Behavioral Change Following Culturally-Informed Biomarker Disclosure in Alzheimer’s Disease

阿尔茨海默病的文化知情生物标志物披露后的行为变化

• 批准号: 10475212
• 负责人: Annalise Rahman-Filipiak
• 金额: $ 18.44万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-01 至 2026-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10475212
• 关键词: Adaptive Behaviors; Address; Adult; Aging; Alzheimer' s Disease; Alzheimer' s disease diagnosis; Alzheimer' s disease pathology; Alzheimer' s disease related dementia; Alzheimer’s disease biomarker; Amyloid; Attenuated; Behavior; Behavioral; Bioethics; Biological Markers; Black Populations; Black race; Clinical; Cognition; Cognitive; Cognitive aging; Complex; Consensus; Data; Dementia; Detection; Development; Diagnosis; Diagnostic; Disclosure; Early Diagnosis; Education; Elderly; Enrollment; Ethics; Etiology; Evaluation; Face; Faculty; Feedback; Foundations; Funding; Future; Gerontology; Goals; Health; Health Benefit; Health Care Costs; Health Disparities Research; Health behavior; Health behavior change; Image; Individual; Institutes; Intervention; Interview; Knowledge; Life Style; Link; Literature; Longitudinal Studies; Longitudinal cohort; Low income; Measurement; Measures; Mentored Patient-Oriented Research Career Development Award; Mentors; Methods; Michigan; Minority; Neurologic; Neuropsychology; Outcome; Parents; Participant; Patients; Positron-Emission Tomography; Prevalence; Principal Investigator; Protocols documentation; Public Health; Race; Randomized; Reaction; Research; Research Methodology; Research Personnel; Risk; Safety; Sampling; Scientific Advances and Accomplishments; Source; Techniques; Therapeutic; Therapeutic Effect; Time; TimeLine; Training; Treatment Cost; United States National Institutes of Health; Universities; Validation; Visit; Work; amnestic mild cognitive impairment; base; behavior change; biomarker identification; biomarker validation; biopsychosocial; career; cognitive benefits; cohort; contextual factors; dementia risk; ethnic diversity; experience; health care availability; health disparity; interest; novel; patient population; predictive marker; protein biomarkers; psychologic; racial and ethnic disparities; racial difference; racial diversity; ranpirnase; recruit; social determinants; social health determinants; socioeconomics; standard of care; tau Proteins

Project Summary Alzheimer’s Disease (AD) and Dementia-Alzheimer’s Type (DAT) prevalence is growing among older adults, and disproportionately so in Black seniors. Scientific advances have allowed for detection of protein biomarkers associated with AD and increased risk for DAT. Both cognitively healthy and symptomatic older adults are interested in their personalized PET amyloid and tau information. However, biomarker disclosure rarely occurs in either clinical or research settings, in part due to concerns about how patients will react to and use this information in the absence of validated treatments for DAT. While several studies have supported the safety of positron emission tomography (PET) amyloid disclosure in regards to psychological reactions, very few have examined actual behavior following risk feedback, and no studies have examined a prolonged timeline of behavior change. The therapeutic effect of health behavior and lifestyle change on cognition and functioning is well-established; however, whether disclosure may precipitate health-related change is unknown. Furthermore, no study to date has investigated tau disclosure. These questions are most pertinent to two populations: patients with amnestic Mild Cognitive Impairment (aMCI), for whom this feedback may be most motivating, and Black individuals, who may face biopsychosocial barriers to executing adaptive health related changes, even if motivated to do so. To date, no study has systematically addressed racial differences in reactions to risk disclosure or the mechanisms underlying these differences. This empirical gap highlights a timely opportunity to understand and address a potential source of disparity in AD diagnosis and treatment. The proposed project and closely aligned training plan will respond to this call by comparing behavior change in individuals who receive either ‘standard of care’ diagnostic disclosure, or diagnostic feedback enhanced by disclosure of combined PET amyloid and tau imaging. We will build from the robust framework of the Michigan Alzheimer’s Disease Research Center’s (MADRC) longitudinal cohort and two associated NIA-funded studies to recruit a biomarker-characterized and rigorously diagnosed sample of 50% Black and 50% White patients with aMCI. This sample will be randomly assigned to treatment condition, and then followed for bi-annual visits over two years. Specifically, we will use a mixed-methods approach to assess health behavior change (Aim 1a), advanced planning (Aim 1b), and research participation (Aim 1c), as well as how a known social determinant of health (healthcare access) influences change in these outcomes by racial group (Aim 2). The training in AD biomarker measurement and validation, ethical and public health implications of biomarker disclosure, racial-ethnic disparities in aging, and mixed methods approaches, in addition to the critical concepts explored in this study, will create the ideal foundation for the principal investigator to excel as an independent early career researcher in the field of minority cognitive aging.

项目概要 阿尔茨海默病 (AD) 和痴呆-阿尔茨海默氏病 (DAT) 在老年人中的患病率正在上升， 在黑人老年人中尤其如此。科学进步使得蛋白质的检测成为可能 与 AD 相关的生物标志物和 DAT 风险增加。认知健康且有症状的老年人 成年人对个性化 PET 淀粉样蛋白和 tau 蛋白信息感兴趣。然而，生物标志物披露 在临床或研究环境中很少发生，部分原因是担心患者将如何反应和 在缺乏经过验证的 DAT 治疗方法的情况下使用此信息。虽然多项研究支持 正电子发射断层扫描 (PET) 淀粉样蛋白披露在心理反应方面的安全性，非常 很少有人检查风险反馈后的实际行为，也没有研究检查长期风险反馈 行为改变的时间表。健康行为和生活方式的改变对认知和能力的治疗作用 功能完善；然而，披露是否会促成与健康相关的变化尚不清楚。 此外，迄今为止还没有研究调查 tau 的披露。这些问题与两个最相关 人群：患有遗忘症轻度认知障碍（aMCI）的患者，对于他们来说，这种反馈可能是最多的 激励和黑人个体，他们在执行适应性健康相关的工作时可能面临生物心理社会障碍 改变，即使有动机这样做。迄今为止，还没有研究系统地解决种族差异 对风险披露的反应或这些差异背后的机制。这种经验差距凸显了 及时了解和解决 AD 诊断和治疗差异的潜在根源。 拟议的项目和紧密结合的培训计划将通过比较行为变化来响应这一号召 在接受“护理标准”诊断披露或通过以下方式增强诊断反馈的个人中 公开 PET 淀粉样蛋白和 tau 蛋白联合成像。我们将建立在密歇根州强大的框架之上 阿尔茨海默病研究中心 (MADRC) 的纵向队列和两项由 NIA 资助的相关研究 招募 50% 黑人和 50% 白人患者的生物标志物特征和严格诊断样本 与 aMCI。该样本将被随机分配到治疗条件，然后每两年进行一次随访 两年多了。具体来说，我们将使用混合方法来评估健康行为变化（目标 1a）、预先规划（目标 1b）和研究参与（目标 1c），以及已知的社会如何 健康的决定因素（医疗保健获取）影响按种族群体划分的这些结果的变化（目标 2）。这 AD 生物标志物测量和验证、生物标志物的伦理和公共卫生影响方面的培训 除了关键概念之外，披露、老龄化方面的种族差异和混合方法方法 本研究中探索的内容将为首席研究员作为独立的优秀研究者奠定理想的基础 少数族裔认知衰老领域的早期职业研究员。