Subjective Cognition in Motoric Cognitive Risk Syndrome: Enhancing Cerebrovascular Risk Detection in Health Disparity Populations

运动认知风险综合症的主观认知：加强健康差异人群的脑血管风险检测

• 批准号: 10761692
• 负责人: CAROLINE NESTER
• 金额: $ 3.15万
• 依托单位: CUNY GRADUATE SCH AND UNIV CTR
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-30 至 2024-10-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10761692
• 关键词: Acceleration; Address; Aging; Alzheimer' s Disease; Biological Assay; Cellular Phone; Clinical; Cognition; Cognitive; Collaborations; Communities; Complex; Dementia; Detection; Development; Diagnosis; Diagnostic; Disease; Early Diagnosis; Early identification; Elderly; Enrollment; Evaluation; Foundations; Future; Gait; Gait speed; Goals; Impaired cognition; Impairment; Individual; Intervention; Knowledge; Learning; Longitudinal Studies; Measures; Memory; Methodology; Methods; Modality; Monitor; Nature; Nerve Degeneration; Neuropsychology; Older Population; Paper; Participant; Persons; Population; Populations at Risk; Predictive Value; Preventive measure; Public Health; Questionnaires; Reduce health disparities; Reporting; Research; Research Personnel; Research Training; Resources; Risk; Risk Factors; Role; Rural; Sampling; Scientist; Screening procedure; Self Assessment; Severities; Syndrome; Techniques; Telephone Interviews; Testing; Training; Vascular Cognitive Impairment; Vascular Dementia; Vulnerable Populations; Work; accurate diagnosis; advanced disease; aging population; cerebrovascular; clinical care; clinically relevant; cognitive ability; cognitive change; cognitive disability; cognitive function; cognitive testing; cohort; cost; dementia risk; diaries; disability; disorder risk; functional decline; functional disability; functional status; geriatric depression; health disparity populations; improved; innovation; mild cognitive impairment; mixed dementia; novel; pre-clinical; programs; response; risk prediction; screening

Around the globe, the population is aging at an unprecedented rate, motivating early identification of older adults at-risk for cognitive and functional decline. Unfortunately, for health disparity populations, dementia is frequently underdiagnosed or detected in advanced disease stages, when it is too late to implement preventative measures. In response to growing public health concerns, Motoric Cognitive Risk Syndrome (MCR) was characterized in 2013 as a predementia condition that combines two clinical presentations independently associated with dementia: slow gait speed and subjective cognitive concerns (SCC). MCR is associated with increased risk for dementia over its individual components of SCC or slow gait alone, making it a valuable marker of early neurodegenerative changes. MCR does not require expensive, complex assessments to assign diagnosis, broadening its accessibility to detect dementia in remote or under-resourced settings. MCR predicts risk for both Alzheimer’s disease (AD) and vascular cognitive impairment/dementia (VCID). However, MCR demonstrates unique sensitivity to early cerebrovascular alterations, so it is most predictive of VCID. At present, there is no consistent method to assess SCC in MCR – a key diagnostic feature of the syndrome. The majority of studies query memory concerns using a single item from a geriatric depression scale, which has become the standard approach in the field. However, a prior study led by the applicant failed to find an association between memory concerns and MCR, calling into question the current methodology. The lack of understanding about SCC in individuals with MCR may greatly limit sensitivity to risk for future decline. Given these critical gaps in knowledge, this proposal will build upon the applicant’s preliminary work to holistically analyze the assessment of SCC in a demographically diverse cohort with MCR. In collaboration with the Einstein Aging Study (EAS), a longitudinal study of community-dwelling older adults, 600 participants will be enrolled to determine the feasibility of SCC assessment to predict: (1) cognitive decline; (2) functional decline and disability; and (3) compare and contrast SCC in MCR and another predementia condition, mild cognitive impairment (MCI). A novel, multifaceted approach will be employed to assess SCC, including an expanded version of a widely used paper-and-pencil questionnaire, telephone interview, and daily diary evaluation (over 14 days) via smartphone. Results will yield a validated SCC screen that is easily administered, interpreted, and able to detect cerebrovascular risk for cognitive decline and disability. Because of MCR’s far-reaching applicability, results may have meaningful public health implications around the globe, as they would facilitate early detection of VCID, AD, and/or mixed dementias, and intervention opportunities for at-risk individuals. In addition, the proposed training plan will advance the applicant’s goal of becoming an independent clinical scientist, serving to promote methods of early dementia detection that lead to the reduction of health disparities for vulnerable populations.

在全球范围内，人口正在以前所未有的速度老龄化，这促使人们尽早发现有认知和功能衰退风险的老年人。不幸的是，对于健康差距较大的人群来说，痴呆症往往未得到充分诊断或在疾病晚期才被发现，而此时实施预防措施为时已晚。为了应对日益增长的公众健康担忧，运动认知风险综合征（MCR）在2013年被确定为一种痴呆症前期疾病，结合了两种与痴呆症独立相关的临床表现：慢速步态和主观认知问题（SCC）。MCR与SCC的单个组成部分或单独的步态缓慢的痴呆风险增加有关，使其成为早期神经退行性变化的有价值的标志物。MCR不需要昂贵、复杂的诊断评估，从而扩大了在偏远或资源不足地区发现痴呆症的可及性。MCR可预测阿尔茨海默病（AD）和血管性认知障碍/痴呆（VCID）的风险。然而，MCR对早期脑血管病变表现出独特的敏感性，因此最能预测VCID。目前，没有一致的方法来评估MCR中的SCC -该综合征的一个关键诊断特征。大多数研究使用老年抑郁量表中的单个项目来查询记忆问题，这已成为该领域的标准方法。然而，先前由申请人领导的一项研究未能发现记忆问题与MCR之间的联系，这使人们对当前的方法产生了质疑。对MCR患者的SCC缺乏了解可能会极大地限制对未来衰退风险的敏感性。鉴于这些关键的知识差距，本提案将建立在申请人的初步工作基础上，全面分析MCR患者在人口统计学多样化队列中SCC的评估。与Einstein Aging Study （EAS）合作，对社区居住的老年人进行纵向研究，将招募600名参与者，以确定SCC评估预测：(1)认知能力下降；(2)功能衰退和残疾；(3)比较MCR中的SCC与另一种痴呆前状态轻度认知障碍（MCI）。将采用一种新颖的、多方面的方法来评估SCC，包括广泛使用的纸笔问卷的扩展版本、电话访谈和通过智能手机进行的每日日记评估（超过14天）。结果将产生一个有效的SCC筛查，易于管理，解释，并能够检测认知能力下降和残疾的脑血管风险。由于MCR的广泛适用性，结果可能在全球范围内具有重要的公共卫生意义，因为它们将有助于早期发现VCID、AD和/或混合性痴呆，并为高危个体提供干预机会。此外，拟议的培训计划将促进申请人成为一名独立临床科学家的目标，促进早期发现痴呆症的方法，从而减少弱势群体的健康差距。