PROMIS Profile Measures in Older Adults - Identifying Cognitive Thresholds for Reliable and Valid Responses

项目摘要 美国国立卫生研究院(NIH)患者报告结果测量信息系统 (PROMIS®)措施被开发，以提供患者报告的高度精确和有效的测量 结果，建立一个跨慢性健康状况的通用指标，并实现计算机化的自适应 测试。Promis工具尚未在老年人中进行广泛测试，特别是在80岁以上的人群中 轻度认知障碍(MCI)和阿尔茨海默氏症及相关痴呆症患者年龄较大 (ADRD)。MCI和ADRD患者对PROMIS量表回答的信度和效度 是未知的，认知测量的阈值也是未知的，在这种情况下，自我报告的提示数据不再是 代表潜在的健康状况。本项目的具体目标是验证PROMIS概况 在老年人中使用这些措施，并确定认知障碍使这些措施无效的阈值。 我们将在老年人中测试PROMIS个人资料测量(29项、43项和57项版本)的实用性 使用不同程度的认知障碍来找到阈值(分界点)，而患者报告的数据无法 不再可靠或有效地获得。认知水平将通过蒙特利尔认知评估进行评估 (MOCA)和简易精神状态检查(MMSE)。共448名门诊受试者入选 确保65-79岁和80岁以上的受试者数量相等的做法，以及认知能力的范围 功能从正常认知到MCI再到ADRD。对48名老年人的定性认知访谈将检查 耐心地了解个别项目和提供有效信息的能力。认知型访谈将 被用来阐明基于项目相对于认知的认知复杂性的反应模式 参与者的能力。PROMIS轮廓认知阈值的定量研究 测量(29项、43项和57项版本)将在另外400名老年人中进行，以确定 响应变得不一致(不可靠)和无效的认知阈值。量表信度和条目 功能将通过三种方式进行评估：i)调查PROMIS档案中不同项目的功能 对于患者报告内部不太一致的MoCA和MMSE阈值(使用项目- 反应理论建模)；ii)PROMIS轮廓的半信度，以确定内部一致性在哪里 低于α=0.8；和三)，将检查目标1中阐明的反应模式，以确定阈值 受试者使用满意策略。有效性将通过检查以下各项的一致性来评估 PROMIS配置文件和其他变量之间的关系(例如，宣传品代理报告、自我报告 类似的措施)横向同时有效和纵向(例如，住院、跌倒)，以 显示预测性有效性。这项研究将产生实用的数据，以便在研究和临床中立即翻译 实践对不同程度认知障碍老年人提供准确信息的能力 对残疾和心理痛苦的PROMIS测量的反应。

Project Summary The National Institutes of Health (NIH) Patient-Reported Outcomes Measurement Information System (PROMIS®) measures were developed to provide highly precise and valid measures of patient-reported outcomes, establish a common metric across chronic health conditions, and enable computerized adaptive testing. The PROMIS tools have not been widely tested in the older adult population, especially those aged 80 and older nor among those with Mild Cognitive Impairment (MCI) and Alzheimer's and Related Dementias (ADRD). The reliability and validity of responses provided by those with MCI or ADRD on PROMIS measures is unknown, as are the threshold on cognitive measures where self-reported PROMIS data are no longer representative of underlying health status.The Specific Aim of this project is to validate the PROMIS Profile measures in older adults and to identify the threshold where cognitive impairment invalidates these measures. We will test the utility of the PROMIS Profile measures (29-, 43-, and 57-item versions) among older adults with varying levels of cognitive impairment to find thresholds (cut points) where patient-reported data can no longer be reliably or validly attained. Cognitive levels will be assessed with the Montreal Cognitive Assessment (MoCA) and the Mini-Mental State Examination (MMSE). A total of 448 subjects will be enrolled from outpatient practices ensuring equal numbers of subjects, ages 65-79 and 80+ years as well as a spectrum of cognitive function from normal cognition to MCI to ADRD. Qualitative cognitive interviews in 48 older adults will examine patient understanding of individual items and capacity to provide valid information. The cognitive interviews will be used to elucidate patterns of response based on cognitive complexity of the items relative to the cognitive capacity of the participants. Quantitative investigation of the thresholds of cognition on the PROMIS profile measures (29-, 43-, and 57-item versions) will be done in an additional sample of 400 older adults to identify the cognitive threshold where responses become inconsistent (unreliable) and invalid. Scale reliability and item functioning will be assessed in three ways: i) investigating differential item functioning on the PROMIS Profiles for the MoCA and MMSE threshold where patient reports become less internally consistent (using Item- Response Theory modeling); ii) split-half reliability of PROMIS Profiles to identify where internal consistency falls below alpha=0.8; and iii), patterns of responses elucidated in Aim 1 will be examined to identify thresholds where subjects use satisficing strategies. Validity will be assessed by examining the consistency of relationships between PROMIS Profiles and other variables (e.g., collateral proxy reports, self-reports on similar measures) cross-sectionally for concurrent validity and longitudinally (e.g., hospitalizations, falls), to show predictive validity. The study will result in practical data for immediate translation in research and clinical practice on the capacity of older adults with varying levels of cognitive impairment to provide accurate responses on PROMIS measures of disability and psychological distress.