Community-based approach to Early Identification of transitions to Mild Cognitive Impairment (MCI) and Alzheimer's Disease (AD) in African Americans

基于社区的方法早期识别非裔美国人向轻度认知障碍 (MCI) 和阿尔茨海默病 (AD) 的转变

• 批准号: 10372939
• 负责人: VOYKO KAVCIC
• 金额: $ 65.89万
• 依托单位: WAYNE STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-07-01 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10372939
• 关键词: African American; African American population; Age; Age-associated memory impairment; Aging; Alzheimer' s Disease; Alzheimer' s Disease Core Center; Alzheimer' s disease risk; Area; Behavioral; Binding; Blood Pressure; Brain; Caring; Cholesterol; Clinical; Cognition; Cognitive; Communities; Computers; Consensus; Data; Dementia; Detection; Development; Diagnosis; Diagnostic; Diagnostic Procedure; Disease; Early Diagnosis; Early identification; Economics; Elderly; Electroencephalography; Electrophysiology (science); Enrollment; Event-Related Potentials; Family; Funding; General Population; Genes; Gerontology; Glycosylated hemoglobin A; Impaired cognition; Institutes; Intervention; Longevity; Longitudinal Studies; Measures; Memory; Methodology; Methods; Michigan; Minority Groups; Modification; Monitor; Nerve Degeneration; Neurobiology; Participant; Patients; Persons; Pharmacologic Substance; Pharmacology; Population; Populations at Risk; Procedures; Process; Research; Risk; Site; Techniques; Technology; Testing; Time; Underserved Population; United States National Institutes of Health; Universities; base; behavioral pharmacology; caucasian American; cognitive change; cognitive function; cognitive performance; cognitive rehabilitation; cognitive testing; cohort; community based evaluation; community setting; comorbidity; computerized; cost; dementia risk; diagnostic accuracy; experimental study; health disparity; human old age (65+); improved; indexing; individual patient; metropolitan; mild cognitive impairment; novel; novel marker; novel strategies; novel therapeutic intervention; outreach; portability; recruit; risk prediction; screening; secondary analysis; social; socioeconomics; stem; symposium

With the rapid increase in longevity and considerable expansion of the share of elderly in the population, it is becoming ever important to understand the mechanisms underlying age-related cognitive declines in order to guide environmental and clinical interventions for older adults and for more accurate prediction of risk for dementia [e.g., Alzheimer’s disease (AD)]. A crucial challenge of aging research is improving understanding of the neurobiological basis of conditions leading to dementia, in order to refine the diagnostic procedures and to target new behavioral and pharmacological interventions. A main avenue for the neurobiological understanding of very early risk processes leading to dementia would be the screening of large populations at risk by means of quick, low-cost, and widely available procedures. The present proposal will test to what extent computerized cognitive tests and portable electroencephalography (EEG) can be used to easily, accurately and efficiently evaluate early cognitive decline in elderly at risk for developing AD. Health disparities represent a critical roadblock mitigating the social and fiscal benefits of early identification and care, not only to the individual patient and family, but also at the state and federal levels. Community-dwelling, African-American elders show faster rates of cognitive decline and are almost twice as likely to develop mild cognitive impairment (MCI) and AD as are older, white Americans. However, they are less likely to be diagnosed or receive treatment in the early stages of these disorders. Development of economically viable and culturally acceptable methods of early detection is critical in minority populations. We propose to identify the first signs of dementia in at risk African Americans with subjective memory complaints (SMC) in their communities within the Detroit metro area by using computerized cognitive tests CogState and NIH Toolbox and a portable EEG. We plan to combine cross-sectional with longitudinal studies: within the first two years, we will cognitively evaluate a total of 500 at risk African Americans with SMC. From these participants we will select 200 who at entry to the longitudinal study will not be diagnosed with either dementia or MCI but will, however, undergo repeated cognitive and EEG testing every 6 months over a 3 year period. We will compare these approaches of repeated cognitive and EEG/ Event-Related Potentials (ERP) testing in terms of their sensitivity of identifying persons already at risk who will progress to MCI and/or AD. Our proposed community based evaluation that combines behavioral and EEG/ERP methods will be used to generate profiles of at risk healthy elderly African-Americans, who may within a short period of time develop MCI or AD. We expect that with the combination of behavioral and EEG/ERP methods, we will be able to develop objective markers, which will reliably identify early signs of cognitive decline. Such markers will be used for identification of significant cognitive decline, and to evaluate efficiency of new pharmacological approaches, which will lead to the development of new therapeutic interventions and disease modification.

随着人口寿命的迅速延长和老年人口比例的大幅增加， 了解与年龄相关的认知能力下降的机制变得越来越重要 指导老年人的环境和临床干预措施，并更准确地预测老年人的风险 痴呆症[例如阿尔茨海默病 (AD)]。衰老研究的一个关键挑战是提高对衰老的理解 导致痴呆症的神经生物学基础，以完善诊断程序并 针对新的行为和药理学干预措施。理解神经生物学的主要途径 导致痴呆症的早期风险过程是通过以下手段对大量高危人群进行筛查 快速、低成本且广泛可用的程序。本提案将测试计算机化程度 认知测试和便携式脑电图（EEG）可用于轻松、准确、高效地 评估有患 AD 风险的老年人的早期认知能力下降。 健康差距是削弱早期教育社会和财政效益的一个关键障碍。 识别和护理不仅针对患者个人和家属，而且还针对州和联邦层面。 居住在社区的非裔美国老年人的认知能力下降速度更快，几乎是非裔美国人老年人的两倍 与年长的美国白人一样，他们可能会患上轻度认知障碍 (MCI) 和 AD。然而，他们是 在这些疾病的早期阶段被诊断或接受治疗的可能性较小。发展 经济上可行且文化上可接受的早期检测方法对于少数群体至关重要。 我们建议识别具有主观记忆力的高危非裔美国人痴呆症的最初迹象 通过使用计算机认知测试在底特律都市区内的社区中进行投诉（SMC） CogState 和 NIH 工具箱以及便携式脑电图。我们计划将横断面研究与纵向研究结合起来： 在头两年内，我们将对总共 500 名有 SMC 风险的非裔美国人进行认知评估。从 我们将在这些参与者中选择 200 名，他们在进入纵向研究时不会被诊断出患有任何一种疾病 痴呆症或 MCI，但将在 3 年内每 6 个月接受一次重复的认知和脑电图测试 时期。我们将比较这些重复认知和脑电图/事件相关电位 (ERP) 的方法 测试其敏感性，以识别已经处于危险中且将进展为 MCI 和/或 AD 的人。 我们提出的基于社区的评估结合了行为和 EEG/ERP 方法，将被使用 生成处于危险中的健康老年非洲裔美国人的档案，他们可能在短时间内发展为 MCI 或 AD。我们期望通过行为和 EEG/ERP 方法的结合，我们将能够 开发客观标记，这将可靠地识别认知能力下降的早期迹象。这样的标记将是 用于识别显着的认知能力下降，并评估新药理学的有效性 方法，这将导致新的治疗干预措施和疾病修饰的发展。