Multicultural Community Dementia Screening

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ABSTRACT The US Preventative Services Task Force (USPSTF) concluded that current evidence is insufficient to assess the balance of benefits vs harms of screening for mild cognitive impairment (MCI) and early Alzheimer's disease and related disorders (ADRD), first published in 2014 and recently updated. Instead, the USPSTF has called for more research, publishing a research plan in 2017 to evaluate the evidence of dementia screening. Community detection of MCI and early ADRD may be limited due to the lack of screening tests characterizing the earliest signs of impairment, monitoring response to interventions, correspondence to biomarkers, and the potential benefits versus harms from screening. The inability to detect MCI and ADRD may affect eligibility determination for care and services, and impede case ascertainment and recruitment in clinical research. In our prior 5-year funding cycle, we asked important questions regarding (a) the best methods to screen, (b) effective of these methods across relevant biological variables (age, sex, race, and ethnicity), (c) how measures correspond to “Gold Standard” evaluations, and (d) what individuals do with results. Our overarching GOAL of the current proposed investigation is to address the major challenges to improve the detection of MCI and early ADRD. We emphasize deep phenotyping—the acquisition of multiple types of data from the same individual repeated over time from multiple individuals. Although interested in broader MCI/ADRD detection, we leverage the amyloid, tau, neurodegeneration (ATN) research framework to anchor this work, particularly how biomarkers and relevant biological variables (e.g., age, sex, race, ethnicity) explain differential risk for transition across the ATN Framework stages. To do this, we propose 3 SPECIFIC AIMS: (1) Determine population-based MCI/ADRD prevalence in 2500 adults age 55+ enrolled in Florida Blue Cross medical insurance (total sampling frame: 5.2 million) using a novel on-line evaluation; (2) Recruit 500 individuals from Aim 1 for annual in-person comprehensive visits with deep phenotyping to determine the accuracy of on-line evaluation against longitudinal cognitive, fluid, genetic, MRI, and amyloid and tau PET imaging biomarkers, and evaluate the ability of baseline measures to predict longitudinal cognitive decline and transition across NIA-AA stages and by relevant biological variables; and (3) Define the benefits vs. harms of MCI/ADRD screening by testing improved decision-making (advance care planning, medications), patient-centered (health-related quality of life, physical functionality, health care utilization) and caregiver-centered outcomes (burden, strain, mood, health-related quality of life) in the longitudinal cohort characterized in Aim 2. Our long-term goal is to increase “real world” early MCI and ADRD detection, diagnosis, and treatment; address USPSTF Key Questions; and reduce disparities in health outcomes. This resonates strongly with the three guiding principles of the National Alzheimer's Project Act (NAPA), especially its third principle: “Transform the way we approach Alzheimer's disease and related dementias.”