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

准确和有效的认知和功能衰退测量用于检测阿尔茨海默病和 拉丁裔/a/x老年人中的相关痴呆症(AD/ADRD)是一个关键的公共卫生优先事项。拉丁裔人口是 美国快速增长和老龄化，预计AD/ADRD在即将到来的拉丁裔老年成年人中将大幅增长 好几年了。目前尚不清楚认知评估工具是否以同样的精确度和 Latinx和非Latinx白人(NLW)老年人的有效性，这是准确检测 AD/ADRD、其决定因素及其影响。本研究将使用混合方法来评估效度和 Latinx和NLW老年人认知和功能衰退测量的等价性 认知评估协议(HCAP)、认知测验组合(HCAP-R)以及信息者对认知和功能的评级 拒绝(HCAP-I)。具体目标1将审查HCAP-R和HCAP-I展示统计证据的程度 跨教育年限、评估语言(英语/西班牙语)和种族(拉美裔/非裔美国人)的衡量偏差，使用 一系列心理测量学分析。健康和退休研究(HRS)-HCAP研究的数据将与 数据来自语料库克里斯蒂的脑攻击监测(基础)--这项分析的认知研究。特定目标2将 利用基础认知研究的纵向数据来检验HCAP-R是否同样可以预测 Latinx和NLW老年人之间知情者评估的认知和功能衰退(HCAP-I)的纵向轨迹 以及对统计测量偏差的调整是否消除了这一预测中的任何差异 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 在墨西哥裔美国老年人样本中检验HCAP-R和HCAP-I项目的语言和文化有效性 受教育程度和西班牙语使用程度各不相同。这些数据将提供一种新的混合方法的集成 (心理测量学，认知和功能衰退的纵向预测，以及定性)，以告知等价性和 HCAP在文化、语言和教育程度不同的老年人中的有效性。这项K23计划将提供 PiBriceño博士接受了培训，以发展心理测量和纵向数据分析、定性研究、 以人口为基础的认知老龄化和健康差距研究，以及研究领导。培训将通过以下方式进行 个人辅导、正式讲习班和研讨会以及国际会议。K23的导师是国际化的 Latinx大脑健康公平、心理测量学、基于人群的认知老龄化和跨文化领域的领军人物 AD/ADRD的神经心理评定。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人员。伊利诺伊大学 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， 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.