Development and Validation of an Instrument to Assess Cognitive Function Regulati

认知功能调节评估仪器的开发和验证

• 批准号: 9029312
• 负责人: Xi Chen
• 金额: $ 12.83万
• 依托单位: UNIVERSITY OF IOWA
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-05-01 至 2018-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9029312
• 关键词: Address; Affect; Alzheimer' s Disease; American; Assessment tool; Award; Caregiver support; Caring; Cause of Death; Clinic; Clinical; Clinical Research; Clinical Treatment; Clinical assessments; Cognitive; Collaborations; Complement; Data; Dementia; Dental; Dental Care; Dental Hygiene; Dental Research; Dental caries; Dentists; Dentures; Development; Development Plans; Diabetes Mellitus; Disease; Doctor of Philosophy; Elderly; Elements; Environment; Epidemiology; Evidence based intervention; Factor Analysis; Fellowship; Focus Groups; Fostering; Funding; Future; Geriatric Assessment; Geriatric Dentistry; Gerontology; Gingiva; Goals; Health; Health Professional; Healthcare; Hygiene; Immune system; Impaired cognition; Individual; Infection; Inflammation; Instruction; Insulin Resistance; Intervention; Knowledge; Lead; Literature; Malnutrition; Measurement; Measures; Mentored Patient-Oriented Research Career Development Award; Mentors; Methodology; Methods; Minnesota; Modeling; Neurology; North Carolina; Nursing Homes; Oral; Oral health; Outcome; Participant; Pathology; Patients; Periodontal Diseases; Persons; Phase; Prevalence; Property; Protocols documentation; Psychometrics; Public Health; Public Health Informatics; Quality of Care; Quality of life; Randomized Controlled Trials; Recurrence; Research; Research Personnel; Research Project Grants; Research Training; Respiratory Tract Infections; Review Literature; Risk; Rotation; Sampling; Sampling Studies; Severities; Staging; Structure; Study Skills; Testing; Time; Tooth Loss; Training; Training Activity; Universities; Validation; Validity and Reliability; Visiting Nurse; Vulnerable Populations; aged; base; cardiovascular disorder risk; career; career development; clinical practice; cognitive function; cognitive neuroscience; cognitive testing; design; diabetic; effective intervention; evidence base; experience; field study; fighting; glycemic control; improved; instrument; loss of function; meetings; mild cognitive impairment; mortality; multidisciplinary; oral care; patient oriented; professor; prototype; response; skills; soft tissue; statistics; theories; tool; treatment planning; validation studies

DESCRIPTION (provided by applicant): Cognitive impairment is a serious public issue affecting more than one-third of Americans aged 71 and older. Impaired cognitive function compromises dentally-related function (DRF) (e.g, making treatment decisions, performing oral hygiene care, and following homecare instructions), remarkably increasing risk of dental caries, periodontal disease and other oral health issues. Poor oral health is associated with diabetes and increases risk of cardiovascular disease and recurrent respiratory infection, the leading causes of death in special-needs patients. Currently, due to the lack of a reliable and practical methodology, DRF assessment is not a standard part of dental assessment and treatment planning. This fact likely affects quality of care and increases the risk of avoidable complications. In response to this unmet need, Dr. Xi Chen (PI) proposes a career development plan to develop an instrument to assess DRF in cognitively-impaired patients. Dr. Chen is one of the few fellowship-trained geriatric dentists with a substantial grounding in research. He completed his geriatric dentistry fellowship and PhD training in Health Informatics at the University of Minnesota and started his career as an assistant professor at the University of North Carolina at Chapel Hill (UNC-CH) in 2008. His unique background in geriatric dentistry, gerontology and clinical research, together with a strong passion and sense of professional responsibility to advance the field of geriatric dentistry, make him an outstanding candidate for this award. In the past three years, UNC-CH has provided start-up funds, protected time and other excellent support for Dr. Chen, which enabled him to formulate a multidisciplinary mentoring team and complete a number of preliminary studies to conceptualize and test the hypotheses of the proposed studies. A prototype instrument has also been developed and is now ready for further testing. All of these elements have prepared Dr. Chen to become an independent investigator in geriatric dental research. The proposed career development plan includes supervised study and mentored research that will augment Dr. Chen's previous training, complement his proposed research, and develop the expertise needed to foster his transition to being an independent geriatric dental researcher. The proposed training plan consists of didactics (e.g. cognitive neuroscience, cognitive function assessment and measurement design, epidemiology and statistics), clinical and research seminars, and supervised clinical rotation in the UNC neurology clinic. During this award Dr. Chen will meet with his mentors once every other week to discuss the proposed research, training and other career development issues. These training activities aim to help Dr. Chen: A) develop expertise in cognitive and functional assessment for cognitively-impaired patients; B) develop expertise in health measurement scale development and validation; and C) improve clinical research skills. Complementary to the training plan, the mentored research plan aims to enhance Dr. Chen's clinical study skills and provide experience in patient-oriented dental research, all of which is essential to achieving his long- term goal -- development of a new evidence-based dental care model for dementia patients. The proposed research plan is an essential step toward his long-term goal and can be divided into two phases. Phase I is to refine the proposed Dentally-related Function Test (DRF-Test) (Specific Aim 1). A prototype DRF-Test including 17 items has been developed by the PI through literature review and focus group discussions. Two content validity tests, one with practicing geriatric dental experts and one with geriatric experts on cognitive/functional assessment, and a field testing will be conducted. These results will be used to further refine the prototype instrument. The psychometric properties of the DRF-Test will be evaluated during Phase II (Specific Aim 2). The DRF-Test and standard cognitive/functional assessments will be administered to 200 participants with MCI or dementia. Factor analysis will be performed to examine the structure of the DRF-Test and eliminate redundant or poorly-performed items. The reliability and validity of the DRF-Test will be evaluated using the Classical Test Theory. As a part of the validation studies, a subset of the study sample (N=125) will be randomly selected to receive oral health assessment focusing on oral hygiene status, denture hygiene (if applicable), gum inflammation and dental caries prevalence. The association between oral health measures and DRF in cognitively-impaired patients will be examined to provide data required to develop evidence-based interventions for cognitively-impaired patients in a future study. The proposed study and training plans are expected to provide Dr. Chen with the skills and experience essential to developing as a patient oriented researcher in geriatric dentistry. This proposal will also result in a practical method to measure DRF, leading to methods for incorporating these results into clinical assessment and treatment planning. Based on the results of this study, a future evidence-based, individualized oral health intervention protocol corresponding to patients' oral health needs, DRF and level of caregiver support will be developed and tested in patients with MCI or dementia. After that, a randomized control study will be conducted to evaluate how DRF-test and this evidence-based protocol may inform clinician's decision and improve clinical practice for cognitively-impaired patients. All of these are essential to achieving my long-term goal of developing a new evidence-based model of dementia dental care.

