By Genoa Barrow | OBSERVER Senior Staff Writer
Dr. Kristen M. George’s succinct bio states that she’s an assistant professor of epidemiology in the department of public health sciences at the UC Davis School of Medicine.
Translation: She’s a brainiac who uses her powers for good.
Dr. George’s research assesses cardiovascular contributions to dementia and cognitive aging. She’s the first author on a new study on how high blood pressure in your 30s can lead to worse brain health in your 70s. Men were particularly affected.
According to the Centers for Disease Control and Prevention, about 47% of Americans have high blood pressure. Because of the sample size, local researchers weren’t able to look at the results in terms of ethnicity. But studies show the rate of hypertension is about 56% in Black adults compared to 48% in white adults, 46% in Asian adults and 39% in Hispanic adults. African Americans ages 35-64 also are 50% more likely to have high blood pressure than whites.
![Models were adjusted for race and ethnicity (Asian, Black, Latino, or White), study (Kaiser Healthy Aging and Diverse Life Experiences [KHANDLE] or Study of Healthy Aging in African Americans [STAR]), age at first multiphasic health checkup (MHC), time between first and last MHC, age at neuroimaging, sex (male or female), and educational attainment (high school diploma or less, some college or trade school, college degree, or graduate degree). Blue circles represent parietal cortex volumes for women, and orange squares represent parietal cortex volumes for men. The solid blue line represents the estimated parietal cortex volumes for women across change in diastolic blood pressure, and the blue shading represents 95% CIs. The solid orange line represents the estimated parietal cortex volumes for men across change in diastolic blood pressure, and the orange shading represents 95% CIs. Courtesy of Kristen M. George, PhD1; Pauline Maillard, PhD2; Paola Gilsanz, ScD3](https://i0.wp.com/sacobserver.com/wp-content/uploads/2023/05/zoi230218f2_1679579368.41738.png?resize=610%2C419&ssl=1)
Dr. George analyzed MRI data from participants in the Kaiser Healthy Aging and Diverse Life Experiences study, patients from Sacramento and the San Francisco Bay Area who were 65 or older and dementia-free. Data collected from a previous health checkup around age 32 also included blood pressure, cholesterol levels and body-mass index. Others also looked at data from the ongoing Study of Healthy Aging in African Americans.
The new report is part of Dr. George’s overall interest in addressing high blood pressure as a way to potentially prevent dementia and Alzheimer’s disease in senior adults. Research has found that Blacks are more than twice as likely to be diagnosed with dementia or Alzheimer’s compared to whites.
“The study doesn’t really tell us anything about how well modification works,” Dr. George said. “It’s pretty well established that maintaining normal blood pressure improves health outcomes, including prevention and delay of dementia. What we don’t really understand is how the timing of hypertension onset influences dementia outcomes. This study really indicates that even people who are relatively young and healthy having high blood pressure is bad for late-life brain health.
“Most of what we know about dementia risk factors is based on midlife adults – people who are in their mid-40s to mid-60s. We don’t really know about early life and young adulthood. It’s important because dementia really develops over several years, often decades. What we’ve learned with imaging and blood testing is that we can see these really early signs of changes in the brain that are indicative of dementia, much sooner than we thought previously. So if we want to prevent or delay onset of cases, we really need to intervene decades before we start to see those changes. This study and other research that have looked at life course risk factors for dementia are really indicating that we need to start these interventions earlier and not waiting until midlife.”
There is hope, she said.
“One positive about hypertension and kind of why I am really interested in cardiovascular disease as a risk factor for dementia is that hypertension is very treatable. It’s relatively inexpensive to treat typically. If you have high blood pressure and you’re a young adult, there are steps that you can hopefully take to get that treated and controlled potentially for the rest of your life. It’s also important to remember and what I try to, especially in my research, recognize is that there are all these other factors, these other social determinants of health, that are impacting people’s lives and their ability to see a doctor or what types of exposures they have over their lifetime. It’s a personal struggle for me as a researcher, but I think it’s an important one that I tried to identify things that can be intervened on, like hypertension. I also want to make sure that I’m keeping in mind all of these other factors that maybe aren’t as modifiable on the individual level, but need to be addressed on a structural or larger level.”
She’s Got It
Dr. George has been at UC Davis for 31/2 years, having started as a postdoctoral fellow before joining the faculty a year and a half ago.
“I actually wanted to be a physician when I was an undergrad, but I just hated the classes, like gen chem and biology,” Dr. George said. “ I think it was more the way that they were taught than the actual subjects.”
A few advisors stepped in and expanded her academic horizons to include public health and epidemiology. She originally planned to become an infectious disease epidemiologist, but that too evolved.
“I didn’t really know much about how epidemiologists study chronic disease, but I was open-minded to it,” Dr. George said. “I was really interested in disparities, especially among Black older adults. As I was learning more about cardiovascular disease, I started reading about dementia.”
For her, the work is deeply personal.
