Neurological and digital correlates of cognition in Older Mandarin-speaking Adults

普通话老年人认知的神经和数字相关性

• 批准号: 10608780
• 负责人: William Tzu-lung Hu
• 金额: $ 223.61万
• 依托单位: RUTGERS BIOMEDICAL AND HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-12-15 至 2025-11-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10608780
• 关键词: Accounting; Acculturation; Adult; Aging; Alzheimer associated neurodegeneration; Alzheimer' s Disease; Americas; Animals; Anterior; Area; Articulation; Asian; Asian Americans; Behavioral; Biological Markers; Blood; California; Cerebrovascular Disorders; Chicago; China; Chinese; Chinese population; Clinical; Clinical Trials; Cognition; Cognitive; Communities; Data Set; Dementia; Detection; Diagnosis; Diagnostic; Digit structure; Disease; Disparate; Early Intervention; Elderly; Eligibility Determination; Enrollment; Equity; Europe; Exposure to; FDA approved; Familiarity; Frequencies; Generations; Goals; Health; High Prevalence; Home; Image; Impaired cognition; Incidence; Instruction; International; Knowledge; Language; Linguistics; Low Prevalence; Magnetic Resonance Imaging; Measures; Medial; Mediating; Memory; Minority; Nerve Degeneration; Neuroanatomy; Neurocognitive; Neurologic; Neurologist; Neuropsychological Tests; Neuropsychology; Participant; Performance; Persons; Plasma; Population Study; Prevalence; Research; Resolution; Resources; Rest; Retrospective Studies; Semantics; Severity of illness; Tablets; Temporal Lobe; Testing; Trail Making Test; Training; Translating; Translations; Validity and Reliability; White Matter Hyperintensity; bilingualism; cerebral atrophy; clinical diagnosis; clinical trial enrollment; cognitive function; cognitive reserve; cognitive testing; dementia risk; digital; digital measure; digital platform; disease phenotype; gray matter; health care availability; health disparity; health equity; healthy aging; improved; insight; instrument; literacy; mild cognitive impairment; neuroprotection; nonEnglish language; normal aging; novel; posters; recruit; social stigma; sound; tool; white matter

ABSTRACT Asian Americans are the fastest growing demographic group in the US, with Chinese now representing the third most common language spoken after English and Spanish. Diagnosis-based studies have shown reduced dementia risks among older Chinese adults in the US and China, but assessment-based studies have suggested significant under-diagnosis by 50% or more. A major problem in diagnosis is the lack of reliable tools to diagnose mild cognitive impairment (MCI) or dementia (including Alzheimer’s disease [AD]) among Chinese adults in the US: about half of Chinese neuropsychological tests were created through content- only translation without adjustment for cultural, linguistic, or neurological factors, while the remaining only have translated instructions. Because language-independent neuropsychological tests are limited in scope and resolution, detection of MCI/AD in older US Chinese adults is often delayed for early intervention, clinical trial enrollment, and initiation of disease-modifying therapies. Building on the unparalleled bilingual neurocognitive expertise at Rutgers and Stanford, we have developed new Mandarin-based neuropsychological tests accounting for cognition-related differences between Mandarin and English to mirror the National Alzheimer’s Coordinating Center assessments. These include: articulation-normalized forward digit span; articulation- and lexeme-adjusted Craft Story 21; lexeme- and frequency-adjusted word list recall; Mandarin-specific word generation tasks guided by character, phoneme/pinyin, and homonym (one character sound corresponding to multiple characters); and exposure-based Trail Making Test B. We leveraged our existing community relationships to demonstrate the feasibility and reliability of using these tools in older Mandarin speakers, and we will further expand their reliability and relationship to performance using English instruments by bilingual older adults (Aim 1); determine construct and diagnostic validity analysis accounting for imaging and plasma biomarkers of neurodegeneration (Aim 2); and determine if bilingualism mediates the effects of neurodegeneration (Aim 3). We will additionally transfer these tests onto a digital platform which can then be used by centers without Mandarin-speaking clinicians, and explore the feasibility of longitudinal neuropsychological, blood, and MRI analysis in a subset of the older Chinese adults. Through this effort, we will provide the first linguistically, culturally, and neuroanatomically appropriate cognitive tests for Mandarin speakers to enhance clinical detection of MCI/AD, enable equitable enrollment into clinical trials, reduce language-associated health disparities, and determine if bilingualism is neuroprotective among Mandarin speakers.

摘要亚裔美国人是美国人口增长最快的群体， 汉语现在是仅次于英语和西班牙语的第三大通用语言。 基于诊断的研究表明，中国老年人患痴呆症的风险降低， 美国和中国，但基于评估的研究表明， 50%或更多。诊断中的一个主要问题是缺乏可靠的工具来诊断轻度 中国人的认知障碍（MCI）或痴呆（包括阿尔茨海默病[AD]） 美国的成年人：大约一半的中国神经心理学测试是通过内容创建的- 只有翻译没有调整文化，语言或神经因素，而 剩下的只有翻译的指令。因为独立于语言的神经心理学 测试的范围和分辨率有限，在美国老年人中检测MCI/AD， 通常因早期干预、临床试验入组和疾病改善治疗的启动而延迟 治疗在罗格斯大学无与伦比的双语神经认知专业知识的基础上， 在斯坦福大学，我们开发了新的基于普通话的神经心理学测试， 普通话和英语之间认知相关的差异，以反映全国阿尔茨海默氏症 协调中心评估。这些包括：发音标准化的向前数字跨度; 发音和词素调整的Craft Story 21;词素和频率调整的词表 回忆;由字符、音素/音素引导的普通话特定单词生成任务， 同音异义词（一个字符的声音对应多个字符）;以及基于 试运行测试B。我们利用现有的社区关系来展示 可行性和可靠性，使用这些工具在老年人的普通话，我们将进一步 通过双语教学， 老年人（目标1）;确定结构和诊断有效性分析， 神经变性的成像和血浆生物标志物（目标2）;并确定是否双语 介导神经变性的作用（目的3）。我们还将这些测试转移到 一个数字平台，可以由没有讲普通话的临床医生的中心使用，以及 探讨纵向神经心理学，血液和MRI分析在一个子集的可行性， 中国老年人。通过这一努力，我们将提供第一个语言，文化， 和神经解剖学上适当的认知测试，以提高临床 检测MCI/AD，使临床试验能够公平招募，减少语言相关的 健康差异，并确定双语是否对讲普通话的人有神经保护作用。