Testing Olfaction in Primary care to detect Alzheimer's disease and other Dementias (TOPAD)

在初级保健中测试嗅觉以检测阿尔茨海默病和其他痴呆症 (TOPAD)

• 批准号: 10079829
• 负责人: DAVANGERE P DEVANAND
• 金额: $ 11.2万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-30 至 2022-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10079829
• 关键词: Address; Advisory Committees; Age; Alzheimer' s Disease; Alzheimer' s disease diagnosis; Area Under Curve; Biological Markers; Biological Specimen Banks; Blood Tests; Brain imaging; Cerebrospinal Fluid; Cognitive; Communities; Dementia; Detection; Diagnosis; Diagnostic; Early Diagnosis; Elderly; Ensure; Evaluation; Family health status; Genomics; Goals; Gold; Health Personnel; Healthcare Systems; Impaired cognition; Impairment; Memory impairment; National Institute on Aging; Nerve Degeneration; Odors; Participant; Pathway interactions; Patients; Pennsylvania; Performance; Persons; Practice Guidelines; Preventive service; Primary Health Care; Proteomics; Protocols documentation; Provider; Receiver Operating Characteristics; Recommendation; Research; Resources; Screening procedure; Smell Perception; Standardization; Testing; Time; United States; Universities; Update; accurate diagnosis; aged; amnestic mild cognitive impairment; base; blood-based biomarker; cognitive testing; community setting; data warehouse; improved; instrument; mental state; metabolomics; mild cognitive impairment; minimally invasive; multidisciplinary; novel strategies; olfactory bulb; primary care setting; primary outcome; response; screening; secondary analysis; secondary outcome; tool

The goal of our project, called “Testing Olfaction in Primary care to detect Alzheimer’s disease and other Dementias (TOPAD)”, is to test the 12-item BSIT, a short, standardized version of the 40-item University of Pennsylvania Smell Identification Test (UPSIT), for detection of dementia among elderly persons with cognitive concerns in a community-based primary care setting, in response to PAR-15-359 (Novel Approaches to Diagnosing Alzheimer’s Disease and Predicting Progression), and its second aim: “Identifying new biomarkers that are minimally invasive, inexpensive, usable in community settings”. Many elderly persons develop dementia that remains undiagnosed in primary care settings until it is severe, leading to catastrophic consequences for patients, families, and the health care system. Odor identification impairment with the 40-item UPSIT is a well- validated biomarker of dementia, particularly dementia of the Alzheimer’s type (DAT), The shorter version of the UPSIT, the 12-item BSIT, has been shown to be similar to the UPSIT in distinguishing and predicting MCI and DAT. We propose the BSIT for detection of dementia in primary care because it takes 5 minutes to administer, is inexpensive, and can be administered by non-medical personnel. We propose to test the BSIT for detection of dementia among 600 patients with cognitive concerns, without a diagnosis of dementia, age 65 years and older, who attend primary care practices in Northern Manhattan. The term cognitive concerns includes subjective cognitive decline (SCD), and warning signs identified by relatives, significant others, and health care providers. All participants will be tested with the BSIT, the MMSE, and other common dementia screening tools. The performance of tools will be assessed using as a gold standard cognitive diagnosis based using the 2011 National Institute on Aging (NIA)/Alzheimer Association (AA) recommendations for dementia and MCI using the National Alzheimer’s Coordinating Center (NACC) protocol. Our primary outcome will be dementia diagnosis at the initial evaluation. Cognitive assessments will be repeated every 12 months. Our secondary outcomes will be cognitive transitions to dementia (and subtypes), MCI and MCI subtypes. Our primary aim is to compare the accuracy of the BSIT with the MMSE for dementia detection at initial evaluation among persons aged 65 years and older with cognitive concerns in primary care. In secondary analyses, we will examine the secondary outcomes and compare the accuracy of the BSIT for dementia detection with other instruments: Montreal Cognitive Assessment (MOCA), Mini-Cog and Memory Impairment Screen (MIS). Our secondary aim is to compare the BSIT with the MMSE in predicting cognitive transitions at 12 and 24 months. In secondary analyses, we will compare the BSIT with other screening instruments (MOCA, Mini-Cog, MIS). TOPAD will be conducted by a multidisciplinary team of experts in Alzheimer’s research, odor identification testing, dementia diagnosis, and primary care.

我们项目的目标是“在初级保健中测试嗅觉，以检测阿尔茨海默氏病和其他 痴呆症（topad）”是为了测试12个项目BSIT，这是40个项目的简短标准化版本 宾夕法尼亚气味识别测试（UPSIT），用于检测老年人的痴呆症 在15-359年的基于社区的初级保健环境中的担忧（新颖的方法 诊断阿尔茨海默氏病并预测进展）及其第二个目的：“确定新的生物标志物 在社区环境中最少，廉价的，便宜，可用”。许多老年人发展痴呆症 在初级保健环境中，直到严重为止，这一直尚未诊断为灾难性的后果 患者，家庭和医疗保健系统。 40个项目UPSIT的气味识别障碍是一个很好的 经过验证的痴呆症生物标志物，尤其是阿尔茨海默氏症类型的痴呆症（DAT），较短的版本 在区分和预测MCI和预测MCI和 dat。我们建议在初级保健中检测痴呆症的BSIT，因为管理需要5分钟 价格便宜，可以由非医学人员管理。我们建议测试BSIT检测 有600例认知问题的患者中的痴呆症，没有痴呆症，65岁的痴呆症患者 年龄较大，参加曼哈顿北部的初级保健实践。一词认知问题包括主观 认知能力下降（SCD）以及亲戚，重要其他和医疗保健提供者确定的警告信号。 所有参与者将使用BSIT，MMSE和其他常见痴呆症筛查工具进行测试。这 工具的性能将以2011年为基于黄金标准认知诊断来评估 国家老化研究所（NIA）/阿尔茨海默氏症协会（AA）关于痴呆和MCI的建议 国家阿尔茨海默氏症协调中心（NACC）方案。我们的主要结果将是痴呆诊断 初始评估。认知评估将每12个月重复一次。我们的次要结果将是 认知向痴呆症（和亚型），MCI和MCI亚型的认知过渡。我们的主要目的是比较 BSIT的精度使用MMSE在65岁的人中进行初步评估时进行痴呆检测的精度 在初级保健中对认知问题的较老。在次要分析中，我们将检查次要 结果并将BSIT的痴呆检测的准确性与其他乐器进行比较：蒙特利尔 认知评估（MOCA），迷你库和记忆障碍筛查（MIS）。我们的第二个目标是 将BSIT与MMSE进行比较，以预测12和24个月的认知转变。在二次分析中 我们将将BSIT与其他筛选仪器（MOCA，MINI-COG，MIS）进行比较。 Topad将进行 由阿尔茨海默氏症研究专家组成的多学科团队，异味识别测试，痴呆诊断， 和初级保健。