Multicultural Community Dementia Screening.

描述(申请人提供)：轻度认知障碍(MCI)、阿尔茨海默病(AD)和相关痴呆症在社区中的检测有限，这是因为缺乏经过充分验证的简短筛查测试来检测最早的损害迹象。临床、流行病学和社会行为研究也因缺乏可应用于社区环境的有效筛查工具而受到阻碍。最近的医疗改革(责任医疗法案)提出了一项个性化预防计划，包括筛查认知障碍，可通过医疗保险报销。不幸的是，没有明确的计划如何最好地筛查老年人的痴呆症，如果MMSE继续使用，现有的文献表明，许多患有MCI和早期痴呆症的老年人将出现假阴性结果。尽管MRI、PET扫描和脑脊液(CSF)等生物标记物增加了AD的诊断可能性；但生物标记物具有侵入性、不舒服、价格昂贵，农村地区、服务不足的社区、保险不足的个人或发展中国家可能难以获得，因此不适合广泛使用。我们的初步数据支持，使用可靠和有效的措施筛查MCI、AD和相关痴呆症可以在可能的早期阶段以廉价、快速和文化敏感的方式改进痴呆症的检测。我们建议解决在社区环境中尽早诊断MCI、AD和相关疾病的最佳实践中的差距，并提供方法学和生物标记物分析的跨文化验证。我们提出了三个具体目标：1)测试患者AD8简要操作测试是否在150名高加索人、非裔美国人和西班牙裔社区居住的老年人中检测到认知障碍。2)测试对痴呆症筛查建议的接受、偏好和遵从性；以及3)用黄金标准临床和认知评估确认筛查结果，并用MRI和脑脊液生物标记物验证AD的生物学证据。这个项目的影响是在医改时代对医学实践的持续影响。 公共卫生相关性：鉴于最近为阿尔茨海默病开发生物标记物的努力，重要的是确定如何更容易地翻译这些信息，以便在繁忙的初级实践环境中使用。该项目有潜力解决如何改善社区对MCI、AD和相关疾病的检测，提供筛查计划的跨文化验证，以及增加少数族裔参与研究的未得到满足的需求。

DESCRIPTION (provided by applicant): Mild Cognitive Impairment (MCI), Alzheimer disease (AD) and related dementias have limited detection in the community due to the lack of brief screening tests that have been adequately validated to detect the earliest signs of impairment. Clinical, epidemiological and social-behavioral research is also hampered by the lack of valid screening instruments that can be applied in community settings. Recent healthcare reform (Accountable Care Act) proposes a Personalized Prevention Plan including screening for cognitive disorders, reimbursable through Medicare. Unfortunately, there is no clear plan how best to screen older adults for dementia, and if the MMSE continues to be utilized the extant literature suggests that many older adults with MCI and early dementia will have false negative results. Although biological markers such as MRI, PET scans, and cerebrospinal fluid (CSF) increase the diagnostic likelihood that AD is present; biomarkers are invasive, uncomfortable, expensive, and may not be readily available to rural areas, underserved communities, underinsured individuals or developing countries making them impractical for broad use. Our preliminary data support that screening for MCI, AD and related dementias using reliable and validated measures can improve dementia detection in an inexpensive, quick and culturally-sensitive manner at the earliest possible stages. We propose to address the gap in the best practice to diagnose MCI, AD and related disorders at the earliest possible stage in community settings and provide cross-cultural validation of methodology and biomarker assays. We propose three Specific Aims: 1) test whether the patient AD8 brief performance tests detects cognitive impairment in a sample of 150 Caucasian, African American and Hispanic community-dwelling older adults. 2) test the acceptance of, preferences about, and compliance with dementia screening recommendations; and 3) confirm screening results with a Gold Standard clinical and cognitive assessment and validate biological evidence of AD with MRI and CSF biomarkers. The impact of this project is the sustained influence on the practice of medicine in the Health Care Reform era. PUBLIC HEALTH RELEVANCE: It is important given the recent efforts to develop biomarkers for Alzheimer disease to determine how this information can more readily be translated for use in the busy primary practice setting. This project has potential to address the unmet needs of how to improve community detection of MCI, AD and related disorders, provide cross-cultural validation of screening programs, and increase minority participation in research.