ARMCADA - Advancing Reliable Measurement in Cognitive Aging and Decision-making Ability

随着年龄的增长，人们越来越重视做出重要的、长期的、多样化的决定，从医疗到财务到法律的等等。这些决定是独立生活的基本能力的基础。认知障碍往往妨碍基本的决策能力，严重影响生活质量。不幸的是，决策能力的缺陷往往导致有害的后果，包括经济损失、无法同意医疗程序，甚至容易受到虐待。越来越多的证据表明，决策能力的早期筛查可以作为与阿尔茨海默病和阿尔茨海默病相关痴呆（AD/ADRD）相关的早期年龄相关认知障碍的重要指标。然而，尽管2020年美国预防服务工作组的一份报告指出了早期评估和检测老年人，照顾者和家庭功能结果的重要性，但认知障碍筛查通常不包括对决策能力的系统和全面评估。 我们将建立认知老化和决策能力的先进可靠测量（ARMCADA）研究网络，并整合调整，开发，验证和规范措施的努力，以评估老龄化人口的决策功能。我们的西北大学团队在开发用于评估系统开发，验证和分发的国家研究网络方面拥有丰富的经验，包括原始的NIH神经科学蓝图合同，以创建NIH神经和行为功能评估（NIHTB）。我们将利用这些专业知识来完成三个具体目标： 拟议项目将1）创建ARMCADA研究网络，目标是推进成功老龄化决策技能的理论分类; 2）在代表整个范围的老龄化样本中识别、综合、创建和验证新的决策措施决策能力水平和少数族裔背景的老年人; 3）促进这些措施在全国范围内的可扩展公共传播，包括纳入电子健康记录系统，有利于早期识别老年认知障碍患者，并评估旨在缓解认知功能下降的潜在干预措施的有效性，AD/ADRD。

With age comes increasing emphasis on making highly consequential, long term and varied decisions, ranging from medical to financial to legal, and beyond. These decisions underlie the basic competencies for independent living. Cognitive impairment often hinders basic decision-making capacities, significantly impacting quality of life. Deficits in decision-making capacity sadly often lead to harmful consequences including financial loss, incapacity to consent to medical procedures, and even vulnerability for elder abuse. There is growing evidence that early screening of decision-making capacity can be an important indicator of early age-related cognitive impairment related to Alzheimer’s disease and Alzheimer’s disease-related dementias (AD/ADRD). Yet, despite a 2020 United States Preventive Services Task Force report pointing to the importance of early assessment and detection of such functional outcomes for older adults, caregivers, and families, cognitive impairment screening typically does not include systematic and comprehensive assessment of decision-making capacity. We will establish the Advancing Reliable Measurement in Cognitive Aging and Decision-making Ability (ARMCADA) research network and integrate efforts to adapt, develop, validate and norm measures to assess decision-making functionality in an aging population. Our Northwestern University team has extensive experience in developing national research networks for the purpose of assessment system development, validation and distribution, including the original NIH Neuroscience Blueprint contract to create the NIH Toolbox for Assessment of Neurological and Behavioral Function® (NIHTB). We will leverage this expertise to complete three specific aims: The proposed project will 1) Create the ARMCADA research network with the goal of advancing a theoretical taxonomy of decision-making skills for successful aging; 2) Identify, synthesize, create, and validate new measures of decision-making in an aging sample representative of the entire range of decision-making capacity levels and older adults from minority backgrounds; 3) Facilitate scalable nationwide public dissemination of these measures, including integration into Electronic Health Record systems, to benefit the early identification of older adults with cognitive impairment and evaluate the efficacy of potential interventions aimed to mitigate cognitive decline commonly associated with AD/ADRD.