Community-based approach to Early Identification of transitions to Mild Cognitive Impairment (MCI) and Alzheimer's Disease (AD) in African Americans

随着寿命的迅速延长和老年人在人口中所占比例的大幅扩大， 了解与年龄相关的认知能力下降的机制变得越来越重要， 指导老年人的环境和临床干预措施，并更准确地预测老年人的风险， 痴呆[例如，阿尔茨海默病（AD）]。衰老研究的一个关键挑战是提高对 导致痴呆症的神经生物学基础，以完善诊断程序， 针对新的行为和药物干预。神经生物学理解的主要途径 导致痴呆症的非常早期的风险过程将是筛查大量处于风险中的人群， 快速，低成本，广泛使用的程序。本提案将测试计算机化程度 认知测试和便携式脑电图（EEG）可用于方便，准确和有效地 评估有AD风险的老年人的早期认知功能下降。 健康方面的差距是一个严重的障碍，它削弱了早期教育的社会和财政效益。 识别和护理，不仅对患者个人和家庭，而且在州和联邦一级。 居住在社区的非洲裔美国老人的认知能力下降速度更快，几乎是老年人的两倍。 可能发展为轻度认知障碍（MCI）和AD，就像美国的老年白色人一样。但他们 不太可能在这些疾病的早期阶段被诊断或接受治疗。发展 经济上可行和文化上可接受的早期检测方法对少数群体至关重要。 我们建议通过主观记忆来识别有痴呆风险的非裔美国人的第一个迹象 投诉（SMC）在底特律市区内的社区，通过使用计算机认知测试 CogState和国家卫生研究院的脑电图仪和便携式脑电图仪。我们计划将联合收割机横向研究与纵向研究相结合： 在最初的两年内，我们将对总共500名患有SMC的非洲裔美国人进行认知评估。从 这些参与者，我们将选择200名在进入纵向研究时不会被诊断为 但在3年内每6个月进行一次重复的认知和脑电图测试 期我们将比较这些方法的重复认知和脑电图/事件相关电位（ERP） 测试在识别已经处于将进展为MCI和/或AD的风险中的人的敏感性方面。 我们提出的基于社区的评估，结合行为和EEG/ERP方法将被使用 生成处于风险中的健康老年非裔美国人的概况，这些人可能在短时间内发展为 MCI或AD。我们希望通过行为和EEG/ERP方法的结合，我们将能够 开发客观的标志物，这将可靠地识别认知能力下降的早期迹象。这些标志物将是 用于识别显著的认知功能下降，并评估新药理学的有效性。 这将导致开发新的治疗干预措施和疾病修饰。

With the rapid increase in longevity and considerable expansion of the share of elderly in the population, it is becoming ever important to understand the mechanisms underlying age-related cognitive declines in order to guide environmental and clinical interventions for older adults and for more accurate prediction of risk for dementia [e.g., Alzheimer’s disease (AD)]. A crucial challenge of aging research is improving understanding of the neurobiological basis of conditions leading to dementia, in order to refine the diagnostic procedures and to target new behavioral and pharmacological interventions. A main avenue for the neurobiological understanding of very early risk processes leading to dementia would be the screening of large populations at risk by means of quick, low-cost, and widely available procedures. The present proposal will test to what extent computerized cognitive tests and portable electroencephalography (EEG) can be used to easily, accurately and efficiently evaluate early cognitive decline in elderly at risk for developing AD. Health disparities represent a critical roadblock mitigating the social and fiscal benefits of early identification and care, not only to the individual patient and family, but also at the state and federal levels. Community-dwelling, African-American elders show faster rates of cognitive decline and are almost twice as likely to develop mild cognitive impairment (MCI) and AD as are older, white Americans. However, they are less likely to be diagnosed or receive treatment in the early stages of these disorders. Development of economically viable and culturally acceptable methods of early detection is critical in minority populations. We propose to identify the first signs of dementia in at risk African Americans with subjective memory complaints (SMC) in their communities within the Detroit metro area by using computerized cognitive tests CogState and NIH Toolbox and a portable EEG. We plan to combine cross-sectional with longitudinal studies: within the first two years, we will cognitively evaluate a total of 500 at risk African Americans with SMC. From these participants we will select 200 who at entry to the longitudinal study will not be diagnosed with either dementia or MCI but will, however, undergo repeated cognitive and EEG testing every 6 months over a 3 year period. We will compare these approaches of repeated cognitive and EEG/ Event-Related Potentials (ERP) testing in terms of their sensitivity of identifying persons already at risk who will progress to MCI and/or AD. Our proposed community based evaluation that combines behavioral and EEG/ERP methods will be used to generate profiles of at risk healthy elderly African-Americans, who may within a short period of time develop MCI or AD. We expect that with the combination of behavioral and EEG/ERP methods, we will be able to develop objective markers, which will reliably identify early signs of cognitive decline. Such markers will be used for identification of significant cognitive decline, and to evaluate efficiency of new pharmacological approaches, which will lead to the development of new therapeutic interventions and disease modification.