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5-Cog Battery to improve detection of cognitive impairment and dementia

5-Cog 电池可改善认知障碍和痴呆症的检测

基本信息

批准号：
10263305
负责人：
JOE VERGHESE
金额：
$ 82.17万
依托单位：
ALBERT EINSTEIN COLLEGE OF MEDICINE
依托单位国家：
美国
项目类别：
财政年份：
2017
资助国家：
美国
起止时间：
2017-09-25 至 2022-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10263305
关键词：
African American Assessment tool Biological Assay Cognitive Complex Computerized Medical Record Control Groups Cost Effectiveness Analysis Coupled Data Decision Trees Dementia Detection Diagnosis Drug Prescriptions Educational Background Electronic Health Record Ethnic Origin Ethnic group Evaluation Event Gait Health Professional Hispanics Human Resources Impaired cognition India Individual Internet Intervention Investigation Laboratories Logistics Low Literacy Population Measures Medical Medicare Memory impairment Mental Depression Methods Motor Neuropsychological Tests Outcome Outpatients Paper Patient Care Persons Phase Population Primary Care Physician Primary Health Care Procedures Process Questionnaires Randomized Randomized Clinical Trials Registries Risk Rural Services Single-Blind Study Site Social Work Specialist Specificity Standardization Syndrome System Test Result Testing Training Validation Visit Work active control base cognitive testing cohort cost dementia care experience feasibility testing follow-up grasp group intervention health care service utilization health disparity populations health literacy high risk implementation barriers improved informant literacy mild cognitive impairment multi-ethnic older patient patient population primary care setting recruit screening socioeconomics tool validation studies

项目摘要

Cognitive impairment related to dementia is frequently under-diagnosed in primary care settings despite the availability of numerous assessment tools. Missed detection delays treatment of reversible conditions as well as provision of support services and critical planning. This problem is more prevalent among older African- Americans and Hispanics than among older whites. Our group has two decades of experience developing tools to detect dementia in health disparate populations. Notably, we developed the Picture-based Memory Impairment Screen (PMIS) that relies on culture fair pictures and does not need to be administered by a medical professional. We also validated the Motoric Cognitive Risk syndrome (MCR). This highly accessible test relies on the presence of slow gait and cognitive self-complaints to identify individuals at high risk of converting to dementia. Both the PMIS and the MCR are highly sensitive and specific first-line assays that can be followed up with more thorough and complex cognitive testing. Building on our work, we propose to develop and validate a 5-minute screen (5-Cog) to identify persons at high risk of developing dementia and to flag them for further evaluation. We propose to do this in urban, multi-ethnic Bronx primary care populations with socio-economic challenges. The 5-Cog battery will include the PMIS, MCR syndrome diagnosis, and a 2-item depression screener. In the 18-month UG3 phase, we propose to fine-tune the components of the 5-Cog that will be tested in a health disparate population in the Bronx, and could be extended to other participating sites under this RFA. We will also test the feasibility of administering the 5-Cog by non-physicians to increase accessibility of our battery in primary care settings. In the 42-month UH3 phase, we propose a single-blind, randomized clinical trial in 1,200 older primary care patients presenting with cognitive complaints who will be randomized to receive either the 5-Cog battery (intervention group) or a 5-minute health literacy questionnaire (control group). Non-physicians will administer the intervention and control tests in primary care sites, and test results will be provided to primary care physicians for further action. ‘Improved dementia care’ will be measured by using a composite endpoint including new Mild Cognitive Impairment syndrome (MCI) or dementia diagnoses, laboratory investigations to rule out reversible causes of cognitive impairment, new dementia medication prescriptions, and specialist or social work referrals. The outcome events will be tracked using our electronic health record system. We will also conduct health care utilization and cost effectiveness analysis of the 5-Cog intervention in real-world settings. By the end of the UH3 phase, we will create a web registry to make 5-Cog test items and procedures available for download by health care professionals. The 5-Cog battery will overcome many of the implementation barriers of previous cognitive screens; it will be fast, low cost, easy to implement (requires only pen, paper and stopwatch), can be administered by non- clinicians after minimal training, not educationally or culturally biased, not confounded by depression and does not require informants.

