Culture-Fair Screening and Diagnosis of Early Dementia

描述（由申请人提供）：对于所有患者，在疾病的最早可诊断阶段给予AD和其他痴呆的新治疗方法可能会增强疗效。这就需要高灵敏度、高特异性和高可靠性的早期痴呆筛查和诊断策略。为了在初级保健环境中实现这一目标，测试性能应受种族/民族和教育的影响最小，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有效的文化公平策略，以确定在初级保健治疗或参与临床试验的横截面非常早期痴呆症患者。我们假设这将涉及对所有老年患者进行快速筛查，并对筛查阳性的患者进行有限的额外检测，以证明记忆障碍和DSM IV标准所要求的另一种认知障碍。只有符合痴呆症神经心理学标准的患者才能进行临床评估，从而使筛查和诊断在初级保健环境中变得可行。我们还将研究种族/民族和教育对诊断过程的影响。将从城市老年医学诊所招募250名非洲裔美国人和250名白人患者及其知情人，并随机分配至4种诊断条件之一，这些诊断条件由评估者是否了解患者的种族和/或教育程度定义。诊断和临床分期将在3个波中的每一个波通过共识确定，与筛选试验和其他波的结果无关。最终将使用患者的纵向记录建立共识金标准诊断。从这项研究的结果，我们将建议的策略，以最大限度地确定患者的非常早期痴呆症的横截面。具体目标包括：具体目标1：评估每种测试和测试组合用于识别流行痴呆症的灵敏度和特异性。具体目标2：在确定痴呆事件的固定灵敏度水平下，评估每个测试和测试组合的特异性。具体目标3：评估了解种族和教育对诊断过程的影响。

DESCRIPTION (provided by applicant): For all patients, the efficacy of new treatments for AD and other dementias may be enhanced when administered during the earliest diagnosable stage of disease. This requires efficient strategies for screening and diagnosing very early dementia at high levels of sensitivity, specificity, and reliability. To achieve this goal in primary care settings, test performance should be minimally influenced by race/ethnicity and education and more sensitive to the memory impairment associated with very early dementia. Our long-term objective is to design efficient culture-fair strategies to identify patients with very early dementia at cross-section for treatment in primary care or for participation in clinical trials. We hypothesize that this will involve rapid screening of all geriatric patients and limited additional testing in patients who screen positive in order to demonstrate memory impairment and another cognitive disturbance as required by DSM IV criteria. A clinical evaluation is triggered only for patients who meet neuropsychological criteria for dementia, making screening and diagnosis feasible in primary care settings. We will also examine the influence of race/ethnicity and education on the diagnostic process. 250 African American and 250 Caucasian patients and their informants will be recruited from an urban geriatric medicine clinic and randomly assigned to 1 of 4 diagnostic conditions defined by whether or not raters know the patient's race and/or education. Diagnosis and clinical staging will be established by consensus at each of 3 waves independent of screening tests and results from other waves. A consensus gold standard diagnosis will be established at the end using the patient's longitudinal record. From the results of this study, we will recommend strategies to maximize the identification of patients with very early dementia at cross section. The specific aims include: Specific Aim 1: To estimate the sensitivity and specificity of each test and test combination for identifying prevalent dementia. Specific Aim 2: To estimate the specificity of each test and test combination at fixed levels of sensitivity for identifying incident dementia. Specific Aim 3: To estimate the effect of knowing race and education on the diagnostic process.