Testing Olfaction in Primary care to detect Alzheimer's disease and other Dementias (TOPAD)

在初级保健中测试嗅觉以检测阿尔茨海默病和其他痴呆症 (TOPAD)

• 批准号: 10192624
• 负责人: DAVANGERE P DEVANAND
• 金额: $ 75.02万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-30 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10192624
• 关键词: Address; Advisory Committees; Age; Alzheimer' s Disease; Alzheimer' s disease diagnosis; Area Under Curve; Biological Markers; Biological Specimen Banks; Blood Tests; Brain imaging; Cerebrospinal Fluid; Cognitive; Communities; Dementia; Detection; Diagnosis; Diagnostic; Early Diagnosis; Elderly; Ensure; Evaluation; Family health status; Genomics; Goals; Gold; Health Personnel; Healthcare Systems; Impaired cognition; Impairment; Memory impairment; National Institute on Aging; Nerve Degeneration; Odors; Participant; Pathway interactions; Patients; Pennsylvania; Performance; Persons; Practice Guidelines; Preventive service; Primary Health Care; Proteomics; Protocols documentation; Provider; Receiver Operating Characteristics; Recommendation; Research; Resources; Screening procedure; Smell Perception; Standardization; Testing; Time; United States; Universities; Update; accurate diagnosis; aged; amnestic mild cognitive impairment; base; blood-based biomarker; cognitive testing; community setting; data repository; improved; instrument; mental state; metabolomics; mild cognitive impairment; minimally invasive; multidisciplinary; novel strategies; olfactory bulb; primary care setting; primary outcome; response; screening; secondary analysis; secondary outcome; tool

The goal of our project, called “Testing Olfaction in Primary care to detect Alzheimer’s disease and other Dementias (TOPAD)”, is to test the 12-item BSIT, a short, standardized version of the 40-item University of Pennsylvania Smell Identification Test (UPSIT), for detection of dementia among elderly persons with cognitive concerns in a community-based primary care setting, in response to PAR-15-359 (Novel Approaches to Diagnosing Alzheimer’s Disease and Predicting Progression), and its second aim: “Identifying new biomarkers that are minimally invasive, inexpensive, usable in community settings”. Many elderly persons develop dementia that remains undiagnosed in primary care settings until it is severe, leading to catastrophic consequences for patients, families, and the health care system. Odor identification impairment with the 40-item UPSIT is a well- validated biomarker of dementia, particularly dementia of the Alzheimer’s type (DAT), The shorter version of the UPSIT, the 12-item BSIT, has been shown to be similar to the UPSIT in distinguishing and predicting MCI and DAT. We propose the BSIT for detection of dementia in primary care because it takes 5 minutes to administer, is inexpensive, and can be administered by non-medical personnel. We propose to test the BSIT for detection of dementia among 600 patients with cognitive concerns, without a diagnosis of dementia, age 65 years and older, who attend primary care practices in Northern Manhattan. The term cognitive concerns includes subjective cognitive decline (SCD), and warning signs identified by relatives, significant others, and health care providers. All participants will be tested with the BSIT, the MMSE, and other common dementia screening tools. The performance of tools will be assessed using as a gold standard cognitive diagnosis based using the 2011 National Institute on Aging (NIA)/Alzheimer Association (AA) recommendations for dementia and MCI using the National Alzheimer’s Coordinating Center (NACC) protocol. Our primary outcome will be dementia diagnosis at the initial evaluation. Cognitive assessments will be repeated every 12 months. Our secondary outcomes will be cognitive transitions to dementia (and subtypes), MCI and MCI subtypes. Our primary aim is to compare the accuracy of the BSIT with the MMSE for dementia detection at initial evaluation among persons aged 65 years and older with cognitive concerns in primary care. In secondary analyses, we will examine the secondary outcomes and compare the accuracy of the BSIT for dementia detection with other instruments: Montreal Cognitive Assessment (MOCA), Mini-Cog and Memory Impairment Screen (MIS). Our secondary aim is to compare the BSIT with the MMSE in predicting cognitive transitions at 12 and 24 months. In secondary analyses, we will compare the BSIT with other screening instruments (MOCA, Mini-Cog, MIS). TOPAD will be conducted by a multidisciplinary team of experts in Alzheimer’s research, odor identification testing, dementia diagnosis, and primary care.

我们的项目的目标，所谓的“测试嗅觉在初级保健，以检测阿尔茨海默氏症和其他疾病， 痴呆症（TOPAD）”，是测试12项BSIT，一个简短的，标准化版本的40项大学的 宾夕法尼亚州痴呆识别测试（UPSIT），用于检测有认知障碍的老年人中的痴呆症 在以社区为基础的初级保健环境的关注，以回应PAR-15-359（新的方法， 诊断阿尔茨海默病和预测进展），其第二个目标：“识别新的生物标志物 它们是微创的，便宜的，可在社区环境中使用的”。许多老年人患上痴呆症 在初级保健环境中一直未被诊断出来，直到它严重，导致灾难性的后果， 患者、家庭和医疗保健系统。气味识别障碍与40项UPSIT是一个很好的- 验证的痴呆，特别是阿尔茨海默型痴呆（DAT）的生物标志物。 UPSIT，12项BSIT，已被证明在区分和预测MCI方面与UPSIT相似， DAT。我们建议在初级保健中使用BSIT检测痴呆症，因为它需要5分钟的时间来管理， 价格便宜，并且可以由非医务人员进行给药。我们建议测试BSIT的检测 在600名有认知问题的患者中，年龄65岁， 在北方曼哈顿参加初级保健实践的老年人。认知问题一词包括主观 认知能力下降（SCD），以及亲属、重要他人和医疗保健提供者识别的警告信号。 所有参与者将接受BSIT，MMSE和其他常见痴呆症筛查工具的测试。的 工具的性能将使用基于2011年认知诊断的金标准进行评估。 美国国家老龄化研究所（NIA）/阿尔茨海默病协会（AA）使用 国家阿尔茨海默氏症协调中心（NACC）协议。我们的主要结果将是痴呆症的诊断， 初步评估。认知评估将每12个月重复一次。我们的次要结果将是 认知转变为痴呆（和亚型），MCI和MCI亚型。我们的主要目的是比较 在65岁人群中，BSIT与MMSE在痴呆检测初始评估中的准确性 以及在初级保健中有认知问题的老年人。在次要分析中，我们将检查次要 结果，并比较BSIT与其他仪器检测痴呆症的准确性：蒙特利尔 认知评估（莫卡）、Mini-Cog和记忆障碍筛查（MIS）。我们的第二个目标是 比较BSIT与MMSE在预测12个月和24个月认知转变方面的差异。在次要分析中， 我们将比较BSIT与其他筛查工具（莫卡，Mini-Cog，MIS）。将进行TOPAD 由一个多学科的专家团队在阿尔茨海默氏症的研究，气味识别测试，痴呆症诊断， 和初级保健。