RACIAL DIFFERENCES IN DEMENTIA SCREENING AND DIAGNOSIS

痴呆症筛查和诊断中的种族差异

• 批准号: 6287198
• 负责人: Ellen Grober
• 金额: $ 6.82万
• 依托单位: MONTEFIORE MEDICAL CENTER (BRONX, NY)
• 依托单位国家: 美国
• 财政年份: 2001
• 资助国家: 美国
• 起止时间: 2001-03-15 至 2003-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6287198
• 关键词: African American; caucasian American; clinical research; cognition; dementia; depression; diagnosis design /evaluation; early diagnosis; educationally disadvantaged; functional ability; geriatrics; health services research tag; human old age (65+); human subject; interview; longitudinal human study; managed care; medically underserved population; memory; mental disorder diagnosis; neuropsychological tests; orientation; patient care management; primary care physician; public health; questionnaires; racial /ethnic difference

This project addresses the urgent public health need for a dementia screening program in primary care settings where racial/ethnic minorities receive their medical care. Minority patients and patients with limited education are the very groups for whom the popular, commonly used mental status tests have poor sensitivity and specificity. To achieve the high sensitivity and specificity needed for efficient primary care-based screening and diagnosis, tests should be minimally influenced by differences in race/ethnicity and education and more sensitive to the memory impairment associated with very early dementia. Our long term objective is to design an efficient, culture-fair strategy to identify patients with incident and early dementia in primary care settings. We hypothesize that this will involve two steps: rapid screening of all geriatric patients followed by limited additional testing of patients who screen positive to establish memory impairment and one other cognitive disturbance as required by DSM IV criteria. We anticipate that both steps can be achieved with no more than 30 minutes of patient testing by a trained assistant. We anticipate that both steps can be achieved with no more tan 30 minutes of patient testing by a trained assistant. The clinician's time is conserved because a clinical evaluation is triggered only for patients who satisfy the neuropsychological criteria for DSM IV dementia. This makes early identification in primary care feasible. The objective of this small grant is to demonstrate that our culture-fair approach to early diagnosis is feasible and that we have reliable methods in place to support our planned RO1 application, a longitudinal of over 500 patients using the proposed methods in the same urban geriatric medicine clinic. Twenty-five African American and 25 Caucasian patients and their informants will be recruited and evaluated with the screening and diagnostic tests and followed-up 6 months later to confirm diagnosis. Diagnosis and clinical staging will be established by consensus of the PI, the neurologist, and the geriatrician independent of screening test results. The specific aims are: 1) to provide preliminary estimates of the reliability of our clinical diagnoses; and 2) to provide preliminary estimates of the sensitivity and specificity of the screening tests in our clinic-based sample.

该项目解决了在少数种族/族裔接受医疗服务的初级保健机构开展痴呆症筛查方案的紧急公共卫生需求。少数民族患者和受教育程度有限的患者正是流行的、常用的精神状态测试灵敏度和特异性较差的人群。为了获得有效的基于初级保健的筛查和诊断所需的高灵敏度和特异性，测试应尽量不受种族/民族和教育差异的影响，并对与早期痴呆相关的记忆损伤更加敏感。我们的长期目标是设计一种有效的、文化公平的策略来识别初级保健机构中发生和早期痴呆的患者。我们假设这将包括两个步骤：对所有老年患者进行快速筛查，然后对筛查阳性的患者进行有限的额外测试，以确定记忆障碍和DSM IV标准要求的另一种认知障碍。我们预计这两个步骤都可以通过训练有素的助手在不超过30分钟的患者测试中实现。我们预计这两个步骤都可以通过训练有素的助手在不超过30分钟的患者测试中实现。因为只有满足DSM IV痴呆的神经心理学标准的患者才会触发临床评估，因此节省了临床医生的时间。这使得初级保健的早期识别成为可能。这笔小额赠款的目的是证明我们的文化公平早期诊断方法是可行的，我们有可靠的方法来支持我们计划的RO1应用，在同一城市老年医学诊所使用拟议方法的500多名患者的纵向研究。招募25名非裔美国人和25名白人患者及其举报人，对其进行筛查和诊断测试评估，并在6个月后随访以确认诊断。诊断和临床分期将由PI、神经科医生和老年病专家达成共识，独立于筛查试验结果。具体目的是：1)提供临床诊断可靠性的初步估计；2)在我们的临床样本中提供筛选试验的敏感性和特异性的初步估计。