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， 拉丁美洲/a/x老年人的相关痴呆症（AD/ADRD）是一个关键的公共卫生优先事项。拉丁裔人口是 在美国迅速增长和老龄化，预计未来老年拉丁美洲成年人的AD/ADRD将大幅增长 年目前尚不清楚认知评估工具是否以同样的精度测量认知健康， 拉丁裔和非拉丁裔白色（NLW）老年人之间的有效性，这是准确检测的关键障碍， AD/ADRD，其决定因素及其影响。本研究将采用混合方法评估有效性， 使用统一的标准，Latinx和NLW老年人认知和功能下降指标的等效性 认知评估方案（HCAP）认知测试组合（HCAP-R）和被调查者的认知和功能评分 下降（HCAP-I）。具体目标1将检查HCAP-R和HCAP-I显示以下统计证据的程度： 使用一种测量方法，测量了不同教育年限、评估语言（英语/西班牙语）和种族（拉丁语/NLW）之间的测量偏倚， 一系列的心理分析。健康与退休研究（HRS）-HCAP研究的数据将与 数据来自Corpus Christi（BASIC）的大脑攻击监测-认知研究。具体目标2将 利用来自基本认知研究的纵向数据来检查HCAP-R是否同样预测 Latinx和NLW老年人之间的被告知者认知和功能下降（HCAP-I）的纵向轨迹 以及是否对统计测量偏差进行调整消除了这种预测性差异 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查HCAP-R和HCAP-I项目的语言和文化效度 不同的教育水平和西班牙语的使用。这些数据将提供一种新颖的混合方法的整合 （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在不同文化、语言和教育背景的老年人中的有效性。K23计划将提供 PI Briceño博士接受培训，以发展心理测量和纵向数据分析，定性研究， 基于人口的认知老化和健康差异研究，以及研究领导力。培训将通过 个人辅导、正式讲习班和研讨会以及国际会议。K23导师是国际性的 拉丁美洲大脑健康公平，心理测量学，基于人口的认知老化和跨文化的领导者 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R 01并成为AD/ADRD认知健康差异的独立研究员。大学 密歇根州提供了一个理想的环境进行拟议的研究和职业发展，丰富的 资源、设施、培训机会和合作。

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.