Measurement of cognition and functional decline in Latinx older adults for detection of Alzheimer’s Disease and Related Dementias: A mixed-methods approach

准确有效地测量认知和功能下降，以检测阿尔茨海默病和 拉丁裔/a/x 老年人的相关痴呆症 (AD/ADRD) 是一项重要的公共卫生优先事项。拉丁裔人口为 在美国，AD/ADRD 在美国迅速增长和老龄化，预计未来拉丁裔老年人中 AD/ADRD 的数量将大幅增长 年。目前尚不清楚认知评估工具是否能够以同样的精度和准确性来衡量认知健康状况。 在拉丁裔和非拉丁裔白人 (NLW) 老年人中的有效性，这是准确检测的关键障碍 AD/ADRD、其决定因素及其影响。本研究将使用混合方法来评估有效性和 使用协调标准对拉丁裔和 NLW 老年人认知和功能下降的衡量指标进行等效 认知评估协议 (HCAP) 认知测试组合 (HCAP-R) 和认知和功能的知情人评级 下降（HCAP-I）。具体目标 1 将检查 HCAP-R 和 HCAP-I 表现出的统计证据的程度 跨教育年限、评估语言（英语/西班牙语）和种族（拉丁语/荷兰语）的测量偏差，使用 系列心理测量分析。健康与退休研究 (HRS)-HCAP 研究的数据将与 用于此分析的数据来自科珀斯克里斯蒂脑攻击监测 (BASIC)-认知研究。具体目标 2 将 利用 BASIC-Cognitive 研究的纵向数据来检验 HCAP-R 是否同样可以预测 拉丁裔和 NLW 老年人之间知情者评定的认知和功能下降 (HCAP-I) 的纵向轨迹 成人以及对统计测量偏差的调整是否消除了这种预测的任何差异 等价性。具体目标 3 将使用定性方法（认知访谈）进行新的数据收集，以 检查墨西哥裔美国老年人样本中 HCAP-R 和 HCAP-I 项目的语言和文化有效性 不同的教育水平和西班牙语使用情况。这些数据将提供混合方法的新颖整合 （心理测量、认知和功能下降的纵向预测以及定性）以告知等效性和 HCAP 在文化、语言和教育背景不同的老年人中的有效性。此 K23 计划将提供 PI Briceño 博士接受过培训，以发展心理测量和纵向数据分析、定性研究、 基于人口的认知老龄化和健康差异研究以及研究领导力。培训将通过 个人指导、正式讲习班和研讨会以及国际会议。 K23导师都是国际化的 拉丁裔大脑健康公平性、心理测量学、基于人口的认知老龄化和跨文化领域的领导者 AD/ADRD 的神经心理学评估。 K23 将为 Briceño 博士提供专业知识和初步数据 提交 R01 并成为 AD/ADRD 认知健康差异的独立研究员。大学 密歇根州为开展拟议的研究和职业发展提供了理想的环境，拥有丰富的资源 资源、设施、培训机会和协作。

Accurate and valid measurement of cognitive and functional decline for the detection of Alzheimer’s Disease and Related Dementias (AD/ADRD) in Latino/a/x older adults is a critical public health priority. The Latinx population is rapidly growing and aging in the U.S. with enormous expected growth of AD/ADRD in older Latinx adults in the coming years. It is unknown whether cognitive assessment instruments measure cognitive health with equal precision and validity across Latinx and non-Latinx white (NLW) older adults, which is a critical barrier to the accurate detection of AD/ADRD, its determinants, and its impact. This study will use a mixed-methods approach to evaluate the validity and equivalence of measures of cognitive and functional decline in Latinx and NLW older adults, using the Harmonized Cognitive Assessment Protocol (HCAP) cognitive test battery (HCAP-R) and informant ratings of cognitive and functional decline (HCAP-I). Specific Aim 1 will examine the extent to which the HCAP-R and HCAP-I exhibit statistical evidence of measurement bias across years of education, assessment language (English/Spanish), and ethnicity (Latinx/NLW), using a series of psychometric analyses. Data from the Health and Retirement Study (HRS)-HCAP study will be combined with data from the Brain Attack Surveillance in Corpus Christi (BASIC)-Cognitive study for this analysis. Specific Aim 2 will utilize longitudinal data from the BASIC-Cognitive study to examine whether the HCAP-R is equally predictive of longitudinal trajectories of informant-rated cognitive and functional decline (HCAP-I) between Latinx and NLW older adults and whether adjustment for statistical measurement bias eliminates any differences in this predictive equivalence. Specific Aim 3 will perform new data collection using a qualitative methodology (cognitive interviewing) to examine the linguistic and cultural validity of HCAP-R and HCAP-I items in a sample of Mexican American older adults with varying levels of education and Spanish language use. These data will provide a novel integration of mixed methods (psychometric, longitudinal prediction of cognitive and functional decline, and qualitative) to inform the equivalence and validity of the HCAP across culturally, linguistically, and educationally diverse older adults. This K23 program will provide PI Dr. Briceño with training to develop expertise in psychometric and longitudinal data analysis, qualitative research, population-based cognitive aging and health disparities research, and research leadership. Training will occur through individual mentoring, formal workshops and seminars, and international conferences. The K23 mentors are international leaders in Latinx brain health equity, psychometrics, population-based cognitive aging, and cross-cultural neuropsychological assessment of AD/ADRD. The K23 will provide Dr. Briceño with expertise and preliminary data to submit an R01 and to become an independent researcher in cognitive health disparities in AD/ADRD. The University of Michigan provides an ideal environment to conduct the proposed research and career development, with abundant resources, facilities, training opportunities, and collaboration.