Culture-Fair Screening and Diagnosis of Early Dementia

描述（由申请人提供）：对于所有患者，在疾病的最早诊断阶段给予阿尔茨海默病和其他痴呆症的新治疗方法可能会提高疗效。这需要有效的策略来筛查和诊断非常早期的痴呆症，并具有高灵敏度、特异性和可靠性。为了在初级保健环境中实现这一目标，测试成绩应尽量不受种族/民族和教育的影响，并对与早期痴呆相关的记忆障碍更加敏感。我们的长期目标是设计有效的文化公平策略，在横截面上识别早期痴呆患者，以便进行初级保健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DSM IV标准要求的记忆障碍和另一种认知障碍。只有符合痴呆神经心理学标准的患者才会触发临床评估，使筛查和诊断在初级保健机构中可行。我们还将研究种族/民族和教育对诊断过程的影响。250名非裔美国人和250名白种人患者和他们的线人将从一个城市老年医学诊所招募并随机分配到4种诊断条件中的1种由评分者是否知道患者的种族和/或教育程度决定。诊断和临床分期将在独立于筛查试验和其他波的结果的3波中的每一波中达成共识。共识金标准诊断将建立在最后使用患者的纵向记录。根据本研究的结果，我们将推荐在横截面上最大限度地识别早期痴呆患者的策略。具体目的包括：具体目的1：估计每种测试和测试组合的敏感性和特异性，以确定流行痴呆。特定目标2：在确定痴呆事件的固定敏感性水平上，估计每种测试和测试组合的特异性。具体目标3：估计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.