Cognitive Assessment of Ederly Primary Care Patients

老年初级保健患者的认知评估

• 批准号: 7093112
• 负责人: JUDITH A SAXTON
• 金额: $ 52.08万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-07-15 至 2010-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7093112
• 关键词: accident proneness; aging; behavioral /social science research tag; cholinesterase inhibitors; clinical research; clinical trials; cognition; cognition disorders; computer assisted diagnosis; computer human interaction; dementia; diagnosis design /evaluation; early diagnosis; geriatrics; human old age (65+); human subject; longitudinal human study; mental disorder chemotherapy; mental disorder diagnosis; neuropsychological tests; neuropsychology; patient oriented research; primary care physician; psychological aspect of aging

DESCRIPTION (provided by applicant): Significant numbers of older individuals experience cognitive decline with aging. The causes of cognitive dysfunction range from the devastating effects of Alzheimer's disease (AD) to normal mild forgetfulness described by most older individuals. However, the vast majority of cognitive dysfunction in older persons is related to potentially treatable disorders e.g. thyroid disease, renal disease or depression. Most older Americans receive their health care solely within the general practice setting and even mild cognitive dysfunction can impact adherence with medical interventions and impair decision-making. However, most primary care physicians (PCP) do not screen for cognitive difficulties and most older patients do not report cognitive problems. Identification of cognitive impairment at an office visit would permit earlier referral for diagnostic work-up and earlier and more appropriate treatment. To date, no studies have examined the effectiveness of providing cognitive screening in the primary care setting. We propose to screen 1000 patients age 65+ within four participating community practices for the presence of cognitive dysfunction using standardized neuropsychological tools. The four physician practices will be randomly assigned to either a "treatment as usual" (TAU) or "Cognitive Report" (CR) group. For the patients in the CR group the cognitive results will be provided to their PCP together with supporting educational activities. We will follow both groups over two years to assess outcomes of interest (e.g. change in cognition, service utilization, medications and medication adherence, PCP office and ER visits, hospitalizations, specialist referrals, mortality etc). We hypothesize that if the PCP is aware of cognitive difficulties he/she will modify patient interactions and treatment plans to accommodate the patient's level of functioning resulting in improved clinical practice and clinical outcomes. Finally, we plan to investigate a brief computerized test of cognition. Such a test could be routinely administered in PCP offices, making cognitive data readily available in the primary care setting. The results of this study will have both immediate and long-term practical and public health significance. First, this study will immediately provide PCP's with the knowledge and ability to identify, and therefore treat, patients with (1) early AD, slowing the progression of cognitive decline from the earliest point; (2) potentially reversible causes of cognitive decline thus reducing the added burden of cognitive deficits; and (3) mild cognitive dysfunction which may affect ability to follow medication regimens or treatment plans. Second, this study will help prepare PCP's to identify and manage older patients with cognitive decline as improved treatments for AD and other cognitive disorders become available over the next three-five years.

描述（由申请人提供）：大量老年人经历了认知能力下降，随着衰老的衰老。认知功能障碍的原因范围从阿尔茨海默氏病（AD）的毁灭性影响到大多数老年人所描述的正常轻度健忘。但是，老年人的绝大多数认知功能障碍与潜在的可治疗疾病有关，例如甲状腺疾病，肾脏疾病或抑郁症。大多数年长的美国人仅在一般实践环境中获得医疗保健，即使是轻度的认知功能障碍也会影响医疗干预措施的依从性并损害决策。但是，大多数初级保健医生（PCP）没有筛查认知困难，并且大多数老年患者没有报告认知问题。在办公室访问中认知障碍的识别将允许较早的转诊进行诊断检查以及更早和更适当的治疗。迄今为止，尚无研究检查在初级保健环境中提供认知筛查的有效性。我们建议使用标准化的神经心理学工具在四种参与社区实践中筛查1000名65岁以上的患者，以实现认知功能障碍。四种医师实践将随机分配给“照常治疗”（TAU）或“认知报告”（CR）组。对于CR组的患者，认知结果将提供给其PCP，并提供支持的教育活动。我们将在两年内关注这两个小组，以评估感兴趣的结果（例如，认知，服务利用，药物和药物依从性，PCP办公室和急诊就诊，住院，专家转诊，死亡率等）。我们假设，如果PCP意识到认知困难，他/她将修改患者的互动和治疗计划，以适应患者的功能水平，从而改善临床实践和临床结果。最后，我们计划研究简短的计算机认知测试。可以在PCP办公室常规管理此类测试，从而使认知数据在初级保健设置中很容易获得。 这项研究的结果将具有即时和长期实践和公共健康意义。首先，这项研究将立即为PCP提供识别（1）早期AD患者的知识和能力，从而减慢了最早的认知能力下降的进展； （2）认知下降的可能可逆原因，从而减轻了认知缺陷的额外负担； （3）可能影响遵循药物治疗方案或治疗计划的能力的轻度认知功能障碍。其次，这项研究将有助于PCP准备识别和管理认知能力下降的老年患者，因为改进的AD和其他认知障碍的治疗方法在未来三十五年内可用。