CIND: Risk Factors for Conversion to Dementia

描述（由申请人提供）：对痴呆症发病机制的进一步了解给科学家们带来了新的希望，他们可能很快就会发现这种使人衰弱的疾病的改善治疗方法。初步证据表明，如果临床医生在临床前阶段尽早采用疾病改善治疗，将是最有效的。痴呆症的疾病改善治疗可能有潜在的严重副作用或并发症，因此尽早准确地识别患者至关重要。术语认知损伤-非痴呆（CIND）已被用来描述这种临床前状态。CIND捕获了广泛的功能障碍途径，并且这种情况的过程是可变的，一些受试者在很长一段时间内保持稳定，而另一些受试者则转变为痴呆，而另一些则恢复到明显的正常状态。在这一建议中，我们试图检查心血管危险因素在诊断认知状态中的作用。我们建议在初级保健环境中对这些患者进行大规模治疗。将从Wishard卫生系统初级保健数据库中随机抽取2000名65岁及以上的患者进行评估和诊断。CIND患者将每年随访（并重新诊断）4年。全面的评估程序将确保最佳的诊断准确性。广泛的注册医疗记录系统将允许回顾性和前瞻性地获取广泛的健康和医疗信息，并随着时间的推移将这些信息映射到临床诊断中。通过这种方式，我们将能够提高我们对哪些患有认知障碍-无痴呆（CIND）的老年人将发展为痴呆的理解，从而最有可能从早期开始的疾病改善治疗中获益。

DESCRIPTION (provided by applicant): Improved understanding of the pathogenesis of dementia brings renewed hope that scientists might soon discover disease-modifying treatments for this debilitating disorder. Initial evidence suggests that disease-modifying treatments would be the most effective if clinicians employed them early, in the preclinical phase. Disease-modifying treatments for dementia are likely to have potentially serious side effects or complications, and therefore it will be vital to identify patients as early and accurately as possible. The term cognitive impairment-no dementia (CIND) has been used to describe this preclinical state. CIND captures a broad range of pathways to dysfunction and the course of this condition is variable with some subjects remaining stable for long period while other convert to dementia and other revert to apparent normalcy. In this proposal, we seek to examine the role of cardiovascular risk factors on diagnosed cognitive status cross-sectionally and longitudinally. We propose to do this in the primary care environment where wide-scale treatment of these patients will occur. A random sample of 2000 patients aged 65 and older from the Wishard Health System primary care database will be evaluated and diagnosed. Patients with CIND will be followed (and re-diagnosed) annually for 4 years. Thorough procedures for assessment will assure optimum diagnostic accuracy. The extensive Regenstrief Medical Records System will allow retrospective and prospective capture of a wide range of health and medical information and the mapping of this information onto clinical diagnosis over time. In this way, we will be able to improve our understanding of which older adults with cognitive impairment-no dementia (CIND) will progress to dementia and would thus be the most likely to benefit from early initiation of disease-modifying treatments.