Multicultural Community Dementia Screening

摘要 美国预防服务工作组(USPSTF)得出结论，目前的证据不足以评估 轻度认知障碍(MCI)和早期阿尔茨海默病筛查的利与弊 相关障碍(ADRD)，2014年首次出版，最近更新。相反，USPSTF呼吁采取更多行动 研究，2017年公布了一项研究计划，以评估痴呆症筛查的证据。社区 MCI和早期ADRD的检测可能受到限制，因为缺乏筛选测试来表征最早的 损害的迹象、对干预措施的监测反应、与生物标记物的对应关系以及潜在的 筛查的利与弊。无法检测到MCI和ADRD可能会影响资格确定 用于护理和服务，并阻碍临床研究中的病例确定和招募。在我们之前的5年中 在供资周期中，我们提出了关于(A)筛选最佳方法、(B)这些方法的有效性的重要问题 方法跨越相关的生物变量(年龄、性别、种族和民族)，(C)衡量标准如何与“黄金”相对应 标准“评价，以及(D)个人如何处理结果。我们目前提出的总体目标是 调查的目的是解决主要挑战，改进对MCI和早期ADRD的检测。我们强调 深度表型-从同一个人那里获取多种类型的数据，随着时间的推移从 多个个体。虽然对更广泛的MCI/ADRD检测感兴趣，但我们利用淀粉样蛋白tau， 神经退行性变(ATN)研究框架，以支撑这项工作，特别是生物标志物和相关性 生物学变量(例如，年龄、性别、种族、民族)解释了跨越ATN的不同风险 框架阶段。为此，我们提出了三个具体目标：(1)确定基于总体的MCI/ADRD 参加佛罗里达州蓝十字医疗保险的2500名55岁以上成年人的患病率(总抽样范围：5.2 百万)使用新的在线评估；(2)从目标1招募500人参加年度面对面评估 通过深入的表型进行全面访问，以确定在线评估的准确性 认知、体液、遗传、核磁共振、淀粉样蛋白和tau PET成像生物标志物，并评估基线能力 通过NIA-AA阶段和相关生物学方法预测纵向认知衰退和转变的方法 变量；以及(3)通过测试改进的决策来确定MCI/ADRD筛查的利与弊 (高级护理计划、药物)、以患者为中心(与健康相关的生活质量、身体功能、 医疗服务利用)和以照顾者为中心的结果(负担、压力、情绪、与健康相关的生活质量) 纵向队列的特点是目标2。我们的长期目标是增加“现实世界”早期的MCI和ADRD 检测、诊断和治疗；解决USPSTF的关键问题；并减少卫生成果方面的差距。这 与《国家阿尔茨海默氏症项目法》的三项指导原则产生强烈共鸣，特别是 它的第三个原则是：“改变我们处理阿尔茨海默病和相关痴呆症的方式。”

ABSTRACT The US Preventative Services Task Force (USPSTF) concluded that current evidence is insufficient to assess the balance of benefits vs harms of screening for mild cognitive impairment (MCI) and early Alzheimer's disease and related disorders (ADRD), first published in 2014 and recently updated. Instead, the USPSTF has called for more research, publishing a research plan in 2017 to evaluate the evidence of dementia screening. Community detection of MCI and early ADRD may be limited due to the lack of screening tests characterizing the earliest signs of impairment, monitoring response to interventions, correspondence to biomarkers, and the potential benefits versus harms from screening. The inability to detect MCI and ADRD may affect eligibility determination for care and services, and impede case ascertainment and recruitment in clinical research. In our prior 5-year funding cycle, we asked important questions regarding (a) the best methods to screen, (b) effective of these methods across relevant biological variables (age, sex, race, and ethnicity), (c) how measures correspond to “Gold Standard” evaluations, and (d) what individuals do with results. Our overarching GOAL of the current proposed investigation is to address the major challenges to improve the detection of MCI and early ADRD. We emphasize deep phenotyping—the acquisition of multiple types of data from the same individual repeated over time from multiple individuals. Although interested in broader MCI/ADRD detection, we leverage the amyloid, tau, neurodegeneration (ATN) research framework to anchor this work, particularly how biomarkers and relevant biological variables (e.g., age, sex, race, ethnicity) explain differential risk for transition across the ATN Framework stages. To do this, we propose 3 SPECIFIC AIMS: (1) Determine population-based MCI/ADRD prevalence in 2500 adults age 55+ enrolled in Florida Blue Cross medical insurance (total sampling frame: 5.2 million) using a novel on-line evaluation; (2) Recruit 500 individuals from Aim 1 for annual in-person comprehensive visits with deep phenotyping to determine the accuracy of on-line evaluation against longitudinal cognitive, fluid, genetic, MRI, and amyloid and tau PET imaging biomarkers, and evaluate the ability of baseline measures to predict longitudinal cognitive decline and transition across NIA-AA stages and by relevant biological variables; and (3) Define the benefits vs. harms of MCI/ADRD screening by testing improved decision-making (advance care planning, medications), patient-centered (health-related quality of life, physical functionality, health care utilization) and caregiver-centered outcomes (burden, strain, mood, health-related quality of life) in the longitudinal cohort characterized in Aim 2. Our long-term goal is to increase “real world” early MCI and ADRD detection, diagnosis, and treatment; address USPSTF Key Questions; and reduce disparities in health outcomes. This resonates strongly with the three guiding principles of the National Alzheimer's Project Act (NAPA), especially its third principle: “Transform the way we approach Alzheimer's disease and related dementias.”