Multicultural Community Dementia Screening

摘要 美国咨询服务特别工作组（USPSTF）得出结论，目前的证据不足以评估 轻度认知障碍（MCI）和早期阿尔茨海默病筛查的利弊平衡， 相关疾病（ADRD），首次发表于2014年，最近更新。相反，USPSTF呼吁更多 研究，在2017年发布了一项研究计划，以评估痴呆症筛查的证据。社区 MCI和早期ADRD的检测可能是有限的，因为缺乏表征最早期ADRD的筛查试验。 损害的迹象，监测对干预措施的反应，与生物标志物的对应关系，以及潜在的 筛查的利弊。无法检测MCI和ADRD可能会影响合格性确定 并阻碍临床研究中的病例确定和招募。在过去的5年里， 资金周期，我们问了一些重要的问题，关于（a）最好的方法来筛选，（B）有效的，这些 相关生物变量（年龄，性别，种族和民族）的方法，（c）措施如何对应于“黄金” 标准”评价，以及（d）个人如何处理结果。我们目前提出的总体目标 研究的目的是解决提高MCI和早期ADRD检测的主要挑战。我们强调 深度表型分析-从同一个体中采集多种类型的数据， 多个个体虽然对更广泛的MCI/ADRD检测感兴趣，但我们利用淀粉样蛋白，tau， 神经变性（ATN）研究框架，以锚这项工作，特别是如何生物标志物和相关 生物变量（例如，年龄、性别、人种、种族）解释了ATN之间的转换风险差异 框架阶段。为此，我们提出了3个具体目标：（1）确定基于人群的MCI/ADRD 在佛罗里达蓝十字医疗保险登记的2500名55岁以上成年人中的患病率（总抽样框架：5.2 （2）从目标1中招募500人，每年亲自参加一次培训， 通过深入的表型分析进行全面的访视，以确定在线评估的准确性 认知、体液、遗传、MRI以及淀粉样蛋白和tau PET成像生物标志物，并评估基线 预测NIA-AA阶段之间的纵向认知下降和过渡的措施，并通过相关的生物学 变量;和（3）通过测试改进的决策来定义MCI/ADRD筛查的益处与危害 （提前护理计划，药物治疗），以患者为中心（健康相关的生活质量，身体功能， 医疗保健利用）和以患者为中心的结果（负担、紧张、情绪、健康相关的生活质量）， 目标2中描述的纵向队列。我们的长期目标是增加“真实的世界”早期MCI和ADRD 检测，诊断和治疗;解决USPSTF关键问题;减少健康结果的差异。这 与国家阿尔茨海默病项目法案（NAPA）的三项指导原则产生强烈共鸣，特别是 它的第三个原则：“改变我们对待阿尔茨海默病和相关痴呆症的方式。”

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.”