描述（由申请人提供）：认知障碍是一个严重的公共问题，影响了71岁及以上的美国人中三分之一以上。认知功能受损会损害与之相关的功能（例如，做出治疗决策，进行口腔卫生护理以及遵循家庭护理指示），显着增加了龋齿，牙周疾病和其他口腔健康问题的风险。口腔健康状况不佳与糖尿病有关，并增加了心血管疾病和复发性呼吸道感染的风险，这是特殊需求患者死亡的主要原因。目前，由于缺乏可靠且实用的方法，DRF评估不是牙科评估和治疗计划的标准部分。这一事实可能会影响护理质量，并增加避免并发症的风险。为了应对这种未满足的需求，Xi Chen博士（PI）提出了一项职业发展计划，以制定一种评估认知受损患者的DRF的工具。 Chen博士是少数受过奖学金的老年牙医之一，在研究方面具有巨大的基础。他于2008年在明尼苏达大学完成了他的老年牙科研究金和博士健康信息学培训，并在北卡罗来纳大学教堂山（UNC-CH）担任助理教授的职业生涯。他在老年牙科，老年学和临床研究方面的独特背景，使他成为了强烈的热情和良好的职业奖项，使他成为了专业的竞选。在过去的三年中，UNC-CH为Chen博士提供了启动资金，受保护的时间和其他出色的支持，这使他能够建立一个多学科的指导团队，并完成许多初步研究，以概念化和测试拟议研究的假设。还开发了一种原型仪器，现在准备进行进一步测试。所有这些因素都使Chen博士成为老年牙科研究的独立研究者。拟议的职业发展计划包括监督研究和指导研究，这些研究将扩大陈先生的先前培训，补充他的拟议研究，并开发出促进他过渡到成为独立的老年牙科研究人员所需的专业知识。拟议的培训计划包括教学法（例如认知神经科学，认知功能评估和测量设计，流行病学和统计学），临床和研究研讨会，以及UNC神经病学诊所的临床旋转。在这个奖项中，陈博士将每隔一周一次与他的导师会面，讨论拟议的研究，培训和其他职业发展问题。这些培训活动旨在帮助Chen博士：a）为认知受损的患者发展认知和功能评估方面的专业知识； b）发展健康测量量表开发和验证方面的专业知识； c）提高临床研究技能。对培训计划的补充，这项指导的研究计划旨在提高陈博士的临床研究技能，并提供以患者为导向的牙科研究的经验，所有这些对于实现他的长期目标 - 开发新的基于证据的牙科护理模型对痴呆症患者的发展至关重要。拟议的研究计划是朝着他的长期目标迈出的重要一步，可以分为两个阶段。第一阶段将完善所提出的烈性功能测试（DRF检验）（特定AIM 1）。 PI通过文献综述和焦点小组讨论开发了一个原型DRF测试，其中包括17个项目。两项内容有效性测试，一项具有老年牙科专家的实践，另一项是认知/功能评估的老年专家，将进行现场测试。这些结果将用于进一步完善原型仪器。 DRF检验的心理测量特性将在II期期间评估（特定目标2）。 DRF检验和标准认知/功能评估将对200名具有MCI或痴呆症的参与者进行。将进行因子分析以检查DRF检验的结构并消除冗余或表现不佳的项目。 DRF检验的可靠性和有效性将使用经典测试理论进行评估。作为验证研究的一部分，将随机选择研究样本（n = 125）的一部分，以接受口腔健康评估，重点是口腔卫生状况，牙齿卫生（如果适用），牙龈炎症和龋齿症状。将检查在认知受损的患者中口腔健康指标与DRF之间的关联，以提供在未来的研究中为认知障碍患者开发基于证据的干预措施所需的数据。拟议的研究和培训计划预计将为Chen博士提供作为面向患者的老年牙科研究人员所必需的技能和经验。该建议还将导致一种测量DRF的实用方法，从而导致将这些结果纳入临床评估和治疗计划中的方法。根据这项研究的结果，将在MCI或痴呆症患者中开发和测试与患者口腔健康需求相对应的未来基于循证的，个性化的口腔健康干预方案，DRF和护理人员支持水平。之后，将进行一项随机对照研究，以评估DRF检验和基于证据的方案如何为临床医生的决定提供信息，并改善认知受损患者的临床实践。所有这些对于实现我的长期目标是开发新的基于证据的痴呆症护理模型的长期目标。