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年患有阿尔茨海默病和相关痴呆症的拉丁裔/西班牙裔老年人数量将增加六倍，拉丁裔/西班牙裔社区将面临“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及合并AD和VaD （AD/VaD）的风险相关。获得诊断和治疗受到语言能力、个人信仰和经济状况的阻碍，诊断延误多达5年。因为大多数老年患者一年要看几次初级保健医生，所以有机会确定轻度AD和相关痴呆的患者。不幸的是，初级保健对轻度痴呆的认识很差，因为缺乏准确和有效的病例发现方法来识别差异组中的轻度痴呆。当使用迷你精神状态检查（MMSE）来识别病例时，拉丁裔/西班牙裔患者和受教育程度低的患者的误诊率很高。需要一种在差异组中同样有效的病例发现工具，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。第一阶段只需要5分钟，并且具有很高的灵敏度。只有30%的第一阶段失败的患者接受第二阶段治疗，只需12分钟。ADS-PC比MMSE具有更好的工作特性和时间效率。它对非裔美国人和白种人以及受教育程度低和高的人同样有效。在这个R21中，我们将我们的病例发现工作扩展到来自一家联邦认证的社区卫生中心的讲西班牙语的老年人，该中心主要服务于南布朗克斯的拉丁裔/西班牙裔社区。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（~75例）和随机筛选阴性对照（~75例）将进行研究质量评估，以确定临床标准（痴呆，无痴呆），并根据该标准评估ADS-PC的并发结构效度。我们将比较ADS-PC和MMSE的工作特征，确定最准确和有效的方法来识别轻度痴呆和AD病例。诊断信息和治疗建议将提供给病人的医生。除非初级保健对轻度痴呆症的认识得到改善，否则少数民族患者和受教育程度低的个体将无法获得目前已证实的药理学和行为干预措施以及未来的疾病改善治疗，从而确保痴呆治疗和预防方面的差距。

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.