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Addressing Alzheimer's Disease and Related Dementias Disparities: The American Indigenous Cognitive Assessment (AMICA) Project

解决阿尔茨海默病和相关痴呆症的差异：美国土著认知评估 (AMICA) 项目

基本信息

批准号：
10623223
负责人：
CAREY E GLEASON
金额：
$ 204.25万
依托单位：
UNIVERSITY OF MINNESOTA
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-06-01 至 2027-05-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10623223
关键词：
Acceleration Activities of Daily Living Address Adult Aging Alzheimer disease detection Alzheimer&apos s disease related dementia American Indians Area Assessment tool Australia Canada Caregivers Caring Clinical Communities Congresses Consensus Cultural Backgrounds Dementia Development Diagnosis Disparity Elderly Epidemiology Eye Feedback Goals Improve Access Indigenous Indigenous American Inequity Interview Knowledge Letters Measures Mediation Mental Depression Methodology Minnesota Modification Native-Born New Mexico Outcome Participant Persons Policies Population Practice Guidelines Predictive Value Procedures Process Property Provider Psychometrics Pueblo Race Reporting Research Research Priority Reservations Risk Running Safety Site Specificity Surveys Testing Time Tribes United States Wisconsin accurate diagnosis barrier to care clinical practice cognitive interview cognitive testing community based participatory research dementia care disparity reduction early onset experience health disparity improved instrument member neuropsychiatry research clinical testing response standard of care tool tribal community urban Native American

项目摘要

The Addressing Alzheimer’s Disease and Related Dementias Disparities: The American Indigenous Cognitive Assessment (AMICA) Project tackles the significant dementia disparity that exists for Indigenous populations by determining the scalability of recently developed, culturally tailored, brief cognitive tests for dementia for use in diverse American Indian (AI) populations. Compared to the majority population, Indigenous rates of Alzheimer’s disease and related dementias (ADRD) are approximately 3 times higher. This research will adapt and validate a battery of complementary Indigenous cognitive assessment tools developed in Canada and Australia for use among AI populations in the United States. This battery expands and adapts the Canadian Indigenous Cognitive Assessment (CICA), as well as the Australian Kimberley Indigenous assessments for depression (KICA depression), Activities of Daily Living (KICA-ADL) and a caregiver report (KICA-Carer). Culture and context are central to Indigenous peoples’ experience with dementia and dementia diagnosis. Due to significant cultural differences between tribal populations in Australia, Canada, and the US, existing Indigenous culturally valid clinical tools cannot be used in the US until they are first adapted and re-validated. Until unbiased tools are developed, we run the risk of basing critical clinical and policy decisions on flawed epidemiological estimates of ADRD which, in turn, further exacerbates dementia inequities. Using community- based participatory research approaches blended with Indigenous methodologies, we will revise existing Indigenous assessments to align with AI cultural context as well as the neuropsychiatric properties. We intend to measure and assess the reliability, validity, and cultural acceptance of the adapted instruments with a total of 390 dyads of people with dementia and their caregivers (n=780) in in two culturally distinct tribal communities in Minnesota, Wisconsin, and an urban AI population in New Mexico. Our central hypothesis is that developing a culturally safe cognitive assessment approach that accounts for cultural context will provide accurate diagnoses, which in turn will help us achieve our long-term goal of improving the diagnosis and care of Indigenous persons with dementia across the ADRD continuum. Our specific aims are to: 1) create American Indian appropriate versions of the CICA Cog, KICA Carer, KICA depression and KICA-ADL (the “AMICA battery”); 2) assess the psychometric properties and cultural acceptability of the four tools in the AMICA battery. We hypothesize that the AMICA battery will demonstrate strong reliability, validity, sensitivity, specificity, positive and negative predictive value relative to the two-eyed seeing consensus diagnosis. Thus the AMICA battery will produce the same diagnoses, while providing greater cultural safety, than the standard assessments. By achieving these aims we can expect to deliver the first culturally adapted valid cognitive assessment battery for American Indian older adults. In doing so, this research will help to reduce disparities, accelerate research, and enhance access to high quality clinical practice.

解决阿尔茨海默病和相关痴呆差异：美国土著认知