Community-Based Early Identification of MCI in at Risk African Americans

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DESCRIPTION (provided by applicant): Community-dwelling, African-American elders show faster rates of cognitive decline than elderly white Americans and are almost twice as likely to develop mild cognitive impairment (MCI) and Alzheimer's disease (AD). However, in the early stages of these disorders, African-American elders are less likely to be diagnosed or receive treatment. Such health disparities represent a critical roadblock to early identification and care for MCI and dementia, which not only diminishes the medical and social benefits to the individual patient and family, but also fiscal savings at the state and federal levels. Development of economically viable and culturally acceptable methods of early detection of cognitive change is critical in minority populations. With the increase in longevity and the rapid increase in the proportion of elderly in the population, it is important to evaluate the earliest risk for dementia more accurately in order to guide environmental and clinical interventions for older adults. MCI, characterized by cognitive difficulties without clear functional impairment, is a daily-life-limitig condition that in most cases is a precursor to AD. Access to well characterized elderly who are at risk for MCI (e.g., memory complaint, but otherwise healthy) provides a unique opportunity to study the earliest signs of accelerated cognitive decline in individuals at highest risk for developing dementia. The proposed cross-sectional study will test to what extent computerized cognitive tests and portable electroencephalography (EEG/ERP) methodology can be used to easily, accurately and efficiently identify early cognitive decline and MCI in elderly African-Americans within their community setting. Additionally, we will also evaluate feasibility and acceptability of these computer-based and electrophysiological methods. We propose to accomplish the above aims by recruiting a total of 200 at risk African Americans (age e 65 years) from among the 1,100 participants in the Healthier Black Elders Center (HBEC) in their communities within the Detroit metro area. We will use an MCI-enriched sampling by recruiting only those older African Americans who in the recent past expressed subjective memory complaints. These 200 at risk elder African Americans will be extensively evaluated with two computerized tests (i.e., CogState and NIH Toolbox), EEG/ERP recordings, and a structured medical/neuropsychological exam and consensus. Our community based proposal, combining behavioral and EEG/ERP methods, will be used to establish the utility and acceptability of these measures and to potentially generate profiles of at risk healthy, elderly African-Americans, who may, within a short period of time, develop MCI (participants will be longitudinally followed after this project). We predict that a combination of behavioral and EEG/ERP methods will allow development of objective markers that will reliably identify early signs of cognitive decline. Such markers, in addition to identification of significant cognitive decline, may also play a significan role in the recruitment of larger, more diverse populations in order to evaluate the efficiency of new pharmacological approaches.