Culture-Fair Screening and Diagnosis of Early Dementia

描述(由申请人提供)：对于所有患者，如果在疾病的最早可诊断阶段进行治疗，AD和其他痴呆的新治疗方法的疗效可能会增强。这需要有效的策略来筛选和诊断非常早期的痴呆症，并具有高度的敏感性、特异性和可靠性。为了在初级保健环境中实现这一目标，测试成绩应最大限度地受到种族/民族和教育的影响，并对与早期痴呆相关的记忆损害更加敏感。我们的长期目标是设计有效的文化公平策略，在横断面上识别非常早期痴呆的患者，以便在初级保健中进行治疗或参与临床试验。我们假设这将包括对所有老年患者进行快速筛查，并对筛查呈阳性的患者进行有限的额外测试，以证明记忆障碍和DSM IV标准所要求的另一种认知障碍。只有符合痴呆神经心理学标准的患者才会触发临床评估，从而使初级保健环境中的筛查和诊断变得可行。我们还将研究种族/民族和教育对诊断过程的影响。250名非洲裔美国人和250名白人患者及其信息者将从一家城市老年医学诊所招募，并随机分配到4种诊断条件中的一种，根据评分员是否知道患者的种族和/或教育程度来定义。诊断和临床分期将在3个波中的每一个波上达成共识，独立于筛查试验和其他波的结果。最终将使用患者的纵向记录建立一致的黄金标准诊断。根据这项研究的结果，我们将建议最大限度地在横断面上识别非常早期痴呆患者的策略。具体目标包括：具体目标1：评估每个测试和测试组合在识别普遍痴呆方面的敏感度和特异度。具体目标2：在确定偶发痴呆的敏感度水平上，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.