Behavioral Change Following Culturally-Informed Biomarker Disclosure in Alzheimer’s Disease

阿尔茨海默病的文化知情生物标志物披露后的行为变化

• 批准号: 10677615
• 负责人: Annalise Rahman-Filipiak
• 金额: $ 18.44万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-01 至 2026-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10677615
• 关键词: Adaptive Behaviors; Address; Adult; Aging; Alzheimer' s Disease; Alzheimer' s disease diagnosis; Alzheimer' s disease pathology; Alzheimer' s disease related dementia; Alzheimer’s disease biomarker; Amyloid; Attenuated; Behavior; Behavioral; Bioethics; Biological Markers; Black Populations; Black race; Clinical; Cognition; Cognitive; Cognitive aging; Complex; Consensus; Data; Dementia; Detection; Development; Diagnosis; Diagnostic; Disclosure; Disparity; Early Diagnosis; Education; Elderly; Enrollment; Ethics; Etiology; Evaluation; Face; Faculty; Feedback; Foundations; Funding; Future; Gerontology; Goals; Health; Health Benefit; Health Care Costs; Health Disparities Research; Health behavior; Health behavior change; Image; Individual; Intervention; Interview; Knowledge; Life Style; Link; Literature; Longitudinal Studies; Longitudinal cohort; Low income; Measurement; Measures; Mentored Patient-Oriented Research Career Development Award; Mentors; Methods; Michigan; Minority; Neurologic; Neuropsychology; Outcome; Parents; Participant; Patients; Population; Positron-Emission Tomography; Prevalence; Principal Investigator; Protocols documentation; Public Health; Race; Randomized; Reaction; Research; Research Methodology; Research Personnel; Risk; Safety; Sampling; Scientific Advances and Accomplishments; Source; Techniques; Therapeutic; Therapeutic Effect; Time; Training; United States National Institutes of Health; Universities; Validation; Visit; Work; amnestic mild cognitive impairment; behavior change; biomarker identification; biomarker validation; biopsychosocial; career; cognitive benefits; cohort; contextual factors; dementia risk; ethnic disparity; ethnic diversity; experience; health assessment; health care availability; health determinants; health disparity; interest; novel; predictive marker; protein biomarkers; psychologic; racial difference; racial disparity; racial diversity; racial population; recruit; skills; social determinants; social health determinants; socioeconomics; standard of care; tau Proteins; timeline

Project Summary Alzheimer’s Disease (AD) and Dementia-Alzheimer’s Type (DAT) prevalence is growing among older adults, and disproportionately so in Black seniors. Scientific advances have allowed for detection of protein biomarkers associated with AD and increased risk for DAT. Both cognitively healthy and symptomatic older adults are interested in their personalized PET amyloid and tau information. However, biomarker disclosure rarely occurs in either clinical or research settings, in part due to concerns about how patients will react to and use this information in the absence of validated treatments for DAT. While several studies have supported the safety of positron emission tomography (PET) amyloid disclosure in regards to psychological reactions, very few have examined actual behavior following risk feedback, and no studies have examined a prolonged timeline of behavior change. The therapeutic effect of health behavior and lifestyle change on cognition and functioning is well-established; however, whether disclosure may precipitate health-related change is unknown. Furthermore, no study to date has investigated tau disclosure. These questions are most pertinent to two populations: patients with amnestic Mild Cognitive Impairment (aMCI), for whom this feedback may be most motivating, and Black individuals, who may face biopsychosocial barriers to executing adaptive health related changes, even if motivated to do so. To date, no study has systematically addressed racial differences in reactions to risk disclosure or the mechanisms underlying these differences. This empirical gap highlights a timely opportunity to understand and address a potential source of disparity in AD diagnosis and treatment. The proposed project and closely aligned training plan will respond to this call by comparing behavior change in individuals who receive either ‘standard of care’ diagnostic disclosure, or diagnostic feedback enhanced by disclosure of combined PET amyloid and tau imaging. We will build from the robust framework of the Michigan Alzheimer’s Disease Research Center’s (MADRC) longitudinal cohort and two associated NIA-funded studies to recruit a biomarker-characterized and rigorously diagnosed sample of 50% Black and 50% White patients with aMCI. This sample will be randomly assigned to treatment condition, and then followed for bi-annual visits over two years. Specifically, we will use a mixed-methods approach to assess health behavior change (Aim 1a), advanced planning (Aim 1b), and research participation (Aim 1c), as well as how a known social determinant of health (healthcare access) influences change in these outcomes by racial group (Aim 2). The training in AD biomarker measurement and validation, ethical and public health implications of biomarker disclosure, racial-ethnic disparities in aging, and mixed methods approaches, in addition to the critical concepts explored in this study, will create the ideal foundation for the principal investigator to excel as an independent early career researcher in the field of minority cognitive aging.

项目摘要 阿尔茨海默氏病（AD）和痴呆症阿尔茨海默氏症类型（DAT）的患病率正在增长 在黑人老年人中，这么不成比例。科学进步允许检测蛋白质 与AD相关的生物标志物和DAT风险增加。认知健康和有症状的老年 成年人对他们的个性化宠物淀粉样蛋白和TAU信息感兴趣。但是，生物标志物披露 很少发生在临床或研究环境中，部分原因是对患者如何反应和 在没有经过验证的DAT处理的情况下，请使用此信息。虽然几项研究支持了 正电子发射断层扫描（PET）淀粉样蛋白在心理反应方面的披露，非常非常 很少有人检查了在风险反馈之后的实际行为，并且没有研究检查了延长 行为改变的时间表。健康行为和生活方式改变对认知和生活方式的治疗作用对认知和 功能是完善的；但是，披露是否可能导致与健康相关的变化是未知的。 此外，迄今为止尚无研究调查TAU披露。这些问题与两个有关 人群：柔和的轻度认知障碍患者（AMCI），这种反馈可能是最大的 激励人和黑人可能面临生物心理社会障碍以执行适应性健康相关的障碍 改变，即使有动力。迄今为止，尚无系统地解决种族差异 对风险披露或这些差异的机制的反应。这个经验差距突出显示 及时了解和解决广告诊断和治疗中潜在差异的机会。 拟议的项目和紧密一致的培训计划将通过比较行为改变来响应此呼叫 在接受“护理标准”诊断披露或诊断反馈的个人中 披露宠物淀粉样蛋白和tau成像的联合披露。我们将从密歇根州的强大框架中建造 阿尔茨海默氏病研究中心（MADRC）纵向队列和两项相关的NIA资助研究 招募由生物标志物特征和严格诊断的50％黑人和50％白人患者的样本 与AMCI。该样本将随机分配到治疗条件，然后遵循两年一次的访问 超过两年。具体而言，我们将使用混合方法来评估健康行为的改变（目标 1A），高级计划（AIM 1B）和研究参与（AIM 1C）以及已知的社会如何 卫生（医疗保健获取）的决定因素会影响种族群体这些结果的变化（AIM 2）。 AD生物标志物测量和验证，生物标志物的道德和公共卫生影响培训 除了关键概念之外 在这项研究中探索的将为主要研究者创造理想的基础，使其成为独立的独立 少数族裔认知衰老领域的早期职业研究员。