Evaluating Chinese-speaking community-dwelling elders in the United States with the Uniform Data Set

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Project Summary Dementia is a common disorder in adults aged 65 or above. Cognitive tests can improve the diagnosis of dementia in older adults. Elderly Chinese Americans have a high risk of inaccurate diagnosis or delayed diagnosis of dementia due to the absence of normative data on cognitive tests. The Alzheimer Disease Centers (ADCs) around the United States assess normal aging, Mild Cognitive Impairment (MCI), Alzheimer's Disease (AD), and other types of dementia in older adults using the National Alzheimer's Coordinating Center's Uniform Data Set (NACC UDS) evaluation. The evaluation consists of a clinical interview, medical exam, cognitive testing, and functional assessment. Blood collection for Apolipoprotein E ε4 (APOE ε4) genotyping is commonly completed as part of the standard dementia evaluation. Data from several cultures and populations have been reported for UDS cognitive tests but few reports in Chinese speaking individuals are available. The NACC is working to collect UDS data for the Chinese population in China. However, cognitive data for Chinese in China might not be generalized to the Chinese population in the US. Given the growing US Chinese population, and their increasing need for dementia care, it is critical to develop normative data to provide precision in the determination of cognitive deficit. The proposed study is designed to generate UDS cognitive data using a cohort of healthy elderly Chinese Americans with a wide range of age and educational attainment. To demonstrate the sensitivity of the cognitive tests, we will assess the relationship of cognitive performance with demographic (e.g., age, gender, and education), experiential (e.g., year and age arrived at the United States), clinical (e.g., cognitive status, activities of daily living, and behavioral symptoms), and genetic variables (e.g., APOE ε4). Participants must be cognitively normal, primarily Chinese speaking, and aged 65 or above. All enrollees will undergo a 3-hour in-person NACC UDS evaluation. The Chinese translation of the NACC UDS instruments will be administered by the bilingual English/Chinese staff at the Alzheimer's Disease Research Center (ADRC) at Icahn School of Medicine at Mount Sinai (ISMMS). Based on our prior recruitment experience of elderly Chinese Americans for clinical study, we expect to enroll 150 normal controls in a 2-year period. Regression models will be used to examine the relationship of cognitive performance with demographic, experiential, clinical, and genetic variables. The ADRC at ISMMS has been successful in recruiting and evaluating Spanish speaking elders in the US. This project builds on this experience to evaluate elderly Chinese Americans, the fastest growing minority group in the US. Our results will support the development of normative data for the detection and diagnosis of cognitive decline and dementia in this underserved population. The data will also provide valuable cross-country comparison and add value to the NACC database.