Behavioral Change Following Culturally-Informed Biomarker Disclosure in Alzheimer’s Disease

项目摘要 阿尔茨海默病（AD）和痴呆-阿尔茨海默型（DAT）在老年人中的患病率正在增加， 在黑人老年人中，这种情况不成比例。科学的进步使得检测蛋白质 与AD相关的生物标志物和DAT风险增加。 成年人对他们的个性化PET淀粉样蛋白和tau蛋白信息感兴趣。然而，生物标志物披露 在临床或研究环境中很少发生，部分原因是担心患者会对 在缺乏有效的DAT治疗方法的情况下使用此信息。虽然有几项研究支持 正电子发射断层扫描（PET）淀粉样蛋白披露在心理反应方面的安全性， 很少有人研究过风险反馈后的实际行为，也没有研究过长期的风险反馈。 行为改变的时间轴。健康行为和生活方式改变对认知和行为功能的治疗作用 功能已得到证实;然而，披露是否会引发与健康相关的变化尚不清楚。 此外，迄今为止还没有研究调查tau蛋白的披露。这些问题与两个问题最为相关 人群：遗忘型轻度认知障碍（aMCI）患者，对他们来说，这种反馈可能是最重要的。 激励，和黑人个人，谁可能面临生物心理社会障碍，以执行适应性健康相关 改变，即使有动机这样做。到目前为止，还没有研究系统地解决种族差异， 对风险披露的反应或这些差异背后的机制。这一经验差距突出表明， 及时了解和解决AD诊断和治疗差异的潜在来源。 拟议的项目和紧密结合的培训计划将通过比较行为变化来响应这一呼吁 在接受“标准护理”诊断披露或诊断反馈增强的个体中， 本发明公开了组合的PET淀粉样蛋白和tau成像。我们将从密歇根州的强大框架， 阿尔茨海默病研究中心（MADRC）的纵向队列和两项相关的NIA资助的研究 招募一个生物标志物特征化和严格诊断的50%黑人和50%白色患者样本 关于AMCI该样本将被随机分配至治疗条件，然后进行一年两次的随访 超过两年。具体而言，我们将使用混合方法来评估健康行为变化（Aim 1a），先进的规划（目标1b），和研究参与（目标1c），以及如何一个已知的社会 健康的决定因素（医疗保健获得）影响了种族群体的这些结果的变化（目标2）。的 AD生物标志物测量和验证培训，生物标志物的伦理和公共卫生影响 披露，老龄化的种族-民族差异，以及混合方法的方法，除了关键的概念 在这项研究中探索，将创造理想的基础，为主要研究者脱颖而出，作为一个独立的 少数民族认知老化领域的早期职业研究员。

Project Summary Alzheimer’s Disease (AD) and Dementia-Alzheimer’s Type (DAT) prevalence is growing among older adults, and disproportionately so in Black seniors. Scientific advances have allowed for detection of protein biomarkers associated with AD and increased risk for DAT. Both cognitively healthy and symptomatic older adults are interested in their personalized PET amyloid and tau information. However, biomarker disclosure rarely occurs in either clinical or research settings, in part due to concerns about how patients will react to and use this information in the absence of validated treatments for DAT. While several studies have supported the safety of positron emission tomography (PET) amyloid disclosure in regards to psychological reactions, very few have examined actual behavior following risk feedback, and no studies have examined a prolonged timeline of behavior change. The therapeutic effect of health behavior and lifestyle change on cognition and functioning is well-established; however, whether disclosure may precipitate health-related change is unknown. Furthermore, no study to date has investigated tau disclosure. These questions are most pertinent to two populations: patients with amnestic Mild Cognitive Impairment (aMCI), for whom this feedback may be most motivating, and Black individuals, who may face biopsychosocial barriers to executing adaptive health related changes, even if motivated to do so. To date, no study has systematically addressed racial differences in reactions to risk disclosure or the mechanisms underlying these differences. This empirical gap highlights a timely opportunity to understand and address a potential source of disparity in AD diagnosis and treatment. The proposed project and closely aligned training plan will respond to this call by comparing behavior change in individuals who receive either ‘standard of care’ diagnostic disclosure, or diagnostic feedback enhanced by disclosure of combined PET amyloid and tau imaging. We will build from the robust framework of the Michigan Alzheimer’s Disease Research Center’s (MADRC) longitudinal cohort and two associated NIA-funded studies to recruit a biomarker-characterized and rigorously diagnosed sample of 50% Black and 50% White patients with aMCI. This sample will be randomly assigned to treatment condition, and then followed for bi-annual visits over two years. Specifically, we will use a mixed-methods approach to assess health behavior change (Aim 1a), advanced planning (Aim 1b), and research participation (Aim 1c), as well as how a known social determinant of health (healthcare access) influences change in these outcomes by racial group (Aim 2). The training in AD biomarker measurement and validation, ethical and public health implications of biomarker disclosure, racial-ethnic disparities in aging, and mixed methods approaches, in addition to the critical concepts explored in this study, will create the ideal foundation for the principal investigator to excel as an independent early career researcher in the field of minority cognitive aging.