Testing Olfaction in Primary care to detect Alzheimer's disease and other Dementias (TOPAD)

在初级保健中测试嗅觉以检测阿尔茨海默病和其他痴呆症 (TOPAD)

• 批准号: 9426429
• 负责人: DAVANGERE P DEVANAND
• 金额: $ 81.19万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-30 至 2022-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9426429
• 关键词: Address; Advisory Committees; Age; Alzheimer' s Disease; Area Under Curve; Biological Markers; Blood Tests; Brain imaging; Cerebrospinal Fluid; Cognitive; Communities; Databases; Dementia; Detection; Diagnosis; Diagnostic; Early Diagnosis; Elderly; Ensure; Evaluation; Family health status; Genomics; Goals; Gold; Health Personnel; Healthcare Systems; Impaired cognition; Impairment; Memory impairment; National Institute on Aging; Nerve Degeneration; Odors; Participant; Pathway interactions; Patients; Pennsylvania; Performance; Persons; Practice Guidelines; Preventive service; Primary Health Care; Proteomics; Protocols documentation; Provider; Receiver Operating Characteristics; Recommendation; Research; Resources; Smell Perception; Standardization; Testing; Time; United States; Universities; Update; accurate diagnosis; aged; amnestic mild cognitive impairment; base; blood-based biomarker; cognitive testing; community setting; improved; instrument; mental state; metabolomics; mild cognitive impairment; minimally invasive; multidisciplinary; novel strategies; olfactory bulb; primary care setting; primary outcome; response; screening; secondary analysis; secondary outcome; tool

The goal of our project, called “Testing Olfaction in Primary care to detect Alzheimer’s disease and other Dementias (TOPAD)”, is to test the 12-item BSIT, a short, standardized version of the 40-item University of Pennsylvania Smell Identification Test (UPSIT), for detection of dementia among elderly persons with cognitive concerns in a community-based primary care setting, in response to PAR-15-359 (Novel Approaches to Diagnosing Alzheimer’s Disease and Predicting Progression), and its second aim: “Identifying new biomarkers that are minimally invasive, inexpensive, usable in community settings”. Many elderly persons develop dementia that remains undiagnosed in primary care settings until it is severe, leading to catastrophic consequences for patients, families, and the health care system. Odor identification impairment with the 40-item UPSIT is a well- validated biomarker of dementia, particularly dementia of the Alzheimer’s type (DAT), The shorter version of the UPSIT, the 12-item BSIT, has been shown to be similar to the UPSIT in distinguishing and predicting MCI and DAT. We propose the BSIT for detection of dementia in primary care because it takes 5 minutes to administer, is inexpensive, and can be administered by non-medical personnel. We propose to test the BSIT for detection of dementia among 600 patients with cognitive concerns, without a diagnosis of dementia, age 65 years and older, who attend primary care practices in Northern Manhattan. The term cognitive concerns includes subjective cognitive decline (SCD), and warning signs identified by relatives, significant others, and health care providers. All participants will be tested with the BSIT, the MMSE, and other common dementia screening tools. The performance of tools will be assessed using as a gold standard cognitive diagnosis based using the 2011 National Institute on Aging (NIA)/Alzheimer Association (AA) recommendations for dementia and MCI using the National Alzheimer’s Coordinating Center (NACC) protocol. Our primary outcome will be dementia diagnosis at the initial evaluation. Cognitive assessments will be repeated every 12 months. Our secondary outcomes will be cognitive transitions to dementia (and subtypes), MCI and MCI subtypes. Our primary aim is to compare the accuracy of the BSIT with the MMSE for dementia detection at initial evaluation among persons aged 65 years and older with cognitive concerns in primary care. In secondary analyses, we will examine the secondary outcomes and compare the accuracy of the BSIT for dementia detection with other instruments: Montreal Cognitive Assessment (MOCA), Mini-Cog and Memory Impairment Screen (MIS). Our secondary aim is to compare the BSIT with the MMSE in predicting cognitive transitions at 12 and 24 months. In secondary analyses, we will compare the BSIT with other screening instruments (MOCA, Mini-Cog, MIS). TOPAD will be conducted by a multidisciplinary team of experts in Alzheimer’s research, odor identification testing, dementia diagnosis, and primary care.

我们项目的目标是“在初级保健中测试嗅觉以检测阿尔茨海默病和其他疾病” 痴呆症 (TOPAD)”，旨在测试 12 项 BSIT，这是 40 项大学测试的简短标准化版本。 宾夕法尼亚气味识别测试 (UPSIT)，用于检测患有认知障碍的老年人是否患有痴呆症 响应 PAR-15-359（解决问题的新方法） 诊断阿尔茨海默病并预测进展），其第二个目标是：“识别新的生物标志物 微创、廉价、可在社区环境中使用”。许多老年人患有痴呆症 在初级保健机构中仍未得到诊断，直到病情严重为止，从而导致灾难性后果 患者、家庭和医疗保健系统。 40 项 UPSIT 的气味识别障碍是一个很好的 经验证的痴呆症生物标志物，特别是阿尔茨海默氏症型痴呆 (DAT)，其较短版本 UPSIT（12 项 BSIT）已被证明在区分和预测 MCI 和 数据。我们建议在初级保健中使用 BSIT 来检测痴呆症，因为它需要 5 分钟来管理， 价格便宜，并且可以由非医务人员进行管理。我们建议测试 BSIT 进行检测 600 名有认知问题但未诊断为痴呆、年龄 65 岁且患有痴呆症的患者 老年人，他们在曼哈顿北部参加初级保健实践。认知问题一词包括主观的 认知能力下降 (SCD)，以及亲属、重要他人和医疗保健提供者发现的警告信号。 所有参与者都将接受 BSIT、MMSE 和其他常见痴呆症筛查工具的测试。这 工具的性能将使用基于 2011 年认知诊断的黄金标准进行评估 国家老龄化研究所 (NIA)/阿尔茨海默病协会 (AA) 针对痴呆症和 MCI 的建议 国家阿尔茨海默病协调中心 (NACC) 协议。我们的主要结果是痴呆症诊断 初步评价。认知评估将每 12 个月重复一次。我们的次要结果将是 认知转变为痴呆（和亚型）、MCI 和 MCI 亚型。我们的主要目的是比较 BSIT 与 MMSE 对 65 岁老年人初步评估痴呆症检测的准确性 以及在初级保健中存在认知问题的老年人。在二次分析中，我们将检查二次 结果并将 BSIT 与其他仪器检测痴呆症的准确性进行比较：蒙特利尔 认知评估 (MOCA)、Mini-Cog 和记忆障碍筛查 (MIS)。我们的次要目标是 将 BSIT 与 MMSE 在预测 12 个月和 24 个月时的认知转变方面进行比较。在二次分析中， 我们将 BSIT 与其他筛查仪器（MOCA、Mini-Cog、MIS）进行比较。将进行 TOPAD 由阿尔茨海默氏症研究、气味识别测试、痴呆症诊断等领域的多学科专家团队组成， 和初级保健。