与痴呆症相关的认知障碍在初级保健环境中经常被低估，尽管提供多种评估工具。漏检也会延迟可逆性疾病的治疗作为提供支助服务和关键规划。这个问题在年长的非洲人中更为普遍- 美国人和西班牙裔人比年龄较大的白人更多。我们的团队有二十年的工具开发经验以检测健康状况不同人群中的痴呆症。值得注意的是，我们开发了基于图片的存储器依赖于文博会图片且不需要由医学专业人士。我们还验证了运动认知风险综合征(MCR)。这一高度可访问的测试依赖于步态缓慢和认知自我抱怨的存在，以确定高危人群变成痴呆症。PMIs和MCR都是高度灵敏和特异的一线分析方法，可以随后进行更彻底、更复杂的认知测试。在我们工作的基础上，我们建议开发和验证5分钟屏幕(5-Cog)来识别高血压者对罹患痴呆症的风险进行评估，并将其标记为进一步评估。我们建议在城市、多民族地区这样做布朗克斯初级保健人口面临社会经济挑战。5-Cog电池将包括PMI， MCR综合征诊断，以及两项抑郁筛查。在为期18个月的UG3阶段，我们建议微调5-Cog的组件，这些组件将在在布朗克斯区不同人群的健康，并可以扩大到其他参与地点根据这一RFA。我们还将测试由非医生管理5-Cog的可行性，以增加我们电池的可及性在初级保健环境中。在为期42个月的UH3阶段，我们建议在1200名老年初级保健人员中进行单盲、随机临床试验出现认知主诉的患者将被随机接受5-Cog电池 (干预组)或5分钟健康素养问卷(对照组)。非内科医生将管理初级保健地点的干预和控制测试，以及测试结果将提供给初级保健医生们准备采取进一步行动。将使用复合终点来衡量“改善的痴呆症护理” 包括新的轻度认知障碍综合征(MCI)或痴呆症诊断，实验室调查排除认知障碍的可逆原因、新的痴呆症药物处方和专科医生或社会工作转介。结果事件将使用我们的电子健康记录系统进行跟踪。我们会并在现实生活中进行5-Cog干预的卫生保健利用和成本效益分析设置。在UH3阶段结束时，我们将创建一个Web注册表，以制定5-Cog测试项目和程序可供医疗保健专业人员下载。 5-Cog电池将克服以前认知屏幕的许多实施障碍；它将是速度快、成本低、易于实施(只需要笔、纸和秒表)，可由非临床医生经过最低限度的培训，不受教育或文化上的偏见，不会被抑郁症困扰，不需要告密者。

项目成果

期刊论文数量（9）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Motoric Cognitive Risk Syndrome in Polypharmacy.

DOI：
10.1111/jgs.16380
发表时间：
2020-05
期刊：
Journal of the American Geriatrics Society
影响因子：
6.3
作者：
George CJ;Verghese J
通讯作者：
Verghese J

Cross-Cultural Comparisons of Subjective Cognitive Complaints in a Diverse Primary Care Population.

DOI：
10.3233/jad-201399
发表时间：
2021
期刊：
Journal of Alzheimer's disease : JAD
影响因子：
0
作者：
Rodríguez D;Ayers E;Weiss EF;Verghese J
通讯作者：
Verghese J

Is the Montreal cognitive assessment culturally valid in a diverse geriatric primary care setting? Lessons from the Bronx.

蒙特利尔认知评估在多元化的老年初级保健环境中在文化上有效吗？

DOI：
10.1111/jgs.18705
发表时间：
2024
期刊：
Journal of the American Geriatrics Society
影响因子：
6.3
作者：
Stimmel,MarninaB;Orkaby,ArielaR;Ayers,Emmeline;Verghese,Joe;Nsubayi,CelesteK;Weiss,EricaF
通讯作者：
Weiss,EricaF

Picture-Based Memory Impairment Screen: Effective Cognitive Screen in Ethnically Diverse Populations.