RACIAL DIFFERENCES IN DEMENTIA SCREENING AND DIAGNOSIS

该项目解决了在种族/少数民族接受医疗的初级保健环境中迫切需要一项痴呆症筛查方案的公共卫生需求。少数族裔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度较低的群体。为了实现有效的基于初级保健的筛查和诊断所需的高敏感性和特异性，测试应最大限度地受到种族/民族和教育差异的影响，并对与极早期痴呆症相关的记忆损害更敏感。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环境中的突发事件和早期痴呆患者。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标准所要求的另一种认知障碍。我们预计，这两个步骤都可以在训练有素的助手进行不超过30分钟的患者测试的情况下完成。我们预计，这两个步骤都可以实现，而不再需要训练有素的助手进行30分钟的患者测试。临床医生的时间是节省的，因为只有满足DSM IV痴呆症的神经心理学标准的患者才会触发临床评估。这使得在初级保健中及早识别是可行的。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RO1应用，纵向调查在同一城市老年医学诊所使用建议方法的500多名患者。将招募25名非洲裔美国人和25名高加索人患者及其告密者，进行筛查和诊断试验评估，并在6个月后进行随访以确认诊断。诊断和临床分期将通过PI、神经科医生和老年医生的共识建立，独立于筛查测试结果。具体目标是：1)对我们临床诊断的可靠性提供初步估计；以及2)对我们临床样本中筛查试验的敏感性和特异性提供初步估计。

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.