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

描述(申请人提供)：五年前，阿尔茨海默氏症协会警告说，由于预计到2050年，患有AD和相关痴呆的拉美裔/拉美裔老年人的数量将增加六倍，拉美裔/拉美裔社区将出现一场“迫在眉睫的”危机。血管危险因素在拉丁裔/西班牙裔患者中升高，与认知能力下降和AD、VAD以及伴发AD和VAD(AD/VAD)的风险相关。获得诊断和治疗的机会受到语言熟练程度、个人信仰和经济状况的阻碍，诊断被推迟了长达五年。因为大多数老年患者每年都会去看几次初级保健医生，所以有机会确定患有轻度阿尔茨海默病和相关痴呆的患者。不幸的是，初级保健中对轻度痴呆的认识很差，因为缺乏准确和有效的病例查找方法来识别差异群体中的轻度痴呆。当使用迷你精神状态检查(MMSE)来识别病例时，拉丁裔/西班牙裔患者和低教育程度患者的错别率很高。对在差异群体中同样有效的病例查找工具的需求促使我们开发了两阶段阿尔茨海默病初级护理筛查(ADS-PC)，以识别差异群体中的轻度痴呆症和AD。第一个阶段只需要五分钟，并且是为高灵敏度设计的。第二阶段只适用于第一阶段失败的30%的患者，只需12分钟。与MMSE相比，ADS-PC具有更好的操作特性和更高的时间效率。它在非裔美国人和高加索人以及受教育程度较低和较高的人中同样有效。在这本R21中，我们将我们的病例查找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，该中心服务于南布朗克斯以拉丁裔/西班牙裔为主的社区。将使用ADS-PC对500名讲西班牙语的患者进行筛查，以确定可能患有痴呆症的个体。筛查阳性患者(~75人)和随机抽取筛查阴性对照(~75人)将进行研究质量评估，以确定ADS-PC的并发结构效度评估的临床标准(痴呆症和非痴呆症)。我们将比较ADS-PC和MMSE的操作特点，并确定识别轻度痴呆和AD病例的最准确和最有效的方法。诊断信息和治疗建议将提供给患者的医生。除非初级保健中对轻度痴呆症的认识有所改善，否则少数族裔患者和教育程度较低的个人将无法获得当前一代经过验证的药物和行为干预措施以及未来的疾病修正治疗，从而确保痴呆症治疗和预防方面的差异。 与公共卫生相关：五年前，阿尔茨海默氏症协会警告称，由于预计到2050年，患有阿尔茨海默病和相关痴呆症的拉美裔老年人数量将增加6倍，拉美裔/拉美裔社区将出现一场“迫在眉睫的”危机。不幸的是，在大多数拉美裔/西班牙裔老年人接受护理的初级保健环境中，对轻度痴呆症的认识很差。由于缺乏准确和有效的病例查找方法来识别差异群体中的轻度痴呆症，我们开发并验证了一种有效和经济的工具来识别初级保健环境中的早期痴呆症和阿尔茨海默病患者。在这本R21中，我们将我们的病例查找工作扩展到来自联邦合格社区卫生中心的讲西班牙语的患者，该中心服务于南布朗克斯以拉丁裔/西班牙裔为主的社区。筛查阳性患者和随机抽样的筛查阴性对照将接受研究质量评估，以确定痴呆状态。这将是评估我们案件查找工具准确性的标准。我们将把我们的病例查找工具的操作特点与最广泛使用的痴呆症筛查测试进行比较，并确定在拉丁裔/西班牙裔老年人中识别轻度痴呆症的最准确和最有效的方法。诊断信息和治疗建议将提供给患者的医生。

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.