RACIAL DIFFERENCES IN DEMENTIA SCREENING AND DIAGNOSIS

该项目解决了在少数民族/种族接受医疗保健的初级保健环境中对痴呆症筛查计划的迫切公共卫生需求。少数民族患者和受教育程度有限的患者是流行的，常用的精神状态测试的敏感性和特异性较差的群体。为了实现有效的初级保健筛查和诊断所需的高灵敏度和特异性，测试应尽量减少种族/民族和教育差异的影响，并对与极早期痴呆症相关的记忆障碍更敏感。我们的长期目标是设计一个有效的，文化公平的战略，以确定事件和早期痴呆症患者在初级保健设置。我们假设这将涉及两个步骤：快速筛查所有老年患者，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在经过培训的助手进行不超过30分钟的患者测试的情况下完成。我们预计，这两个步骤都可以在经过培训的助手进行不超过30分钟的患者测试的情况下完成。临床医生的时间是节省的，因为临床评估仅对满足DSM IV痴呆的神经心理学标准的患者触发。这使得在初级保健中进行早期识别成为可能。这笔小额赠款的目的是证明我们的文化公平的早期诊断方法是可行的，并且我们有可靠的方法来支持我们计划的RO 1应用，该应用是在同一城市老年人中使用拟议方法的500多名患者的纵向研究医学诊所。将招募25名非洲裔美国人和25名白人患者及其知情人，并进行筛查和诊断检测，6个月后进行随访以确认诊断。诊断和临床分期将由PI、神经科医生和老年科医生达成共识，独立于筛选试验结果。具体目标是：1）提供我们临床诊断可靠性的初步估计; 2）提供我们基于临床的样本中筛选测试的灵敏度和特异性的初步估计。

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.