Accelerating digital cognitive screening for Alzheimer's disease in the Primary Care Setting

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PROJECT SUMMARY/ABSTRACT: This integrated research and training plan will prepare Dr. Thompson, a research assistant professor and licensed clinical neuropsychologist, to become an independent PI. Dr. Thompson’s long-term goal is to become an expert in the validation and application of novel AD screening methods within healthcare settings, particularly those serving racial/ethnic groups with disparities in rates of AD vs. AD diagnosis. Her short-term goals for this K23 are to: (1) gain expertise in primary care-based recruitment, implementation science, pragmatic measurement, and statistical methods for the rigorous development and validation of novel cognitive protocols, (2) to test the hypothesis that combined use of remote (self-administered), app-based testing and table-based screening in primary care clinics will be feasible, acceptable, and associated with AD biomarkers. The early detection of cognitive impairment is one of the most important challenges in AD research. Cost- efficient and effective screening strategies for primary care will greatly enhance early diagnosis and treatment. Cognitive assessment is non-invasive, scalable, and covered by most insurance. Cognitive screening is a required part of the Medicare Annual Wellness Visit typically done by PCPs. However, current cognitive screening tools are insensitive to subtle cognitive changes and have poor specificity in underrepresented populations. Digital cognitive tools overcome many limitations of current paper-and-pencil based approaches. In this project, Dr. Thompson will partner with local primary care practices to enroll a diverse sample (25% identifying as a racial/ethnic minority, Spanish or English speaking) of 100 older adults without prior dementia diagnosis. Participants will complete phone screening and consent and do 5 days of brief NIH MobileToolbox (MTB) assessments on a smartphone within one month of their annual PCP follow-up visit. Participants without a compatible device or home internet receive a study-provided device. At their PCP follow-up visit, participants will complete brief tablet-based and traditional paper-and-pencil-based screening measures. We will obtain feedback from participants and PCPs on the use of the novel digital screening tools. Participants will complete a brief visit to the Butler Memory and Aging Program to do a blood draw for AD plasma biomarker analysis. Under the guidance of a strong mentorship team of NIH-funded researchers, Dr. Thompson will achieve four specific training goals: 1. Acquire experience and specialized training in primary care outreach and recruitment, with a focus on practices that serve underrepresented populations. 2. Extend her knowledge in implementation science, pragmatic measurement, and clinical research trial design. 3. Build advanced knowledge and skills in quantitative and qualitative data analysis, including biostatistics, psychometric evaluation, longitudinal data analysis, and clinical outcomes assessment. 4. Apply/actualize her skills from goals 1-3 to build expertise in the rigorous development and multimodal validation of novel cognitive measures, and develop a scalable primary care-based cognitive screening protocol.