Multicultural Community Dementia Screening

多元文化社区痴呆症筛查

基本信息

批准号：
10396093
负责人：
James E Galvin
金额：
$ 271.32万
依托单位：
UNIVERSITY OF MIAMI SCHOOL OF MEDICINE
依托单位国家：
美国
项目类别：
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/10396093
关键词：
Address Adult Advance Care Planning Advisory Committees Advocate Affect Age Alzheimer&apos s Disease Alzheimer&apos 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

项目摘要

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组 (USPSTF) 的结论是，目前的证据不足以评估筛查轻度认知障碍 (MCI) 和早期阿尔茨海默病的利弊平衡相关疾病 (ADRD)，于 2014 年首次发布，最近更新，相反，USPSTF 呼吁提供更多信息。研究，于 2017 年发布了一项研究计划，以评估社区痴呆症筛查的证据。由于缺乏表征最早的筛查测试，MCI 和早期 ADRD 的检测可能受到限制损伤迹象、监测对干预措施的反应、与生物标志物的对应以及潜在的筛查的好处与坏处无法检测 MCI 和 ADRD 可能会影响资格确定。的护理和服务，并阻碍临床研究中的病例确定和招募。融资周期中，我们提出了以下重要问题：(a) 筛选的最佳方法，(b) 这些方法的有效性跨相关生物变量（年龄、性别、种族和民族）的方法，(c) 测量值如何对应于“黄金” 标准”评估，以及 (d) 个人如何处理结果。我们强调，调查的目的是解决改善 MCI 和早期 ADRD 检测的主要挑战。深度表型分析——随着时间的推移从同一个体重复获取多种类型的数据虽然对更广泛的 MCI/ADRD 检测感兴趣，但我们利用淀粉样蛋白、tau、神经退行性变（ATN）研究框架来锚定这项工作，特别是生物标志物和相关的生物变量（例如年龄、性别、种族、民族）解释了 ATN 过渡的不同风险为此，我们提出了 3 个具体目标： (1) 确定基于人群的 MCI/ADRD。参加佛罗里达州蓝十字医疗保险的 2500 名 55 岁以上成年人的患病率（总抽样框：5.2 百万）使用新颖的在线评估；（2）从目标 1 中招募 500 名人员进行年度面对面评估；通过深度表型分析进行全面访问，以确定纵向在线评估的准确性认知、体液、遗传、MRI、淀粉样蛋白和 tau PET 生物标志物，并评估基线能力预测纵向认知衰退和跨 NIA-AA 阶段转变的措施以及相关生物学变量；(3) 通过测试改进的决策来定义 MCI/ADRD 筛查的好处与坏处（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）目标 2 中描述的纵向队列。我们的长期目标是增加“现实世界”的早期 MCI 和 ADRD 检测、诊断和治疗；解决 USPSTF 的关键问题；并减少健康结果的差异。与国家阿尔茨海默病项目法案 (NAPA) 的三项指导原则产生强烈共鸣，特别是它的第三个原则：“改变我们治疗阿尔茨海默病和相关痴呆症的方式。”