5-Cog Battery to improve detection of cognitive impairment and dementia

5-Cog 电池可改善认知障碍和痴呆症的检测

• 批准号: 9769547
• 负责人: JOE VERGHESE
• 金额: $ 82.35万
• 依托单位: ALBERT EINSTEIN COLLEGE OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-25 至 2022-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9769547
• 关键词: African American; Assessment tool; Biological Assay; Cognitive; Complex; Computerized Medical Record; Control Groups; Cost Effectiveness Analysis; Coupled; Data; Decision Trees; Dementia; Detection; Diagnosis; Educational Background; Electronic Health Record; Ethnic Origin; Ethnic group; Evaluation; Event; Gait; Health; Health Professional; Hispanics; Human Resources; Impaired cognition; India; Individual; Internet; Intervention; Investigation; Laboratories; Logistics; Low Literacy Population; Measures; Medical; Medicare; Memory impairment; Mental Depression; Methods; Motor; Neuropsychological Tests; Outcome; Outpatients; Paper; Patient Care; Persons; Pharmaceutical Preparations; Phase; Population; Primary Care Physician; Primary Health Care; Procedures; Process; Questionnaires; Randomized; Randomized Clinical Trials; Registries; Risk; Rural; Services; Single-Blind Study; Site; Social Work; Specialist; Specificity; Standardization; Syndrome; System; Test Result; Testing; Training; Validation; Visit; Work; active control; base; cognitive testing; cohort; cost; dementia care; experience; follow-up; grasp; group intervention; health care service utilization; health literacy; high risk; improved; informant; literacy; mild cognitive impairment; older patient; patient population; primary care setting; recruit; screening; socioeconomics; tool; validation studies

Cognitive impairment related to dementia is frequently under-diagnosed in primary care settings despite the availability of numerous assessment tools. Missed detection delays treatment of reversible conditions as well as provision of support services and critical planning. This problem is more prevalent among older African- Americans and Hispanics than among older whites. Our group has two decades of experience developing tools to detect dementia in health disparate populations. Notably, we developed the Picture-based Memory Impairment Screen (PMIS) that relies on culture fair pictures and does not need to be administered by a medical professional. We also validated the Motoric Cognitive Risk syndrome (MCR). This highly accessible test relies on the presence of slow gait and cognitive self-complaints to identify individuals at high risk of converting to dementia. Both the PMIS and the MCR are highly sensitive and specific first-line assays that can be followed up with more thorough and complex cognitive testing. Building on our work, we propose to develop and validate a 5-minute screen (5-Cog) to identify persons at high risk of developing dementia and to flag them for further evaluation. We propose to do this in urban, multi-ethnic Bronx primary care populations with socio-economic challenges. The 5-Cog battery will include the PMIS, MCR syndrome diagnosis, and a 2-item depression screener. In the 18-month UG3 phase, we propose to fine-tune the components of the 5-Cog that will be tested in a health disparate population in the Bronx, and could be extended to other participating sites under this RFA. We will also test the feasibility of administering the 5-Cog by non-physicians to increase accessibility of our battery in primary care settings. In the 42-month UH3 phase, we propose a single-blind, randomized clinical trial in 1,200 older primary care patients presenting with cognitive complaints who will be randomized to receive either the 5-Cog battery (intervention group) or a 5-minute health literacy questionnaire (control group). Non-physicians will administer the intervention and control tests in primary care sites, and test results will be provided to primary care physicians for further action. ‘Improved dementia care’ will be measured by using a composite endpoint including new Mild Cognitive Impairment syndrome (MCI) or dementia diagnoses, laboratory investigations to rule out reversible causes of cognitive impairment, new dementia medication prescriptions, and specialist or social work referrals. The outcome events will be tracked using our electronic health record system. We will also conduct health care utilization and cost effectiveness analysis of the 5-Cog intervention in real-world settings. By the end of the UH3 phase, we will create a web registry to make 5-Cog test items and procedures available for download by health care professionals. The 5-Cog battery will overcome many of the implementation barriers of previous cognitive screens; it will be fast, low cost, easy to implement (requires only pen, paper and stopwatch), can be administered by non- clinicians after minimal training, not educationally or culturally biased, not confounded by depression and does not require informants.

尽管在初级保健机构中，与痴呆相关的认知障碍经常被诊断不足 多种评估工具的可用性。漏检也会延迟可逆病症的治疗 如提供支持服务和关键规划。这个问题在非洲老年人中更为普遍 美国人和西班牙裔人的比例高于年长白人。我们的团队拥有二十年的工具开发经验 检测健康状况不同的人群中的痴呆症。值得注意的是，我们开发了基于图片的记忆 损伤筛查 (PMIS) 依赖于文化公平图片，不需要由 医疗专业人士。我们还验证了运动认知风险综合症（MCR）。这个交通便利的 测试依赖于缓慢步态和认知自我抱怨的存在来识别高风险个体 转变为痴呆症。 PMIS 和 MCR 都是高度灵敏和特异性的一线检测方法，可以 随后进行更彻底和复杂的认知测试。 在我们的工作基础上，我们建议开发并验证 5 分钟筛选 (5-Cog)，以识别处于高位的人 患痴呆症的风险，并标记他们以进行进一步评估。我们建议在城市、多民族地区这样做 布朗克斯初级保健人群面临社会经济挑战。 5-Cog 电池将包括 PMIS、 MCR 综合征诊断，以及 2 项抑郁症筛查。 在 18 个月的 UG3 阶段，我们建议对 5-Cog 的组件进行微调，这些组件将在 布朗克斯区不同人群的健康状况，并且可以根据本 RFA 扩展到其他参与地点。我们 还将测试由非医生管理 5-Cog 的可行性，以提高电池的可及性 在初级保健机构中。 在 42 个月的 UH3 阶段，我们建议在 1,200 名老年初级保健人员中进行单盲、随机临床试验 出现认知问题的患者将被随机分配接受 5-Cog 电池 （干预组）或 5 分钟健康素养问卷（对照组）。非医生将进行管理 在初级保健场所进行干预和控制测试，并将测试结果提供给初级保健机构 医生采取进一步行动。 “改善痴呆症护理”将通过使用复合终点来衡量 包括新的轻度认知障碍综合征 (MCI) 或痴呆症诊断、实验室检查 排除认知障碍的可逆性原因、新的痴呆药物处方以及专家或 社会工作转介。结果事件将使用我们的电子健康记录系统进行跟踪。我们将 还对现实世界中的 5-Cog 干预进行医疗保健利用和成本效益分析 设置。在 UH3 阶段结束时，我们将创建一个网络注册表来制作 5-Cog 测试项目和程序 可供医疗保健专业人员下载。 5-Cog电池将克服以前认知屏幕的许多实施障碍；这将是 快速、成本低、易于实施（仅需要笔、纸和秒表），可以由非 临床医生经过最低限度的培训，没有教育或文化偏见，没有被抑郁症所困扰，并且 不需要线人。