CIND: Risk Factors for Conversion to Dementia

描述(由申请人提供)：对痴呆症发病机制的更好理解带来了新的希望，即科学家可能很快就会发现这种虚弱疾病的疾病修正疗法。初步证据表明，如果临床医生在临床前阶段及早使用疾病修正治疗，将是最有效的。痴呆症的疾病修正治疗可能会有潜在的严重副作用或并发症，因此尽早准确地识别患者将是至关重要的。术语认知损害--非痴呆症(CIND)被用来描述这种临床前状态。CIND捕获了一系列导致功能障碍的途径，这种情况的过程是不同的，一些受试者长期保持稳定，另一些人转为痴呆症，其他人恢复到明显的正常状态。在这项提案中，我们试图从横断面和纵向两个方面考察心血管危险因素对诊断认知状态的作用。我们建议在初级保健环境中这样做，在那里将对这些患者进行广泛的治疗。从Wishard Health System初级保健数据库中随机抽取2000名65岁及以上的患者进行评估和诊断。CIND患者将每年进行跟踪(和重新诊断)，为期4年。彻底的评估程序将确保最佳的诊断准确性。广泛的Regenstrief医疗记录系统将允许回顾和前瞻性地捕获广泛的健康和医疗信息，并随着时间的推移将这些信息映射到临床诊断上。通过这种方式，我们将能够提高我们对哪些患有认知障碍-非痴呆症(CIND)的老年人将进展为痴呆症的理解，因此最有可能从早期开始的疾病修改治疗中受益。

DESCRIPTION (provided by applicant): Improved understanding of the pathogenesis of dementia brings renewed hope that scientists might soon discover disease-modifying treatments for this debilitating disorder. Initial evidence suggests that disease-modifying treatments would be the most effective if clinicians employed them early, in the preclinical phase. Disease-modifying treatments for dementia are likely to have potentially serious side effects or complications, and therefore it will be vital to identify patients as early and accurately as possible. The term cognitive impairment-no dementia (CIND) has been used to describe this preclinical state. CIND captures a broad range of pathways to dysfunction and the course of this condition is variable with some subjects remaining stable for long period while other convert to dementia and other revert to apparent normalcy. In this proposal, we seek to examine the role of cardiovascular risk factors on diagnosed cognitive status cross-sectionally and longitudinally. We propose to do this in the primary care environment where wide-scale treatment of these patients will occur. A random sample of 2000 patients aged 65 and older from the Wishard Health System primary care database will be evaluated and diagnosed. Patients with CIND will be followed (and re-diagnosed) annually for 4 years. Thorough procedures for assessment will assure optimum diagnostic accuracy. The extensive Regenstrief Medical Records System will allow retrospective and prospective capture of a wide range of health and medical information and the mapping of this information onto clinical diagnosis over time. In this way, we will be able to improve our understanding of which older adults with cognitive impairment-no dementia (CIND) will progress to dementia and would thus be the most likely to benefit from early initiation of disease-modifying treatments.