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增长最快的人口群体，其中 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在 美国和中国，但基于评估的研究表明，严重低估了诊断 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 中国人的认知障碍或痴呆(包括阿尔茨海默病[AD]) 美国成年人：大约一半的中国神经心理测试是通过内容创建的- 只有翻译而不考虑文化、语言或神经因素，而 剩下的只有翻译后的说明。因为不依赖语言的神经心理学 检测的范围和分辨率有限，在美国华裔老年人中检测到MCI/AD 经常因为早期干预、临床试验登记和疾病修改的启动而被延误 治疗。以罗格斯大学无与伦比的双语神经认知专业知识为基础 斯坦福大学，我们开发了新的基于普通话的神经心理测试，解释了 汉语和英语认知相关差异反映全国阿尔茨海默病 协调中心评估。这包括：发音标准化的正向数字广度； 发音和词位调整的工艺故事21；词位和频率调整的词汇表 回忆；特定于普通话的单词生成任务，由字符、音素/拼音指导，以及 同音异义词(一个字的发音对应多个字)；以及基于曝光的 测试B。我们利用现有的社区关系来演示 在说普通话的老年人中使用这些工具的可行性和可靠性，我们将进一步 通过双语使用英语乐器扩展他们的可靠性和与绩效的关系 老年人(目标1)；确定结构和诊断效度分析 神经退行性变的影像和血浆生物标志物(目标2)；并确定是否会双语 调节神经退行性变的影响(目标3)。我们还将把这些测试转移到 一个数字平台，可以在没有会说普通话的临床医生的情况下由中心使用，以及 探讨纵向神经心理学、血液和核磁共振分析的可行性 年龄较大的中国成年人。通过这一努力，我们将提供第一个语言上，文化上， 对说普通话的人进行神经解剖学上合适的认知测试，以加强临床 检测MCI/AD，实现公平登记临床试验，减少与语言相关的 健康差异，并确定双语在说普通话的人中是否具有神经保护作用。