5-Cog Battery to improve detection of cognitive impairment and dementia

5-Cog 电池可改善认知障碍和痴呆症的检测

基本信息

批准号：
10263305
负责人：
JOE VERGHESE
金额：
$ 82.17万
依托单位：
ALBERT EINSTEIN COLLEGE OF MEDICINE
依托单位国家：
美国
项目类别：
财政年份：
2017
资助国家：
美国
起止时间：
2017-09-25 至 2022-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10263305
关键词：
African American Assessment tool Biological Assay Cognitive Complex Computerized Medical Record Control Groups Cost Effectiveness Analysis Coupled Data Decision Trees Dementia Detection Diagnosis Drug Prescriptions Educational Background Electronic Health Record Ethnic Origin Ethnic group Evaluation Event Gait Health Professional Hispanics Human Resources Impaired cognition India Individual Internet Intervention Investigation Laboratories Logistics Low Literacy Population Measures Medical Medicare Memory impairment Mental Depression Methods Motor Neuropsychological Tests Outcome Outpatients Paper Patient Care Persons Phase Population Primary Care Physician Primary Health Care Procedures Process Questionnaires Randomized Randomized Clinical Trials Registries Risk Rural Services Single-Blind Study Site Social Work Specialist Specificity Standardization Syndrome System Test Result Testing Training Validation Visit Work active control base cognitive testing cohort cost dementia care experience feasibility testing follow-up grasp group intervention health care service utilization health disparity populations health literacy high risk implementation barriers improved informant literacy mild cognitive impairment multi-ethnic older patient patient population primary care setting recruit screening socioeconomics tool validation studies

项目摘要

Cognitive impairment related to dementia is frequently under-diagnosed in primary care settings despite the availability of numerous assessment tools. Missed detection delays treatment of reversible conditions as well as provision of support services and critical planning. This problem is more prevalent among older African- Americans and Hispanics than among older whites. Our group has two decades of experience developing tools to detect dementia in health disparate populations. Notably, we developed the Picture-based Memory Impairment Screen (PMIS) that relies on culture fair pictures and does not need to be administered by a medical professional. We also validated the Motoric Cognitive Risk syndrome (MCR). This highly accessible test relies on the presence of slow gait and cognitive self-complaints to identify individuals at high risk of converting to dementia. Both the PMIS and the MCR are highly sensitive and specific first-line assays that can be followed up with more thorough and complex cognitive testing. Building on our work, we propose to develop and validate a 5-minute screen (5-Cog) to identify persons at high risk of developing dementia and to flag them for further evaluation. We propose to do this in urban, multi-ethnic Bronx primary care populations with socio-economic challenges. The 5-Cog battery will include the PMIS, MCR syndrome diagnosis, and a 2-item depression screener. In the 18-month UG3 phase, we propose to fine-tune the components of the 5-Cog that will be tested in a health disparate population in the Bronx, and could be extended to other participating sites under this RFA. We will also test the feasibility of administering the 5-Cog by non-physicians to increase accessibility of our battery in primary care settings. In the 42-month UH3 phase, we propose a single-blind, randomized clinical trial in 1,200 older primary care patients presenting with cognitive complaints who will be randomized to receive either the 5-Cog battery (intervention group) or a 5-minute health literacy questionnaire (control group). Non-physicians will administer the intervention and control tests in primary care sites, and test results will be provided to primary care physicians for further action. ‘Improved dementia care’ will be measured by using a composite endpoint including new Mild Cognitive Impairment syndrome (MCI) or dementia diagnoses, laboratory investigations to rule out reversible causes of cognitive impairment, new dementia medication prescriptions, and specialist or social work referrals. The outcome events will be tracked using our electronic health record system. We will also conduct health care utilization and cost effectiveness analysis of the 5-Cog intervention in real-world settings. By the end of the UH3 phase, we will create a web registry to make 5-Cog test items and procedures available for download by health care professionals. The 5-Cog battery will overcome many of the implementation barriers of previous cognitive screens; it will be fast, low cost, easy to implement (requires only pen, paper and stopwatch), can be administered by non- clinicians after minimal training, not educationally or culturally biased, not confounded by depression and does not require informants.

尽管有众多评估工具的可用性。遗漏的检测延迟治疗可逆条件作为提供支持服务和关键计划的提供。这个问题在年长的非洲人中更为普遍 - 美国人和西班牙裔比在老年人中。我们的小组有开发工具的二十年经验检测健康人群中的痴呆症。值得注意的是，我们开发了基于图片的内存依赖文化公平图片的损害屏幕（PMI），不需要由医学专家。我们还验证了摩托车认知风险综合征（MCR）。这个高度访问测试依赖于缓慢的战斗机和认知自我指示来识别具有高风险的人转化为痴呆症。 PMI和MCR都是高度敏感和特定的一线测定法随后进行更诚实，更复杂的认知测试。在我们的工作的基础上，我们建议开发和验证一个5分钟的屏幕（5-COG），以识别高度的人患痴呆症的风险并标记为进一步评估。我们建议在城市多种族中这样做布朗克斯初级保健人群面临社会经济挑战。 5 cog电池将包括PMI， MCR综合征诊断和2项抑郁症筛查器。在18个月的UG3阶段，我们建议微调将在A中测试的5个cog的组件布朗克斯区的健康人群不同，可以扩展到此RFA下的其他参与地点。我们还将测试非物理学家管理5 cog以增加电池可访问性的可行性在初级保健环境中。在42个月的UH3阶段，我们提出了1,200个较老的初级保健中的单盲随机临床试验出现认知投诉的患者将被随机接收5 cog电池（干预组）或5分钟的健康素养问卷（对照组）。非医师将管理初级保健站点的干预和控制测试，并将为初级保健提供测试结果医生采取进一步行动。将使用复合端点来测量“改善痴呆症护理” 包括新的轻度认知障碍综合征（MCI）或痴呆诊断，实验室研究排除可逆原因的认知障碍原因，新的痴呆症药物处方以及专家或社会工作推荐。结果事件将使用我们的电子健康记录系统跟踪。我们将还对现实世界中的5-COG干预进行医疗保健利用和成本效益分析设置。到UH3阶段结束时，我们将创建一个Web注册表来制作5个COG测试项目和过程可供卫生保健专业人员下载。 5 cog电池将克服以前认知屏幕的许多实施障碍。这将是可以通过非 - 临床医生经过最少的培训，而不是在教育或文化上有偏见，而不是被抑郁症混淆，并且确实如此不需要信息。

项目成果

期刊论文数量（9）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Is the Montreal cognitive assessment culturally valid in a diverse geriatric primary care setting? Lessons from the Bronx.

蒙特利尔认知评估在多元化的老年初级保健环境中在文化上有效吗？

DOI：
10.1111/jgs.18705
发表时间：
2024
期刊：
Journal of the American Geriatrics Society
影响因子：
6.3
作者：
Stimmel,MarninaB;Orkaby,ArielaR;Ayers,Emmeline;Verghese,Joe;Nsubayi,CelesteK;Weiss,EricaF
通讯作者：
Weiss,EricaF

Motoric Cognitive Risk Syndrome in Polypharmacy.