Multicultural Community Dementia Screening

多元文化社区痴呆症筛查

• 批准号: 10178273
• 负责人: James E Galvin
• 金额: $ 274.62万
• 依托单位: UNIVERSITY OF MIAMI SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-05-01 至 2026-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10178273
• 关键词: Address; Adult; Advance Care Planning; Advisory Committees; Advocate; Affect; Age; Alzheimer' s Disease; Alzheimer' s disease related dementia; Americas; Amyloid; Biological; Biological Markers; Blue Cross; Brain; CCL4 gene; Caregivers; Clinical Research; Cognition; Cognitive; Communities; Confusion; Cultural Diversity; Data; Data Analyses; Decision Making; Dementia; Detection; Diagnosis; Disease; Eligibility Determination; Enrollment; Equilibrium; Ethnic Origin; Evaluation; Family; Florida; Foundations; Funding; Genetic; Goals; Gold; Impaired cognition; Impairment; Individual; Insurance; Intervention; Investigation; Link; Liquid substance; Longitudinal cohort; Magnetic Resonance Imaging; Measures; Medical; Memory; Methods; Mind; Monitor; Moods; Nerve Degeneration; Outcome; Outcome Measure; Participant; Pathology; Patients; Persons; Pharmaceutical Preparations; Phenotype; Physical Function; Plasma; Population Heterogeneity; Positron-Emission Tomography; Preparation; Prevalence; Preventive service; Progress Reports; Protocols documentation; Publishing; Race; Research; Risk; Sampling; Staging; System; Testing; Time; Update; Validation; Visit; Work; care systems; cognitive performance; cohort; comorbidity; detection method; disparity reduction; health care service utilization; health disparity; health related quality of life; imaging biomarker; improved; innovation; instrument; interest; mild cognitive impairment; multiple data types; novel; patient oriented; population based; primary outcome; public health relevance; recruit; response; screening; sex; sociodemographic variables; tau Proteins; tool

ABSTRACT The US Preventative Services Task Force (USPSTF) concluded that current evidence is insufficient to assess the balance of benefits vs harms of screening for mild cognitive impairment (MCI) and early Alzheimer's disease and related disorders (ADRD), first published in 2014 and recently updated. Instead, the USPSTF has called for more research, publishing a research plan in 2017 to evaluate the evidence of dementia screening. Community detection of MCI and early ADRD may be limited due to the lack of screening tests characterizing the earliest signs of impairment, monitoring response to interventions, correspondence to biomarkers, and the potential benefits versus harms from screening. The inability to detect MCI and ADRD may affect eligibility determination for care and services, and impede case ascertainment and recruitment in clinical research. In our prior 5-year funding cycle, we asked important questions regarding (a) the best methods to screen, (b) effective of these methods across relevant biological variables (age, sex, race, and ethnicity), (c) how measures correspond to “Gold Standard” evaluations, and (d) what individuals do with results. Our overarching GOAL of the current proposed investigation is to address the major challenges to improve the detection of MCI and early ADRD. We emphasize deep phenotyping—the acquisition of multiple types of data from the same individual repeated over time from multiple individuals. Although interested in broader MCI/ADRD detection, we leverage the amyloid, tau, neurodegeneration (ATN) research framework to anchor this work, particularly how biomarkers and relevant biological variables (e.g., age, sex, race, ethnicity) explain differential risk for transition across the ATN Framework stages. To do this, we propose 3 SPECIFIC AIMS: (1) Determine population-based MCI/ADRD prevalence in 2500 adults age 55+ enrolled in Florida Blue Cross medical insurance (total sampling frame: 5.2 million) using a novel on-line evaluation; (2) Recruit 500 individuals from Aim 1 for annual in-person comprehensive visits with deep phenotyping to determine the accuracy of on-line evaluation against longitudinal cognitive, fluid, genetic, MRI, and amyloid and tau PET imaging biomarkers, and evaluate the ability of baseline measures to predict longitudinal cognitive decline and transition across NIA-AA stages and by relevant biological variables; and (3) Define the benefits vs. harms of MCI/ADRD screening by testing improved decision-making (advance care planning, medications), patient-centered (health-related quality of life, physical functionality, health care utilization) and caregiver-centered outcomes (burden, strain, mood, health-related quality of life) in the longitudinal cohort characterized in Aim 2. Our long-term goal is to increase “real world” early MCI and ADRD detection, diagnosis, and treatment; address USPSTF Key Questions; and reduce disparities in health outcomes. This resonates strongly with the three guiding principles of the National Alzheimer's Project Act (NAPA), especially its third principle: “Transform the way we approach Alzheimer's disease and related dementias.”

抽象的 美国预防服务工作队（USPSTF）得出结论，当前的证据不足以评估 益处的平衡与筛查轻度认知障碍（MCI）和早期阿尔茨海默氏病的损害 相关疾病（ADRD），最初于2014年发布，最近更新。相反，USPSTF要求更多 研究，在2017年发布研究计划，以评估痴呆症筛查的证据。社区 由于缺乏最早的筛查测试，MCI和ADRD的检测可能受到限制 损害的迹象，监测对干预措施的反应，对生物标志物的信件以及潜力 筛查的福利与危害。无法检测MCI和ADRD可能会影响确定资格确定 用于护理和服务，并阻碍临床研究中的案例确定和招聘。在我们前5年 资金周期，我们询问了有关（a）筛选最佳方法的重要问题，（b）有效 相关生物学变量（年龄，性别，种族和种族）的方法，（c）措施与“黄金相对应 标准”评估，以及（d）个人对结果的影响。我们当前提出的总体目标 调查是针对改善MCI和早期ADRD检测的主要挑战。我们强调 深度表型 - 从同一个人中获取多种类型的数据，随着时间的推移重复 尽管对更广泛的MCI/ADRD检测感兴趣，但我们利用了淀粉样蛋白，Tau， 神经变性（ATN）研究框架以锚定这项工作，尤其是生物标志物和相关方式 生物变量（例如，年龄，性别，种族，种族）解释了跨ATN过渡的差异风险 框架阶段。为此，我们提出了3个具体目的：（1）确定基于人群的MCI/ADRD 佛罗里达州蓝十字医疗保险的2500名成年人的患病率55岁以上（总抽样框架：5.2 百万）使用新颖的在线评估； （2）从AIM 1招募500个人参加年度面对面 通过深度表型进行全面的访问，以确定在线评估对纵向的准确性 认知，流体，遗传，MRI和淀粉样蛋白和tau PET成像生物标志物，并评估基线的能力 预测NIA-AA阶段的纵向认知下降和过渡的措施以及相关的生物学 变量； （3）通过测试改进的决策来定义MCI/ADRD筛选的损害的好处与危害 （预先护理计划，药物），以患者为中心（与健康相关的生活质量，身体功能， 医疗保健利用）和以护理人员为中心的结果（负担，压力，情绪，与健康相关的生活质量） AIM 2中的纵向队列。我们的长期目标是增加“现实世界”早期MCI和ADRD 检测，诊断和治疗；解决USPSTF关键问题；并减少健康结果的分布。这 与《国家阿尔茨海默氏症计划法》（NAPA）的三个指导原则引起共鸣，尤其是 它的第三个原则：“改变我们接近阿尔茨海默氏病和相关痴呆症的方式。”