Cross-Cultural Validity of Cognitive Function Tests

描述（由申请人提供）：美国最大的两个种族/少数民族，非洲裔美国人和西班牙裔美国人，比非西班牙裔白人患糖尿病和某些糖尿病并发症的风险更高。最近发现，2型糖尿病患者的认知障碍和认知能力加速下降的发生率高于非糖尿病患者。在以人口为基础的研究中，这些少数群体出现认知障碍和痴呆的风险也更大。种族/民族与2型糖尿病患者认知障碍之间的关系尚未被研究。在进行此类研究之前，有必要确定一套可靠且跨文化有效的认知功能测试，用于2型糖尿病风险最高的患者群体。本研究的目的是验证一种假设，即一系列文化中立的认知功能测试可以在低识字率、双语、双文化患者群体中产生可靠和有效的特定认知功能领域的测量。这套测试中包含的认知功能测试之前已经在英语和西班牙语人群中进行过测试和规范，但它们的跨文化有效性尚不清楚。从一个大型的城市初级保健诊所网络中招募总共480名2型糖尿病患者，代表四个种族/语言偏好组（120名非西班牙裔白人，120名非西班牙裔非洲人，120名首选语言为英语的西班牙裔美国人和120名首选语言为西班牙语的西班牙裔美国人）。他们将在最初的时间点和一个月后进行测试。患者的时间将得到经济补偿，这样至少312例（65%）患者将有完整的复检数据可供分析。将从参与者及其医疗记录中收集社会人口学和病史数据。身高、体重、血压和腰围将在初次测试前测量。在40%的亚样本（n=208）中，将测量空腹血糖和胰岛素、血脂、血浆同型半胱氨酸（含叶酸和维生素B12）和c反应蛋白。将计算每个族裔群体中单个测试的测试-重测信度，并使用探索性和验证性因素分析对四个定义的种族/族裔和语言群体中的测试有效性进行测试。对于那些发现是可靠和有效的认知功能测量，将使用多元回归分析来测试测试分数与患者的特定临床特征之间的关联，例如年龄，糖尿病持续时间，血糖水平，糖尿病治疗方案，以及每个物理和生化变量将被检查。

DESCRIPTION (provided by applicant): The two largest racial/ethnic minorities in the U.S., African-Americans and Hispanics, are at higher risk for diabetes and certain diabetes complications than non-Hispanic whites. Recently, cognitive impairment and accelerated cognitive decline have been found to be higher in persons with type 2 diabetes than in nondiabetics. In population based studies these minority groups also appear to be greater risk for cognitive impairment and dementia. The relationship between race/ethnicity and cognitive impairment among persons with type 2 diabetes has not been studied. Before such studies can be undertaken, it is necessary to identify a set of cognitive function tests that is reliable and cross culturally valid in patient groups at greatest risk for type 2 diabetes. The purpose of this study is to test the hypothesis that a brief battery of culturally neutral cognitive function tests can yield reliable and valid measures of specific cognitive function domains in low literacy, bilingual, bi-cultural patient populations. The cognitive function tests included in the battery have been previously tested and normed in both English-speaking and Spanish-speaking groups, but their crosscultural validity is not known. A total of 480 patients with type 2 diabetes representing four ethnicity/language preference groups will be recruited from a large, urban, primary care clinic network (120 non-Hispanic whites, 120 non-Hispanic African-Americans, 120 Hispanics whose preferred language is English, and 120 Hispanics whose preferred language is Spanish). They will be tested at an initial time point and one month later. Patients will be compensated financially for their time so that at least 312 (65%) patients with complete test-retest data will be available for analysis. Sociodemographic and medical history data will be collected from the participants and their medical records. Height, weight, blood pressure, and waist circumference will be measured before the initial test session. In a 40% subsample (n=208), fasting plasma glucose and insulin, lipid profile, plasma homocysteine (with folate and vitamin B12), and c-reactive protein will be measured. The test-retest reliability of the individual tests in the battery will be calculated for each ethnic group, and the validity of the tests across the four defined racial/ethnic and linguistic groups will be tested using exploratory and confirmatory factor analysis. For those cognitive function measures found to be reliable and valid, multiple regression analysis will be used to test associations between test scores and specific clinical characteristics of the patients, such as age, duration of diabetes, glycemic level, diabetes treatment regimen, and each of the physical and biochemical variables will be examined.