Measurement and estimation of lucidity prevalence in persons with dementia and neurological disorders

拟议的项目“痴呆症患者清醒率的测量和估计， 神经系统疾病”是对RFA-AG-20-017“痴呆症清醒度（R21/R33）"的响应。我们的目标是 进一步发展一种矛盾清晰度的测量方法，并使用这种方法来估计频率， 通过采访护理之家工作人员观察到的居民事件发生的相关性 在过去的一个月和六个月里。此外，我们将完善清晰度的定义， 进一步发展一种明确“诊断”的个案裁定方法。我们建议研究有关 在R21阶段，一个长期护理设施的300名居民和12个设施的1500名居民 在R33阶段。一线疗养院的工作人员非常适合在矛盾的清晰度， 一种研究不足的现象;可能是由于事件的短暂性和缺乏科学报告 渠道现存的文献集中于轶事证据和病例报告。拟定研究 解决了四个目标：1）制定一项措施，以评估清醒的发生，2）分析 心理测量学特性的措施，3）制定一个共识会议的方法，以确定 可能的，可能的和明确的情况下，和4）进行一个当地的，以人口为基础的研究清醒使用直接 与养老院工作人员的访谈。这项研究将有助于弥补缺乏测量工具， 该领域，并提供有关清醒现象的强大的基础知识。该研究旨在完善 我们的病例发现方法用于先前在疗养院进行的流行病学研究，以研究潜在的 作为早期研究主题的潜在结构，需要明确定义。拟议的团队 具有测量和统计学、老年学、神经科学、流行病学、老年医学和 精神病学（阿尔茨海默氏病），心理学，定性方法和集体护理。其目标是： 目标1-R21：开发一种测量方法来描述痴呆患者的清醒发作， 神经和其他疾病，并确定与事件相关的个体和情节特征; 目标2-R21：利用来自一个国家的数据，进一步制定一个关于所报告事件的案例会议程序。 300份工作人员报告的试点样本，与居住在一个 拥有750张床位的大型长期护理设施; 目标3-R33：对12家长期护理机构的清醒事件进行回顾性研究，以描述 与未发生事件的居民相比，他们的特征; 目标4-建议33：按诊断类别确定事件的发生率和频率; 目的5-R33：检查清醒及其亚型的预测因素。 研究结果可能会导致制定一种病例报告方法，供前线工作人员使用，以确定 清醒的情节，并描述清醒事件，为未来的研究提供信息。

The proposed project, “Measurement and estimation of lucidity prevalence in persons with dementia and neurological disorders” is in response to RFA-AG-20-017 “Lucidity in Dementia (R21/R33)”. Our goals are to develop further a measure of paradoxical lucidity and to use this measure to estimate the frequency and correlates of occurrences by interviewing nursing home staff with respect to incidents observed in residents during the past one-month and six-month periods. In addition, we will refine the definition of lucidity and develop further a case-adjudication method for lucidity “diagnosis”. We propose to study staff reports related to 300 residents of one long-term care facility during the R21 phase and 1500 residents from 12 facilities during the R33 phase. Front line nursing home staff is ideally suited to inform research in paradoxical lucidity, an understudied phenomenon; likely due to the transience of the incidents and the lack of scientific reporting channels. The literature extant focuses on anecdotal evidence and case reports. The proposed study addresses four objectives: 1) develop a measure to assess the occurrence of lucidity, 2) analyze the psychometric properties of the measure, 3) develop a consensus conference methodology to determine possible, probable and definite cases, and 4) conduct a local, population-based study of lucidity using direct interviews with nursing home staff. This study will contribute to remediation of the lack of measurement tools in the field and provide robust basic knowledge about the phenomenon of lucidity. The proposed study refines our case finding methodology used in prior epidemiological research in nursing homes to study underlying latent constructs that are the subject of early-stage research and require definitional clarity. The proposed team has expertise in measurement and statistics, gerontology, neuroscience, epidemiology, geriatric medicine and psychiatry (Alzheimer’s disease), psychology, qualitative methods, and congregate care nursing. The aims are: Aim 1-R21: Develop a measure to describe episodes of lucidity among individuals with dementia, neurological and other illnesses and identify individual and episodic characteristics associated with events; Aim 2-R21: Develop further a procedure for case conferencing of reported events, using data from a pilot sample of 300 staff reports linked to 300 unique residents with and without lucidity events residing in a large 750-bed long term care facility; Aim 3-R33: Conduct a retrospective study of lucidity events in 12 long-term care facilities to describe their characteristics in comparison to residents without an event; Aim 4-R33: Determine the prevalence and frequency of events by diagnostic categories; Aim 5-R33: Examine the predictors of lucidity and its subtypes. Findings could result in the development of a case-reporting methodology for use by front-line staff to identify episodes of lucidity and to characterize lucidity events to inform future research.