Addressing Alzheimer's Disease and Related Dementias Disparities: The American Indigenous Cognitive Assessment (AMICA) Project

解决阿尔茨海默病和相关痴呆症的差异：美国土著认知评估 (AMICA) 项目

• 批准号: 10447514
• 负责人: CAREY E GLEASON
• 金额: $ 180.07万
• 依托单位: UNIVERSITY OF MINNESOTA
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-06-01 至 2027-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10447514
• 关键词: Activities of Daily Living; Address; Adult; Aging; Alzheimer' s disease related dementia; American Indians; Area; Assessment tool; Australia; Canada; Caregivers; Caring; Clinical; Cognitive; Communities; Congresses; Consensus; Cultural Backgrounds; Dementia; Development; Diagnosis; Elderly; Epidemiology; Eye; Feedback; Goals; Improve Access; Indigenous; Indigenous American; Interview; Knowledge; Letters; Measures; Mediation; Mental Depression; Methodology; Minnesota; Modification; Native-Born; New Mexico; Outcome; Participant; Persons; Policies; Population; Practice Guidelines; Predictive Value; Procedures; Process; Property; Provider; Psychometrics; Pueblo Race; Reporting; Research; Research Priority; Reservations; Risk; Running; Safety; Sensitivity and Specificity; Site; Surveys; Testing; Time; Tribes; United States; Wisconsin; accurate diagnosis; barrier to care; base; clinical practice; cognitive testing; community based participatory research; dementia care; disparity reduction; early onset; experience; health disparity; improved; instrument; member; neuropsychiatry; research clinical testing; response; standard of care; tool; tribal community; urban Native American

The Addressing Alzheimer’s Disease and Related Dementias Disparities: The American Indigenous Cognitive Assessment (AMICA) Project tackles the significant dementia disparity that exists for Indigenous populations by determining the scalability of recently developed, culturally tailored, brief cognitive tests for dementia for use in diverse American Indian (AI) populations. Compared to the majority population, Indigenous rates of Alzheimer’s disease and related dementias (ADRD) are approximately 3 times higher. This research will adapt and validate a battery of complementary Indigenous cognitive assessment tools developed in Canada and Australia for use among AI populations in the United States. This battery expands and adapts the Canadian Indigenous Cognitive Assessment (CICA), as well as the Australian Kimberley Indigenous assessments for depression (KICA depression), Activities of Daily Living (KICA-ADL) and a caregiver report (KICA-Carer). Culture and context are central to Indigenous peoples’ experience with dementia and dementia diagnosis. Due to significant cultural differences between tribal populations in Australia, Canada, and the US, existing Indigenous culturally valid clinical tools cannot be used in the US until they are first adapted and re-validated. Until unbiased tools are developed, we run the risk of basing critical clinical and policy decisions on flawed epidemiological estimates of ADRD which, in turn, further exacerbates dementia inequities. Using community- based participatory research approaches blended with Indigenous methodologies, we will revise existing Indigenous assessments to align with AI cultural context as well as the neuropsychiatric properties. We intend to measure and assess the reliability, validity, and cultural acceptance of the adapted instruments with a total of 390 dyads of people with dementia and their caregivers (n=780) in in two culturally distinct tribal communities in Minnesota, Wisconsin, and an urban AI population in New Mexico. Our central hypothesis is that developing a culturally safe cognitive assessment approach that accounts for cultural context will provide accurate diagnoses, which in turn will help us achieve our long-term goal of improving the diagnosis and care of Indigenous persons with dementia across the ADRD continuum. Our specific aims are to: 1) create American Indian appropriate versions of the CICA Cog, KICA Carer, KICA depression and KICA-ADL (the “AMICA battery”); 2) assess the psychometric properties and cultural acceptability of the four tools in the AMICA battery. We hypothesize that the AMICA battery will demonstrate strong reliability, validity, sensitivity, specificity, positive and negative predictive value relative to the two-eyed seeing consensus diagnosis. Thus the AMICA battery will produce the same diagnoses, while providing greater cultural safety, than the standard assessments. By achieving these aims we can expect to deliver the first culturally adapted valid cognitive assessment battery for American Indian older adults. In doing so, this research will help to reduce disparities, accelerate research, and enhance access to high quality clinical practice.

解决阿尔茨海默氏病和相关痴呆症的差异：美国土著认知 评估（AMICA）项目解决了土著人口存在的重大痴呆差差异 确定最近开发的，文化量身定制的简短认知测试的痴呆症的可伸缩性 多元化的美洲印第安人（AI）人口。与大多数人口相比，阿尔茨海默氏症的土著率 疾病和相关痴呆症（ADRD）高约3倍。这项研究将适应和验证 在加拿大和澳大利亚开发的一系列完整的土著认知评估工具供使用 在美国的AI人群中。该电池扩展并适应加拿大的土著认知 评估（CICA）以及澳大利亚的金伯利抑郁症评估（KICA） 抑郁症），日常生活（KICA-ADL）和护理人员报告（KICA-CARER）。 文化和背景是土著人在痴呆症和痴呆诊断方面的经验的核心。到期的 在澳大利亚，加拿大和美国的部落人口之间存在重大的文化差异，现有 在美国首次改编和重新验证之前，在美国不能使用土著有效的临床工具。 在开发公正的工具之前，我们冒着基于有缺陷的关键临床和政策决策的风险 ADRD的流行病学估计值又进一步侵犯了痴呆症不平等。使用社区 - 基于参与研究的方法与土著方法融合在一起，我们将修改现有 与AI文化背景以及神经精神特性保持一致的本地评估。我们打算 衡量和评估适应性工具的可靠性，有效性和文化接受程度 在两个文化上不同的部落社区中，有390名患有痴呆症及其护理人员的人（n = 780） 明尼苏达州，威斯康星州和新墨西哥州的城市AI人口。我们的核心假设是开发 在文化上说文化背景的文化安全认知评估方法将提供准确的诊断， 反过来，这将有助于我们实现改善土著人民的诊断和照顾的长期目标 痴呆症遍布整个连续性。我们的具体目的是：1）创建适当的美洲印第安人 CICA COG，KICA CARER，KICA DEMISW和KICA-ADL的版本（“ Amica电池”）； 2）评估 Amica电池中四个工具的心理测量特性和文化可接受性。我们假设这一点 Amica电池将表现出强大的可靠性，有效性，灵敏度，特异性，正和负面 相对于双眼观察诊断的预测价值。 Amica电池会产生 与标准评估相比，同时提供更大的文化安全性。通过实现这些 我们可以期望为美洲印第安人提供第一个文化适应的有效认知评估电池 老年人。在此过程中，这项研究将有助于减少分布，加速研究并增强访问权限 高质量的临床实践。