Cross-Cultural Validity of Cognitive Function Tests

描述(申请人提供)：美国最大的两个少数民族，非洲裔美国人和西班牙裔美国人，比非西班牙裔白人患糖尿病和某些糖尿病并发症的风险更高。最近发现，2型糖尿病患者的认知障碍和认知加速下降的程度比非糖尿病患者更高。在基于人群的研究中，这些少数群体似乎也有更大的认知障碍和痴呆症风险。种族/民族与2型糖尿病患者认知损害之间的关系尚未得到研究。在进行此类研究之前，有必要确定一套在2型糖尿病风险最高的患者群体中可靠且跨文化有效的认知功能测试。本研究的目的是验证这样一种假设，即一系列简短的文化中立的认知功能测试可以在低识字率、双语、双文化患者群体中产生可靠和有效的特定认知功能领域的测量。包括在电池中的认知功能测试之前已经在说英语和说西班牙语的人群中进行了测试和正常化，但它们的跨文化有效性尚不清楚。将从一个大型的城市初级保健诊所网络招募总共480名2型糖尿病患者，他们代表四个种族/语言偏好群体(120名非西班牙裔白人，120名非西班牙裔非裔美国人，120名首选语言为英语的西班牙裔美国人，以及120名首选语言为西班牙语的西班牙裔美国人)。它们将在最初的时间点和一个月后进行测试。患者的时间将得到经济补偿，因此至少有312名(65%)拥有完整测试-重新测试数据的患者将可用于分析。将从参与者及其医疗记录中收集社会人口和病史数据。在最初的测试之前，将测量身高、体重、血压和腰围。在40%的样本中(n=208)，将测量空腹血糖和胰岛素、血脂、血浆同型半胱氨酸(含叶酸和维生素B12)和C反应蛋白。将计算该组合中各个测试的重测信度，并使用探索性和验证性因素分析来测试四个确定的种族/民族和语言组的测试的有效性。对于那些被证明是可靠和有效的认知功能测量，将使用多元回归分析来测试测试分数与患者特定临床特征的相关性，如年龄、糖尿病病程、血糖水平、糖尿病治疗方案，并检查每个物理和生化变量。

DESCRIPTION (provided by applicant): The two largest racial/ethnic minorities in the U.S., African-Americans and Hispanics, are at higher risk for diabetes and certain diabetes complications than non-Hispanic whites. Recently, cognitive impairment and accelerated cognitive decline have been found to be higher in persons with type 2 diabetes than in nondiabetics. In population based studies these minority groups also appear to be greater risk for cognitive impairment and dementia. The relationship between race/ethnicity and cognitive impairment among persons with type 2 diabetes has not been studied. Before such studies can be undertaken, it is necessary to identify a set of cognitive function tests that is reliable and cross culturally valid in patient groups at greatest risk for type 2 diabetes. The purpose of this study is to test the hypothesis that a brief battery of culturally neutral cognitive function tests can yield reliable and valid measures of specific cognitive function domains in low literacy, bilingual, bi-cultural patient populations. The cognitive function tests included in the battery have been previously tested and normed in both English-speaking and Spanish-speaking groups, but their crosscultural validity is not known. A total of 480 patients with type 2 diabetes representing four ethnicity/language preference groups will be recruited from a large, urban, primary care clinic network (120 non-Hispanic whites, 120 non-Hispanic African-Americans, 120 Hispanics whose preferred language is English, and 120 Hispanics whose preferred language is Spanish). They will be tested at an initial time point and one month later. Patients will be compensated financially for their time so that at least 312 (65%) patients with complete test-retest data will be available for analysis. Sociodemographic and medical history data will be collected from the participants and their medical records. Height, weight, blood pressure, and waist circumference will be measured before the initial test session. In a 40% subsample (n=208), fasting plasma glucose and insulin, lipid profile, plasma homocysteine (with folate and vitamin B12), and c-reactive protein will be measured. The test-retest reliability of the individual tests in the battery will be calculated for each ethnic group, and the validity of the tests across the four defined racial/ethnic and linguistic groups will be tested using exploratory and confirmatory factor analysis. For those cognitive function measures found to be reliable and valid, multiple regression analysis will be used to test associations between test scores and specific clinical characteristics of the patients, such as age, duration of diabetes, glycemic level, diabetes treatment regimen, and each of the physical and biochemical variables will be examined.