“That was an area that really hit home for me because I’ve had three grandparents that have had dementia, so just trying to understand why there’s such large disparities in dementia outcomes, especially why Black older adults are at much higher risk of cardiovascular disease and dementia. I really wanted to understand whether those two things – and how those two things – are related.”
Dementia progressed differently in her relatives.
“One that was a more textbook case of Alzheimer’s disease was my grandfather, who developed it when he was in his late 60s, early 70s,” she shared.
“It just kind of progressed over about eight years maybe. Then I had a grandmother who is deceased now, but hers she started developing symptoms in her 80s and her doctors weren’t really taking it very seriously. They were just kind of like, ‘She’s in her 80s, it’s normal to have memory issues.’ So we never really actually got an official diagnosis of dementia, but she definitely had some cognitive issues and passed away before it progressed to be super severe or anything like that. I currently have my other grandmother who has dementia and is in hospice care now. She’s been diagnosed with Alzheimer’s disease, but it’s progressed very, very slowly. She’s 92.”
Seeing dementia up close informs her work and her knowledge and understanding of it on a different level.
“I think I appreciate a lot of the gray areas in dementia diagnosis and research because I’ve seen it develop so differently within my own grandparents,” Dr. George said. “I really feel like I understand the importance of advocating for patients and their families who suspect that their loved one has dementia. Especially as people get to be older as in their 80s and 90s, it’s kind of considered a normal part of aging in a lot of communities, so recognizing that, no, this isn’t a normal part of aging and that we really need to recognize the signs and symptoms and be able to access appropriate care [is important].”
Dr. George wants to see others join her in the work.
“I definitely think that there’s a lot of room for improvement, both in recruiting researchers who look like me, as well as retaining them,” she said. “Research is not exactly glamorous and not as glamorous as some other medical professions. It’s a long, grueling education road. I know a lot of students from really diverse backgrounds who I’m currently mentoring and other institutions that I know people who are mentoring and so I’m really hopeful that things are changing, but there’s definitely a long way to go.”
Diversity in research itself is also crucial.
“There are very few studies of Alzheimer’s disease, especially imaging that include diverse cohorts,” Dr. George said. “Most of what we know about dementia, we’ve learned from pretty homogenous, highly educated and mostly white samples, so it’s really important that we retest a lot of these hypotheses that we’ve been testing in these homogenous samples.
“We need to retest in more diverse samples, because we know that Black and Latino older adults are much more likely to have cardiovascular disease; we know that they’re more likely to have dementia, so what we need to understand is, are these two high risk groups that we need to really focus on intervening on cardiovascular disease so that we can prevent dementia?”
It Matters
Dr. George points out that there are genetic risk factors that are seen largely in Blacks and others that aren’t.
“We don’t really know exactly why that is, so there are all these nuances in dementia and Alzheimer’s disease research that we still don’t understand because people that we’ve been studying have been mostly homogenous, mostly white.”
Change is happening at a snail’s pace, she said, but there’s cause for optimism.
“I think things are definitely changing. I think there’s a recognition that some of these assumptions that have been made about genetic risk factors, about lifestyle risk factors, social determinants that aren’t the same across different populations. There’s a lot of work being done. I’m part of and I know people who are a part of that who are actively trying to recruit people from backgrounds that haven’t been represented in research, but it definitely is slow.
“I think there’s a lot of community building and trust that needs to be worked towards gaining in communities that have not been included in research, because I think part of it has definitely been that they’ve been excluded,” she continued. “Also the way that we do research isn’t necessarily accessible. A lot of people can’t go into a clinic, to spend hours to do testing for a study and other things like that. I think it’s a really multifaceted and complex issue of getting diverse participants.”
UC Davis is getting it right, she said.
“I definitely think that UC Davis has done a lot to try to recruit more diverse participant samples. I can’t speak too much on it, but I am part of a newer study that has the intention of recruiting people from underrepresented communities, both people of color and also people of low income, into a dementia study. Hopefully, we can start to really build more diverse cohorts and really get a richer understanding of life course risk factors for dementia.”
With better understanding comes a better possibility for more culturally competent care.
“I think there’s a long way to go. It’s not really my area of expertise, because I’m not really doing any sort of direct care, but it’s definitely important. Developing culturally competent interventions could really be a lot more effective if we’re able to really send people the message that treating hypertension isn’t just about preventing a heart attack, it’s about preventing stroke and dementia and all of these other things that you might not be thinking about, but will really impact your quality of life.”
The future is full of possibilities, Dr. George feels, as research begets more research.
“With this study we looked at effects differences and some of the relationships between hypertension and neuroimaging, and we did find some differences, but the study wasn’t big enough to really investigate those differences further.”
It “set off a light bulb” she said, and prompted her and others to think about ways to do a deep investigation of the factors this latest study could not.
“Each study brings on these new questions and it’s really exciting when a study piques the interest of people beyond just other researchers. I think the driver of new research is really kind of what we find along the way and not so much how successful or how widely the research is read.”
View the study at jamanetwork.com/journals/jamanetworkopen/fullarticle/2802984.