Improving the measurement of everyday functional outcomes in diverse populations of older adults with Alzheimer's disease and related disorders

项目摘要 美国的老龄化人口在种族和民族上比以往任何时候都更加多样化。 不同老年人群体的健康差异已得到充分记录，包括证据表明 这表明，在一些人中，阿尔茨海默病（AD）和相关疾病的发病率可能会增加， 组旨在了解、预防和改善AD中的健康差异的研究是一项重要的研究。 公共卫生优先。然而，要研究和解决这些健康差距， 和文化上适当的评估工具，以敏感地测量与AD相关的早期临床体征， 提供良好的结局指标，以跟踪疾病进展和对治疗的反应。测量 这些评估工具的属性必须在不同的概念和心理测量学上是等效的。 人口数量。通过之前的NIA资金（Farias，AG 0215111，AG 031252），我们开发了一种新的 基于问卷的评估工具（用于测量早期局限性的日常认知量表（ECog）） 在日常功能中。我们的工作表明，日常功能的微妙变化，如测量的， ECog可用于识别老年人患轻度认知障碍（MCI）的风险增加 和痴呆症。然而，我们最近的工作表明，目前版本的ECog不太敏感， 预测少数民族/种族亚组（拉丁美洲人和非洲裔美国人）的疾病进展 在非拉丁裔白人中。这些研究结果为调整和进一步完善这一机制的必要性提供了明确的理由。 作为疾病早期指标和各种疾病的结果衡量标准， 人口数量。拟议的研究将采用多种方法（定量和定性）来评估 并提高ECog在不同老年人群中的测量等效性。的目的 这项研究是双重的。在目标1中，我们将利用来自加州大学戴维斯分校阿尔茨海默病的现有数据 疾病中心的多种族纵向队列，以定量评估ECog显示的项目 三个种族/族裔群体（非裔美国人、拉丁美洲人和 非拉丁裔高加索人）使用复杂的分析方法。根据目标1的结果，目标2将采用 完善的认知访谈方法，以进一步评估和确定为什么特别 ECog项目对特定种族/族裔群体有问题。例如，某些项目可能不容易 理解为预期的和/或一些项目可能不适当的文化背景和生活方式的一些 组这些项目将相应修改，第二波认知访谈将进一步 评估项目修订。完成这项研究将提供关键的形成性工作，以提高我们的能力， 在不同的老年人中，以可比的准确性和精确性测量日常功能的早期变化 成人人口。

Project Summary The aging population in the United States is becoming more racially and ethnically diverse than ever before. Health disparities have been well documented across diverse older adult populations, including evidence to suggest that there may be increased rates of Alzheimer's disease (AD) and related disorders among some groups. Researched aimed at understanding, preventing and ameliorating health disparities in AD is a major public health priority. However, to study and address these health disparities requires psychometrically sound and culturally appropriate assessment tools to sensitively measure early clinical signs associated with AD and to provide good outcome measures to track disease progression and response to treatment. The measurement properties of such assessment tools must be conceptually and psychometrically equivalent across diverse populations. With previous NIA funding (Farias, AG 0215111, AG 031252) we developed a novel questionnaire-based assessment tool (the Everyday Cognition scales (ECog) to measure very early limitations in everyday functions. Our work has shown that subtle changes in everyday functions, as measured by the ECog, can be used to identify older adults at increased risk for developing Mild Cognitive Impairment (MCI) and dementia. However, our most recent work has shown that the current version of the ECog is less sensitive to predicting disease progression in ethnic/racial minority subgroups (Latinos and African Americans) than it is in non-Latino Caucasians. Such findings provide clear rationale for the need to adapt and further refine this instrument to improve its utility as an early indicator of disease and as an outcome measure among diverse populations. The proposed study will utilize a multi-method (quantitative and qualitative) approach to evaluate and improve the measurement equivalence of the ECog among diverse older adult populations. The aims of this study are twofold. In Aim 1 we will utilize existing data from the University of California, Davis Alzheimer Disease Center's multiethnic longitudinal cohort to quantitatively evaluate which items of the ECog display evidence of poor measurement equivalence across three racial/ethnic groups (African Americans, Latinos, and non-Latino Caucasians) using sophisticated analytic methods. Informed by results of Aim 1, Aim 2 will employ well-established cognitive interviewing methods to further evaluate and identify the reasons why particular ECog items are problematic for specific racial/ethnic groups. For example, some items may not be readily understood as intended and/or some items may not be appropriate the cultural context and lifestyle of some groups. These items will be modified accordingly and a second wave of cognitive interviews will further evaluate item revisions. Completion of this study will provide the critical formative work to improve our ability to measure early changes in everyday function with comparable accuracy and precision across diverse older adult populations.