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BackgroundTrust and mistrust of the healthcare system by Black and African American individuals is often cited as a primary barrier to willingness to access healthcare and low representation in clinical research. The United States Public Health Service Syphilis Study at Tuskegee is most often cited as the sole reason for this mistrust, however similar and widespread injustices, as well as the history of segregated health systems particularly in the stroke belt, laid the foundation for current health and research inequities. Medical discourses and practices positioned the Black or African American body as “inferior” and created disparities in research, diagnostic practices, and service provision.MethodOur team collaborated with a historian of psychiatry and disability to document the historical factors that have created structural inequities in the South and beyond. The historian (KS) collected archival material related to Milledgeville Central State Hospital in Georgia including physical documents like annual reports, case studies, policies and procedures, and letters from patients. Annual reports which contained extensive diagnostic data were photocopied, computerized and analyzed to characterize patient diagnosis (mental, physical, age‐related), cause of death, and cost expended per patient, by race and gender.ResultsOur data documents the impact of segregated services, racist medical attitudes, abusive treatments, malpractices, physical labor exploitation, unlivable conditions, use of unapproved drugs, and involuntarily sterilizations in B/AA patients from 1956‐1970. Significant diagnostic disparities by race were obvious especially for “cerebral arteriosclerosis” and “schizophrenia”. Here we present data on first admissions diagnosis by age, gender, and race, as well as death rate and cause, and group level fiscal reports.ConclusionAn analysis of historical data demonstrates clear linkages with current issues and practices. Addressing structural racism in research, education and service provision requires an honest reckoning with past practices that persist today. We demonstrate the ways that scientific teams can work with trained historians to unpack the consequences of past policies and set out a method and agenda for collaborative interdisciplinary research moving forward.

Background: Alzheimer's disease (AD) is a devastating, progressive neurodegenerative disease resulting in memory loss and a severe reduction in ability to perform activities of daily living. Ethnicity-related genetic factors promoting the development of dementias among African Americans (AA) and increased risk among females for developing AD indicates that AA female with a parent with AD are at great risk for developing dementias.Method: This phase I study assessed the impact of a 12 week, 20-lesson adapted Argentine Tango intervention (N=24) vs. a no-contact control group (N=10) on measures of cognition, motor and psychosocial performance, and plasma inflammatory markers in middle-aged (45-65 years) AA females who are at increased risk for AD by virtue of parental history.Result: Some females (n=17) were also caregivers, and thus the impact of the program on caregiving burden was examined in this subset. Preliminary analysis of efficacy was conducted with significance tests on biomarkers and key measures of balance, strength, and cognition, including visuospatial and executive function. After 12 weeks, Tango participants had significantly decreased inflammatory cytokine levels: IL-7 (p=.003), IFN-γ (p=.011), and TNFα (p=.011), compared to controls. Participants in Tango improved on the Fullerton Advanced Balance Scale, which measures both dynamic and static balance (p=.023), the 30 second chair stand, which assesses functional lower body strength in older adults (p=.018), and inhibition of the color word interference test, which measures to ability to inhibit cognitive interference (p=0.031).Large effects were noted for the Tango group from pre to postintervention in the Trails B test score, which measures executive control and functioning. Other non-significant, yet large effects were noted in gait speed, spatial cognition, and executive function.Moderate effects were noted in caregiving burden measures among the subset of caregivers. Conclusion:These data show substantial cognitive and motor improvements and reduction in inflammatory biomarkers through a non-pharmacologic and affordable intervention among a small cohort of AA females with a parental history of AD.

Background Dementia caregivers have increased risk for psychological and physiological illness including depression, stress, hypertension, diabetes, diminished QOL, low‐grade inflammation and increased mortality. Dementia risk factors include gender, race and family history. Method This phase I pilot study evaluated the potential physiological, cognitive, motor, and psychosocial benefits of a 12 week, 20‐lesson adapted Argentine Tango intervention (N=30) to a no‐contact control group (N=10) in middle‐aged (45‐65 years) African American women caregivers of their parent with AD. Blood draw for inflammatory markers was done pre/post intervention/control. Result Women were middle age (60.0 yrs), slightly overweight (BMI 30.7) and highly educated (16.3 yrs of education). Significant reductions were noted in pre/post visit change for the Tango group in inflammatory markers including TNFα, interleukin‐7 and interferon‐gamma; maintenance of 30s chair stand performance, balance, and performance on the Tower of London and Stroop interference tests. Other non‐significant trends were noted in caregiving quality of life, gait speed, spatial cognition and executive function. Conclusion The Tango dance intervention is a promising, non‐pharmaceutical intervention for African American women AD caregivers, for preservation of physiological, psychological and cognitive health.