Studying the impact of community violence on Alzheimer’s and dementia in African Americans


Rates of Alzheimer’s disease and related dementias (ADRD) are higher among African Americans than non-Hispanic Whites. Michelle Ko, an assistant professor in the Department of Public Health Sciences, is investigating whether lifetime exposures to violence, as a form of structural racism, may play a role in racial inequities in ADRD. 

Researchers will study the impact of structural violence on cognitive decline in older African Americans
Researchers will study the impact of structural violence on cognitive decline in older African Americans

Ko, a physician scientist, has been awarded a five-year, $2.3 million grant from the National Institutes of Health’s National Institute on Aging. She’ll be examining the impact of exposure to structural violence on older African Americans. Her research will examine whether the racial inequities in community violence and the criminal justice system, at different points in life, are associated with a decline in cognitive function and ADRD. 

Although African Americans are more likely to develop ADRD than non-Hispanic whites, their rate of cognitive decline is not faster. This suggests that increased ADRD arises from experiences that happen earlier in life. Ko seeks to understand the association between exposure to structural violence, especially in childhood and early adulthood, and the subsequent risk of cognitive decline. 

“This work is one contribution to advancing our understanding of how processes of structural racism, and in particular, exposure to violence, may contribute to ADRD,” said Ko. 

Ko and her team will analyze the participants of two large, longitudinal projects, the Study of Healthy Aging in African Americans  and the Kaiser Healthy Aging and Diverse Life Experiences  Study, led by Rachel Whitmer, professor and division chief of epidemiology at UC Davis Health. The projects together have enrolled 1,143 African Americans who were members of one health system for most of their adult lives. Study data include five decades of health records and information on residential history, social and behavioral factors at several time points from birth to later in life. 

Michelle Ko
Michelle Ko received a $2.3 million grant from the National Institute on Aging

These rich data sets will be matched to multiple national data sources that detail community violence and incarceration and neighborhood population and socioeconomic statistics. The goal is to paint a detailed picture of where participants lived and how exposure to violence and structural racism may have affected them later in life. 

“Historically, healthcare professionals have framed ADRD risk factors as consequences of poor health behaviors, rather than what we know from the evidence, that social determinants, such as education and neighborhood quality, are highly consequential,” explained Ko. “The next directions in research lie in understanding how the dimensions of structural racism create inequities in social factors, with the consequences borne by African-American communities.” 

Ko noted that it is critical from a public health standpoint to identify how policies affecting childhood and adult exposures to violence can lessen ADRD risk and impact brain health later in life. African Americans are disproportionately burdened by policies that have left their communities under-resourced, which leads to disparity in many aspects of health, and in turn increases risk factors for ADRD.