Alzheimer Diagnosis in older Adults with Chronic Conditions ADACC Network

项目总结/摘要 大约60%患有阿尔茨海默病或相关痴呆症（ADRD）的老年人有三个或更多个 慢性病多种慢性疾病（MCC）和虚弱也是ADRD的危险因素， AD病理学在认知功能、疾病分期和神经病理学方面的表达 负担利用生物标志物诊断ADRD可能提供更准确和成本效益更高的评估 导致认知障碍的潜在病因，并可能指导治疗和咨询 关于个性化护理路径。然而，将这些生物标志物广泛纳入常规治疗是不可能的。 针对患有多种MCC和认知障碍的老年人的临床护理和人群筛查计划 还没有发生。基于血液的生物标志物现在在临床上可用于辅助ADRD的诊断， 更可行，特别是对于患有MCC的老年人，并且比基于CSF或PET的成本和侵入性更低 生物标志物。然而，没有研究检查这些血液生物标志物用于诊断和预后， 初级保健中的ADRD，特别是在不同人群中。目前尚不清楚这些血迹是如何以及何时 应使用生物标志物，特别是用于老年MCC和/或 有限的预期寿命。此外，MCCs对生物标志物水平的影响尚未得到很好的理解。 许多其他问题仍然存在，如：1）ADRD生物标志物是否能提高老年人的预后 患有MCC和认知障碍的成年人; 2）获得ADRD生物标志物最有益的人 包括血液、CSF或成像; 3）生物标志物如何在初级临床医疗保健中实施 分娩模式; 4）是否存在亚组差异（例如，人种/种族、性别、MCC）， 生物标志物的解释; 5）评估费用估算和报销的风险/效益比; 6） 如何最好地将结果传达给患者及其护理人员;以及7）生物标志物的伦理方面 收集和潜在的偶然发现，由于混合病理，特别是在老年人。的 这项申请的总体目标是建立一个国家联盟，老年人阿尔茨海默氏症诊断 慢性病（ADACC）网络，由多学科调查人员组成，将解决这些问题 和其他问题，并制定有证据支持的战略和准则， 在患有MCC和认知障碍的老年患者中用于ADRD诊断的生物标志物。联合体将 有一个执行委员会，指导委员会和数据协调中心。它将资助三个试点 每年举办一次年会，召开一次年会。将设立工作组， 上面列出的问题和其他问题。成功完成赠款目标将促进诊断， 通过增加对如何以及何时 实施ADRD生物标志物。

PROJECT SUMMARY / ABSTRACT Approximately 60% of older adults with Alzheimer’s disease or a related dementia (ADRD) have three or more chronic conditions. Multiple chronic conditions (MCCs) and frailty are also risk factors for ADRD and can affect the expression of AD pathology with regards to cognitive function, disease stage, and neuropathological burden. Utilizing biomarkers to diagnosis ADRD may provide a more accurate and cost-effective assessment of the underlying etiology contributing to the cognitive impairment and may guide treatments and counseling about individualized care pathways. However, widespread incorporation of these biomarkers into routine clinical care and population screening programs for older adults with multiple MCCs and cognitive impairment has not occurred. Blood-based biomarkers are now clinically available to aid in the diagnosis of ADRD and are more feasible, especially for older adults with MCCs, and less costly and invasive than CSF or PET-based biomarkers. However, no research has examined these blood biomarkers for the diagnosis and prognosis of ADRD in primary care, especially among diverse populations. It is unknown how and when these blood biomarkers should be used, particularly for diagnosis and prognosis among older adults with MCCs and/or limited life expectancy. Moreover, the effect of MCCs on levels of the biomarkers are not well understood. Numerous other questions remain, such as: 1) whether the ADRD biomarkers enhance prognosis among older adults with MCCs and cognitive impairment; 2) for whom it is most beneficial to obtain ADRD biomarkers including blood, CSF or imaging; 3) how the biomarkers can be implemented in a primary clinical healthcare delivery model; 4) whether there are subgroup differences (e.g. race/ethnicity, sex, MCCs) that affect the interpretation of the biomarkers; 5) assessment of cost estimates and risk/benefit ratios for reimbursement; 6) how best to communicate the results to patients and their caregivers; and 7) the ethical aspects of biomarker collection and potential for incidental findings due to mixed pathologies, especially among older adults. The overall goal of this application is to establish a national consortium, the Alzheimer’s Diagnosis in older Adults with Chronic Conditions (ADACC) Network, consisting of multi-disciplinary investigators that will address these and other questions, and develop evidence-backed strategies and guidelines for the use and implementation of biomarkers for ADRD diagnosis in older patients with MCCs and cognitive impairment. The consortium will have an Executive Committee, Steering Committee, and Data Coordinating Center. It will fund three pilot projects each year and convene an annual meeting. Working groups will be developed to focus on the questions listed above and others. Successful completion of the grant aims will advance the diagnosis and care of older adults with MCCs and cognitive impairment by increasing understanding of how and when to implement ADRD biomarkers.