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）项目解决了土著人口中存在的显著痴呆症差异， 确定最近开发的，文化定制的，用于痴呆症的简短认知测试的可扩展性， 美国印第安人（American Indian）与大多数人口相比，土著人的阿尔茨海默氏症发病率 疾病和相关痴呆症（ADRD）的发病率约为3倍。这项研究将适应和验证 在加拿大和澳大利亚开发的一系列补充性土著认知评估工具， 在美国的人工智能人群中。这种电池扩展和适应加拿大土著认知 澳大利亚金伯利土著抑郁症评估（KICA 抑郁症）、日常生活活动（KICA-ADL）和照顾者报告（KICA-Carer）。 文化和背景是土著人民患痴呆症和痴呆症诊断经验的核心。由于 澳大利亚、加拿大和美国的部落人口之间存在着重大的文化差异， 本土文化有效的临床工具不能在美国使用，直到他们首先适应和重新验证。 在开发出公正的工具之前，我们有可能将关键的临床和政策决策建立在有缺陷的基础上。 ADRD的流行病学估计，这反过来又进一步加剧了痴呆症的不平等。利用社区- 基于参与式研究方法与土著方法相结合，我们将修改现有的 土著评估与人工智能文化背景以及神经精神特性保持一致。我们打算 测量和评估适应工具的可靠性、有效性和文化接受度， 390对痴呆症患者和他们的照顾者（n=780）在两个不同文化的部落社区， 明尼苏达州、威斯康星州和新墨西哥州的一个城市AI种群。我们的中心假设是， 考虑文化背景的文化安全认知评估方法将提供准确的诊断， 这反过来将有助于我们实现改善土著人诊断和护理的长期目标 与痴呆症的关系我们的具体目标是：1）创造适当的美国印第安人 CICA Cog、KICA Carer、KICA抑郁和KICA-ADL（“AMICA组合”）的版本; 2）评估 心理测量特性和文化接受的四个工具在AMICA电池。我们假设 AMICA成套测验将显示出很强可靠性、有效性、灵敏度、特异性、阳性和阴性 相对于双眼视觉共识诊断的预测值。因此，AMICA电池将生产 同样的诊断，同时提供更大的文化安全，比标准的评估。通过实现这些 我们可以期待为美国印第安人提供第一个文化适应的有效认知评估电池 老年人在这样做的过程中，这项研究将有助于减少差距，加快研究，并提高获得 高质量的临床实践。

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.