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

项目总结/摘要： 这项综合研究和培训计划将准备汤普森博士，研究助理教授和 有执照的临床神经心理学家，成为一名独立的私家侦探。汤普森博士的长期目标是成为 在医疗机构中验证和应用新型AD筛查方法的专家， 特别是那些服务于AD与AD诊断率存在差异的种族/民族群体的人。她的短期 该K23的目标是：（1）获得基于初级保健的招聘，实施科学， 语用测量和统计方法，用于严格开发和验证新的认知 协议，（2）测试假设，结合使用远程（自我管理），基于应用程序的测试和 在初级保健诊所进行基于表格的筛查将是可行的、可接受的，并且与AD生物标志物相关。 认知功能障碍的早期发现是AD研究中最重要的挑战之一。费用- 为初级保健制定的高效率和有效的筛查战略将大大加强早期诊断和治疗。 认知评估是非侵入性的，可扩展的，并涵盖了大多数保险。认知筛查是一种 通常由PCP完成的Medicare年度健康访视的必要部分。然而，目前的认知 筛查工具对微妙的认知变化不敏感，在代表性不足的人群中特异性差。 人口数量。数字认知工具克服了当前基于纸和笔的方法的许多局限性。 在这个项目中，汤普森博士将与当地的初级保健实践合作，招募多样化的样本（25%）。 确定为种族/少数民族，讲西班牙语或英语）的100名老年人， 诊断.参与者将完成电话筛选和知情同意，并进行5天的简短NIH移动电话检查 (MTB)在其年度PCP随访访视的一个月内通过智能手机进行评估。参加者无 兼容设备或家庭互联网接收研究提供的设备。在初级保健项目的后续访问中， 将完成简短的基于平板电脑和传统的基于纸张和药片的筛查措施。我们将获得 参与者和PCP对使用新型数字筛选工具的反馈。参与者将完成 对巴特勒记忆和衰老计划进行短暂访问，以进行AD血浆生物标志物分析的抽血。 在NIH资助的研究人员组成的强大导师团队的指导下，汤普森博士将实现 四个具体的培训目标：1.获得初级保健外展方面的经验和专门培训， 征聘工作，重点是为任职人数不足的人口服务的做法。2.扩展她的知识 实施科学、实用测量和临床研究试验设计。3.建设先进 定量和定性数据分析的知识和技能，包括生物统计学，心理测量学， 评估、纵向数据分析和临床结果评估。4.应用/实现她的技能， 目标1 - 3：在新的认知测量的严格开发和多模式验证方面建立专门知识， 并开发一个可扩展的基于初级保健的认知筛查方案。

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.