% less likely to be diagnosed with ADRD than their White counterparts. This marked disparity in dementia detection and diagnosis has corresponding implications for

delays in the initiation and continuation of treatment. Intervening to eradicate this disparity is a public health imperative as the field of ADRD care is on the precipice of a sea change due to newly available disease modifying therapies. These therapies require testing to confirm the presence of amyloid accumulation, and they must be

initiated in the early stages of cognitive impairment. Under the current paradigm, the vast majority of African Americans adults for whom these new therapies may be appropriate will be diagnosed too late for their administration. This proposal recognizes that structural factors shaping daily life, like societal stigma around

brain health disorders, and experiences of discrimination in medical settings, contribute profoundly to disparities in ADRD detection among African American adults and require multilevel intervention to be dismantled. In response to NIH RFA-NR-24-004, Transformative Research to Address Health Disparities and Advance Health

Equity, the long-term goal of this project is to address existing, and intercept a worsening of, disparities in early detection and diagnosis of ADRD. To achieve our goal, we will carry out three primary objectives in partnership with the Black Equity Coalition and the Allegheny County Health Department. Using the Culture-Centric Model

of Health Promotion, in Objective/Aim 1 we will elicit and prioritize the voices of African American adults who are directly impacted by late-life cognitive health disparities to create stakeholder-endorsed brain health narrative campaign materials for deployment over multimedia platforms. In Objective/Aim 2, we will use the materials

developed in Aim 1 to deploy a community-focused brain health narrative campaign to combat stigma around brain health disorders in the places where African American adults at risk for ADRD live, work, shop, and play. In Objective/Aim 3, we will assess the feasibility and acceptability of bringing state of the science AD blood-

based biomarker testing infrastructure to the places where African Americans at highest risk for ADRD live, work, shop, and play. By targeting social norms and societal level forces like stigma, this proposal addresses challenges at the NIMHD-defined community and societal levels, while, in the final aim building community-

based infrastructure for addressing a health disparity at the individual level. This approach begins by drawing upon cultural capital in the form of community members’ stories that demonstrate the value of preserving brain health or offer counternarratives about maintaining dignity through dementia. In full circle, these stories become

culturally salient tools to promote accessible, early AD detection in community-based settings, bypassing the traditional healthcare systems and pathways to diagnosis that are not working for African Americans.