Screening and Diagnosis of Mild Alzheimer's Disease in Latino Elders

描述（由申请人提供）：五年前，阿尔茨海默病协会警告说，由于预计到2050年拉丁美洲/西班牙裔老年人患有AD和相关痴呆症的人数将增加六倍，拉丁美洲/西班牙裔社区将出现“迫在眉睫”的危机。在拉丁美洲/西班牙裔患者中升高的血管风险因素与认知能力下降和AD、VaD以及伴随AD和VaD（AD/VaD）的风险相关。获得诊断和治疗受到语言能力、个人信仰和经济地位的阻碍，使诊断推迟了五年之久。由于大多数老年患者每年都要看几次初级保健医生，因此有机会识别轻度AD和相关痴呆症患者。不幸的是，承认轻度痴呆症的初级保健是穷人，因为缺乏准确和有效的情况下发现方法来确定轻度痴呆症的差距组。当使用简易精神状态检查（MMSE）来识别病例时，拉丁裔/西班牙裔患者和受教育程度低的患者的错误分类率很高。需要一种在差异组中同样有效的病例发现工具，这促使我们开发了两阶段阿尔茨海默病初级保健筛查（ADS-PC），以识别差异组中的轻度痴呆和AD。第一阶段仅需五分钟，专为高灵敏度而设计。第二阶段只给30%的第一阶段失败的患者，只需要12分钟。ADS-PC比MMSE具有更好的工作特性和更高的时间效率。它同样适用于非裔美国人和高加索人，以及那些低和高教育。在这个R21中，我们将病例发现工作扩展到来自联邦合格社区卫生中心的讲西班牙语的老年人，该中心为南布朗克斯的主要拉丁裔/西班牙裔社区提供服务。500名讲西班牙语的患者将使用ADS-PC进行筛查，以确定可能患有痴呆症的个体。筛选阳性患者（约75例）和筛选阴性对照随机样本（约75例）将接受研究质量评价，以确定评估ADS-PC并行结构效度的临床标准（痴呆、非痴呆）。我们将比较ADS-PC和MMSE的操作特征，并确定最准确和有效的方法来识别轻度痴呆和AD病例。将向患者的医生提供诊断信息和治疗建议。除非在初级保健中对轻度痴呆症的认识有所提高，否则少数民族患者和教育程度低的个人将无法获得当前一代经过验证的药理学和行为干预措施以及未来的疾病改善治疗，从而确保痴呆症治疗和预防的差异。 公共卫生相关性：五年前，阿尔茨海默病协会警告说，由于预计到2050年拉丁美洲老年人患AD和相关痴呆症的人数将增加六倍，拉丁美洲/西班牙裔社区将出现“迫在眉睫”的危机。不幸的是，在大多数拉丁裔/西班牙裔老年人接受护理的初级保健机构中，对轻度痴呆症的认识很差。由于缺乏准确有效的病例发现方法来识别差异组中的轻度痴呆症，我们开发并验证了一种有效且具有成本效益的工具来识别初级保健环境中的早期痴呆症和AD患者。在这个R21中，我们将病例发现工作扩展到来自联邦合格社区卫生中心的西班牙语患者，该中心为南布朗克斯的拉丁裔/西班牙裔社区提供服务。筛查阳性患者和筛查阴性对照的随机样本将进行研究质量评估，以确定痴呆状态。这将是我们评估病例发现工具准确性的标准。我们将比较我们的病例发现工具的操作特点与最广泛使用的痴呆症筛查测试，并确定最准确和有效的方法来识别拉丁美洲/西班牙裔老年人的轻度痴呆症病例。将向患者的医生提供诊断信息和治疗建议。

DESCRIPTION (provided by applicant): Five years ago, the Alzheimer Association warned of a "looming" crisis in the Latino/Hispanic community due to a projected six-fold increase in the number of Latino/Hispanic elders suffering from AD and related dementias by 2050. Vascular risk factors, which are elevated in Latino/Hispanic patients, are associated with cognitive decline and the risk of AD, VaD and concomitant AD and VaD (AD/VaD). Access to diagnosis and treatment is hampered by language proficiency, personal beliefs, and economic status, delaying diagnosis by as many as five years. Because most elderly patients see a primary care physician several times a year, there is an opportunity to identify patients with mild AD and related dementias. Unfortunately, recognition of mild dementia in primary care is poor because accurate and efficient case finding methods are lacking to identify mild dementia in disparity groups. Misclassification rates are high for Latino/Hispanic patients and for patients with low education when the Mini Mental Status Exam (MMSE) is used to identify cases. The need for a case finding tool that works equally well in disparity groups prompted our development of the two-stage Alzheimer's Disease Screen for Primary Care (ADS-PC) to identify mild dementia and AD in disparity groups. The first stage takes just five minutes and is designed for high sensitivity. The second stage is given only to the 30% of patients who fail the first stage and takes just 12 minutes. The ADS-PC has better operating characteristics and is more time efficient than the MMSE. It works equally well in African American and Caucasian individuals and in those with low and high education. In this R21, we extend our case-finding efforts to Spanish speaking elders from a federally qualified community health center that serves a largely Latino/Hispanic community in the South Bronx. 500 Spanish speaking patients will be screened with the ADS-PC to identify individuals likely to have dementia. Screen positive patients (~75) and a random sample of screen negative controls (~75) will undergo a research quality evaluation to determine the clinical standard (dementia, no dementia) against which the concurrent construct validity of the ADS-PC will be assessed. We will compare the operating characteristics of ADS-PC and the MMSE and determine the most accurate and efficient way to identify cases of mild dementia and AD. Diagnostic information and treatment recommendations will be provided to the patient's physician. Unless recognition of mild dementia in primary care improves, the current generation of proven pharmacological and behavioral interventions and future disease modifying treatments will not be available to minority patients and individuals with low education, ensuring a disparity in dementia treatment and prevention. PUBLIC HEALTH RELEVANCE: Five years ago, the Alzheimer Association warned of a "looming" crisis in the Latino/Hispanic community due to a projected six-fold increase in the number of Latino elders suffering from AD and related dementias by 2050. Unfortunately, recognition of mild dementia is poor in primary care settings where most Latino/Hispanic elders receive their care. Prompted by the lack of accurate and efficient case finding methods to identify mild dementia in disparity groups, we have developed and validated an efficient and cost-effective tool to identify patients with early dementia and AD in primary care settings. In this R21, we extend our case-finding efforts to Spanish speaking patients from a federally qualified community health center that serves a largely Latino/Hispanic community in the South Bronx. Screen positive patients and a random sample of screen negative controls will undergo a research quality evaluation to determine dementia status. This will be the standard against which the accuracy of our case finding tool will be assessed. We will compare the operating characteristics of our case finding tool with the most widely used dementia screening test and determine the most accurate and efficient way to identify cases of mild dementia in Latino/Hispanic elders. Diagnostic information and treatment recommendations will be provided to the patient's physician.