Improving the measurement of everyday functional outcomes in diverse populations of older adults with Alzheimer's disease and related disorders

改善患有阿尔茨海默病和相关疾病的不同老年人群的日常功能结果的测量

• 批准号: 9371281
• 负责人: SARAH E TOMASZEWSKI-FARIAS
• 金额: $ 7.85万
• 依托单位: UNIVERSITY OF CALIFORNIA AT DAVIS
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-08-15 至 2019-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9371281
• 关键词: Activities of Daily Living; Address; Affect; African American; Alzheimer disease detection; Alzheimer' s Disease; Alzheimer' s disease risk; Area; Assessment tool; California; Caucasians; Clinical; Cognition; Cognitive; Comorbidity; Comprehension; Data; Dementia; Development; Diagnosis; Disease; Disease Progression; Early Diagnosis; Education; Elderly; Ethnic Origin; Ethnic group; Familiarity; Federal Government; Foundations; Funding; Health; Health behavior; Impaired cognition; Interview; Latino; Lead; Life Style; Longitudinal cohort; Measurement; Measures; Medical; Methods; Minority Groups; Modification; Monitor; Outcome; Outcome Measure; Patient Care; Population; Population Heterogeneity; Property; Psychometrics; Questionnaires; Race; Reading; Research; Risk; Subgroup; Supportive care; Symptoms; Time; United States; Universities; Work; aging population; analytical method; base; clinical care; cohort; disability; ethnic diversity; functional decline; functional outcomes; health care availability; health difference; health disparity; high risk; improved; informant; instrument; member; mild cognitive impairment; novel; prevent; public health priorities; racial and ethnic; racial diversity; racial minority; sound; tool; treatment response

Project Summary The aging population in the United States is becoming more racially and ethnically diverse than ever before. Health disparities have been well documented across diverse older adult populations, including evidence to suggest that there may be increased rates of Alzheimer's disease (AD) and related disorders among some groups. Researched aimed at understanding, preventing and ameliorating health disparities in AD is a major public health priority. However, to study and address these health disparities requires psychometrically sound and culturally appropriate assessment tools to sensitively measure early clinical signs associated with AD and to provide good outcome measures to track disease progression and response to treatment. The measurement properties of such assessment tools must be conceptually and psychometrically equivalent across diverse populations. With previous NIA funding (Farias, AG 0215111, AG 031252) we developed a novel questionnaire-based assessment tool (the Everyday Cognition scales (ECog) to measure very early limitations in everyday functions. Our work has shown that subtle changes in everyday functions, as measured by the ECog, can be used to identify older adults at increased risk for developing Mild Cognitive Impairment (MCI) and dementia. However, our most recent work has shown that the current version of the ECog is less sensitive to predicting disease progression in ethnic/racial minority subgroups (Latinos and African Americans) than it is in non-Latino Caucasians. Such findings provide clear rationale for the need to adapt and further refine this instrument to improve its utility as an early indicator of disease and as an outcome measure among diverse populations. The proposed study will utilize a multi-method (quantitative and qualitative) approach to evaluate and improve the measurement equivalence of the ECog among diverse older adult populations. The aims of this study are twofold. In Aim 1 we will utilize existing data from the University of California, Davis Alzheimer Disease Center's multiethnic longitudinal cohort to quantitatively evaluate which items of the ECog display evidence of poor measurement equivalence across three racial/ethnic groups (African Americans, Latinos, and non-Latino Caucasians) using sophisticated analytic methods. Informed by results of Aim 1, Aim 2 will employ well-established cognitive interviewing methods to further evaluate and identify the reasons why particular ECog items are problematic for specific racial/ethnic groups. For example, some items may not be readily understood as intended and/or some items may not be appropriate the cultural context and lifestyle of some groups. These items will be modified accordingly and a second wave of cognitive interviews will further evaluate item revisions. Completion of this study will provide the critical formative work to improve our ability to measure early changes in everyday function with comparable accuracy and precision across diverse older adult populations.

项目摘要 美国的老龄化人口在种族和种族上比以往任何时候都变得更加多样化。 在不同的老年人群体中，健康差异已得到充分记录，包括证据 表明某些阿尔茨海默氏病（AD）和相关疾病的发生率可能会增加 组。旨在理解，预防和改善广告中健康差异的研究是主要的 公共卫生优先。但是，要研究和解决这些健康差异需要心理上的声音 以及具有文化适当的评估工具，以敏感地测量与AD和AD相关的早期临床标志 提供良好的结果措施以追踪疾病进展和对治疗的反应。测量 此类评估工具的属性必须在概念和心理上是等于不同的 人群。在以前的NIA资金（Farias，AG 0215111，AG 031252）中，我们开发了一个小说 基于问卷调查的评估工具（日常认知量表（ECOG），以衡量非常早期的限制 在日常功能中。我们的工作表明，日常功能的细微变化，由 ECOG可用于识别患有更为轻度认知障碍风险增加的老年人（MCI） 和痴呆症。但是，我们最近的工作表明，当前版本的ECOG敏感不太敏感 预测种族/种族少数族裔亚组（拉丁裔和非裔美国人）的疾病进展 在非拉丁裔高加索人中。这样的发现为需要适应和进一步完善这一点提供了明确的理由 改善其效用作为疾病早期指标的工具，并作为多样的结果措施 人群。拟议的研究将利用多方法（定量和定性）方法评估 并提高不同成年人种群中ECOG的测量等效性。目的 这项研究是双重的。在AIM 1中，我们将利用加利福尼亚大学戴维斯阿尔茨海默氏症的现有数据 疾病中心的多民族纵向队列，用于定量评估ECOG显示的哪些项目 三个种族/族裔群体（非裔美国人，拉丁裔和拉丁裔和 非拉丁裔高加索人）使用复杂的分析方法。通过AIM 1的结果告知，AIM 2将采用 建立了良好的认知访谈方法，以进一步评估和确定为什么特定的原因 ECOG项目对于特定的种族/族裔群体是有问题的。例如，某些项目可能不容易 理解为预期和/或某些项目可能不适合某些文化背景和生活方式 组。这些项目将进行相应修改，第二波认知访谈将进一步 评估项目修订。这项研究的完成将提供重要的形成性工作，以提高我们的能力 衡量日常功能的早期变化，以相当的精度和精度 成人人群。