The UCSF Brain Health Assessment for the Detection of Cognitive Impairment Among Diverse Populations in Primary Care

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PROJECT SUMMARY / ABSTRACT Efficient and user-friendly neurocognitive screens are needed that are sensitive to the variety of neurocognitive disorder presentations to primary care. The UCSF Brain Health Assessment was developed to efficiently measure the cognitive domains that can be affected in the earliest stages of neurocognitive decline, including memory, executive functions / speed, visuospatial skills, language, behavior, and function. Four subtests and an optional informant survey are administered via an appealing tablet interface and with automated scoring and provider feedback. Preliminary validation studies indicate excellent combined sensitivity and specificity to cognitive impairment among English-speaking older adults with moderate to high levels of education. The primary goals of the proposed work are to optimize and validate the BHA for older adults who are diverse in terms of education and language spoken, to perform cross-validation studies of other paradigms funded by this award, and to evaluate and address barriers to detecting cognitive impairment in primary care. Education and English as a second language each impact cognitive test performance and are barriers to accurate detection of cognitive impairment. This project will address these health disparities by including persons with diverse levels of education and persons whose primary language is Spanish, Mandarin, or Cantonese in both validation and implementation studies. In Aim 1, we will evaluate the validity of the BHA for the detection of cognitive impairment in well-characterized and expertly diagnosed English-speaking older adults with low, moderate, or high education. In Aim 2, we will evaluate the validity of the BHA for the detection of cognitive impairment in well-characterized and expertly diagnosed Spanish-, Cantonese-, or Mandarin-speaking older adults. In Aim 3, we will identify and address implementation challenges in primary care practices that serve patients diverse in terms of education and language spoken. If successful, this project will lead to increased detection of cognitive impairment in everyday community settings, which is essential to enable differential diagnosis and to improve medical management for people with cognitive impairment, including dementia, in the United States.