Abstract
Abstract Background American Samoa is the only U.S. territory located south of the equator. The U.S. Census recorded 46,466 residents, with 11,025 (23.8%) of the population age 50 and over. Healthcare access is extremely limited and the lack of culturally‐sensitive screening tests characterizing the earliest signs of impairment, correspondence to Alzheimer’s Disease and Related Dementias (ADRD) biomarkers, and potential benefits versus harms from screening are barriers for the detection of ADRD. The inability to detect mild cognitive impairment (MCI) and ADRD may affect eligibility determination for acre and services, impeded case ascertainment, and limit ADRD research. Furthermore, social determinants of health, genetic risks, and lifestyle factors may plan an important role in relative vulnerability or resilience of the American Samoa population to develop MCI and ADRD. Method Using our prior work, partnerships, and nascent research infrastructure, we submitted a R01 application creating the Puipui Malu Manatu, or Protecting Memories, study to conduct important phenotypic and genotypic characterization of ADRD in a probability sample of 981 Samoans age 50 and above. Our hypotheses are: 1) ADRD knowledge and research readiness is low, 2) culturally‐adapted instructions will detect MCI and ADRD; and 3) unique patterns of plasma and genetic biomarkers define ADRD in American Samoa older adults. Result We were funded by the National Institutes of Aging (RF1AG075904) for the project to complete the following specific aims: 1) Test ADRD knowledge, health literacy, research readiness and determine ADRD resilience and vulnerability factors, and cognitive status using culturally adapted instruments, 2) Conduct Gold Standard evaluations using the Uniform Data Set (UDSv3.0) from the NIA Alzheimer’s disease research Center program to determine a population‐based prevalence of MCI and ADRD for harmonization, data sharing, and comparison to other groups, 3) Cross‐validate Gold Standard dementia evaluations with genetic and plasma Amyloid‐Tau‐Neuronal Injury/Neurodegeneration framework biomarkers in our probability sample and compare to information available for other racial/ethnic groups. Conclusion Strong collaborations are needed to conduct novel ADRD research studies in American Samoa that is resource poor, yet culturally rich. Our approach allows to weave Westernized and Indigenous approaches to increase knowledge in this field for our population.