Addressing Alzheimer's Disease and Related Dementias Disparities: The American Indigenous Cognitive Assessment (AMICA) Project

解决阿尔茨海默病和相关痴呆症的差异：美国土著认知评估 (AMICA) 项目

• 批准号: 10623223
• 负责人: CAREY E GLEASON
• 金额: $ 204.25万
• 依托单位: UNIVERSITY OF MINNESOTA
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-06-01 至 2027-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10623223
• 关键词: Acceleration; Activities of Daily Living; Address; Adult; Aging; Alzheimer disease detection; Alzheimer' s disease related dementia; American Indians; Area; Assessment tool; Australia; Canada; Caregivers; Caring; Clinical; Communities; Congresses; Consensus; Cultural Backgrounds; Dementia; Development; Diagnosis; Disparity; Elderly; Epidemiology; Eye; Feedback; Goals; Improve Access; Indigenous; Indigenous American; Inequity; Interview; Knowledge; Letters; Measures; Mediation; Mental Depression; Methodology; Minnesota; Modification; Native-Born; New Mexico; Outcome; Participant; Persons; Policies; Population; Practice Guidelines; Predictive Value; Procedures; Process; Property; Provider; Psychometrics; Pueblo Race; Reporting; Research; Research Priority; Reservations; Risk; Running; Safety; Site; Specificity; Surveys; Testing; Time; Tribes; United States; Wisconsin; accurate diagnosis; barrier to care; clinical practice; cognitive interview; cognitive testing; community based participatory research; dementia care; disparity reduction; early onset; experience; health disparity; improved; instrument; member; neuropsychiatry; research clinical testing; response; standard of care; tool; tribal community; urban Native American

The Addressing Alzheimer’s Disease and Related Dementias Disparities: The American Indigenous Cognitive Assessment (AMICA) Project tackles the significant dementia disparity that exists for Indigenous populations by determining the scalability of recently developed, culturally tailored, brief cognitive tests for dementia for use in diverse American Indian (AI) populations. Compared to the majority population, Indigenous rates of Alzheimer’s disease and related dementias (ADRD) are approximately 3 times higher. This research will adapt and validate a battery of complementary Indigenous cognitive assessment tools developed in Canada and Australia for use among AI populations in the United States. This battery expands and adapts the Canadian Indigenous Cognitive Assessment (CICA), as well as the Australian Kimberley Indigenous assessments for depression (KICA depression), Activities of Daily Living (KICA-ADL) and a caregiver report (KICA-Carer). Culture and context are central to Indigenous peoples’ experience with dementia and dementia diagnosis. Due to significant cultural differences between tribal populations in Australia, Canada, and the US, existing Indigenous culturally valid clinical tools cannot be used in the US until they are first adapted and re-validated. Until unbiased tools are developed, we run the risk of basing critical clinical and policy decisions on flawed epidemiological estimates of ADRD which, in turn, further exacerbates dementia inequities. Using community- based participatory research approaches blended with Indigenous methodologies, we will revise existing Indigenous assessments to align with AI cultural context as well as the neuropsychiatric properties. We intend to measure and assess the reliability, validity, and cultural acceptance of the adapted instruments with a total of 390 dyads of people with dementia and their caregivers (n=780) in in two culturally distinct tribal communities in Minnesota, Wisconsin, and an urban AI population in New Mexico. Our central hypothesis is that developing a culturally safe cognitive assessment approach that accounts for cultural context will provide accurate diagnoses, which in turn will help us achieve our long-term goal of improving the diagnosis and care of Indigenous persons with dementia across the ADRD continuum. Our specific aims are to: 1) create American Indian appropriate versions of the CICA Cog, KICA Carer, KICA depression and KICA-ADL (the “AMICA battery”); 2) assess the psychometric properties and cultural acceptability of the four tools in the AMICA battery. We hypothesize that the AMICA battery will demonstrate strong reliability, validity, sensitivity, specificity, positive and negative predictive value relative to the two-eyed seeing consensus diagnosis. Thus the AMICA battery will produce the same diagnoses, while providing greater cultural safety, than the standard assessments. By achieving these aims we can expect to deliver the first culturally adapted valid cognitive assessment battery for American Indian older adults. In doing so, this research will help to reduce disparities, accelerate research, and enhance access to high quality clinical practice.

解决阿尔茨海默病和相关痴呆症的差异：美国本土认知 评估 (AMICA) 项目通过以下方式解决原住民群体中存在的重大痴呆症差异： 确定最近开发的、针对文化定制的、简短的痴呆症认知测试的可扩展性，以用于 与大多数人口相比，不同的美洲印第安人 (AI) 人群的阿尔茨海默氏症患病率。 疾病及相关痴呆症 (ADRD) 大约高出 3 倍。这项研究将进行调整和验证。 在加拿大和澳大利亚开发的一系列补充性土著认知评估工具 这种电池扩展并适应了加拿大本土认知。 评估 (CICA) 以及澳大利亚金伯利土著抑郁症评估 (KICA) 抑郁症）、日常生活活动（KICA-ADL）和护理人员报告（KICA-Carer）。 文化和背景是原住民痴呆症和痴呆症诊断经验的核心。 由于澳大利亚、加拿大和美国部落人口之间存在显着的文化差异， 本土文化上有效的临床工具只有在经过首次调整和重新验证后才能在美国使用。 在开发出公正的工具之前，我们面临着将关键临床和政策决策建立在有缺陷的基础上的风险 ADRD 的流行病学估计反过来又进一步加剧了痴呆症的不平等。 基于参与式研究方法与本土方法相结合，我们将修订现有的 我们希望进行与人工智能文化背景以及神经精神特性相一致的本土评估。 衡量和评估改编工具的可靠性、有效性和文化接受度，总共 位于两个文化不同的部落社区的 390 名痴呆症患者及其照顾者 (n=780) 明尼苏达州、威斯康星州和新墨西哥州的城市人工智能人口我们的中心假设是发展一个人工智能群体。 考虑文化背景的文化安全认知评估方法将提供准确的诊断， 这反过来将帮助我们实现改善原住民诊断和护理的长期目标 我们的具体目标是：1) 创造适合美洲印第安人的环境。 CICA Cog、KICA Carer、KICA 抑郁和 KICA-ADL 版本（“AMICA 电池”2）评估 AMICA 电池中四种工具的心理测量特性和文化可接受性。 AMICA电池将表现出强大的可靠性、有效性、灵敏度、特异性、正负极性 相对于双眼视觉共识诊断的预测价值因此 AMICA 电池将产生。 通过实现这些，可以进行相同的诊断，同时提供比标准评估更高的文化安全性。 我们的目标是为美洲印第安人提供第一个适应文化的有效评估电池 在此过程中，这项研究将有助于减少差距、加速研究并增加获取机会。 高质量的临床实践。