Alzheimer Diagnosis in older Adults with Chronic Conditions ADACC Network

项目摘要/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 慢性疾病。多种慢性病(MCC)和虚弱也是ADRD的危险因素，并可影响 阿尔茨海默病的病理表现与认知功能、疾病分期和神经病理的关系 负担。利用生物标记物诊断ADRD可能提供更准确和更具成本效益的评估 导致认知障碍的潜在病因，并可指导治疗和咨询 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 为患有多发性MCC和认知障碍的老年人提供临床护理和人群筛查计划 还没有发生。基于血液的生物标记物现在可以在临床上用于ADRD的诊断，并且 更可行，特别是对于患有MCC的老年人，而且比基于脑脊液或PET的成本和侵入性更低 生物标志物。然而，还没有研究检查这些血液生物标记物用于诊断和预后。 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液是如何以及何时出现的 应该使用生物标记物，特别是对患有MCC和/或 有限的预期寿命。此外，MCC对生物标志物水平的影响还不是很清楚。 许多其他问题仍然存在，例如：1)ADRD生物标记物是否能改善老年人的预后 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、脑脊液或成像；3)如何在初级临床医疗保健中实施生物标记物 分娩模式；4)是否有亚群差异(如种族/民族、性别、MCC)影响 生物标志物的解释；5)费用估计数和报销风险/收益比率的评估；6) 如何最好地将结果传达给患者及其照顾者；以及7)生物标记物的伦理方面 由于混合病理，特别是在老年人中，收集和偶然发现的可能性。这个 这项申请的总体目标是建立一个全国性的协会，老年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，并制定有证据的战略和指南，以使用和实施 老年MCC伴认知障碍患者ADRD诊断的生物标志物。该财团将 有执行委员会、指导委员会和数据协调中心。它将为三名飞行员提供资金 每年进行一次项目，并召开一次年会。将建立工作组，重点关注 上面列出的问题和其他问题。成功完成赠款目标将推进诊断和 通过增加对如何以及何时护理患有MCC和认知障碍的老年人的了解来护理 实施ADRD生物标记物。

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.