Multicultural Community Dementia Screening.

项目总结 轻度认知障碍(MCI)、阿尔茨海默病(AD)和相关痴呆 由于缺乏足够的简短筛查测试，社区中的检测 经验证可检测出最早的损伤迹象。临床、流行病学和社会- 行为研究也因缺乏有效的筛查工具而受到阻碍 适用于社区环境。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，包括认知障碍筛查，可通过以下方式报销 医疗保险。不幸的是，没有明确的计划如何最好地筛查老年人痴呆症， 如果MMSE继续被使用，现有的文献表明许多老年人 患有MCI和早期痴呆症的患者会有假阴性结果。尽管像这样的生物标记 随着MRI、PET扫描和脑脊液(CSF)检查增加AD的诊断可能性 生物标志物是侵入性的、不舒服的、昂贵的，并且可能不容易获得 农村地区、服务不足的社区、保险不足的个人或发展中国家 它们不切实际，不适合广泛使用。我们的初步数据支持对MCI、AD和 使用可靠和有效的措施可以改善痴呆症的检测 在可能的早期阶段，以廉价、快速和对文化敏感的方式进行培训。我们建议 解决早期诊断MCI、AD和相关疾病的最佳实践方面的差距 在社区环境中可能的阶段，并提供对方法和 生物标记物分析。我们提出了三个具体目标：1)测试患者AD8+/-Brief 性能测试检测出150名高加索人、非裔美国人的认知障碍 以及西班牙裔社区居住的老年人。2)测试对以下内容的接受程度、偏好 以及对痴呆症筛查建议的遵从性；以及3)确认筛查结果 具有黄金标准的临床和认知评估，并验证AD的生物学证据 核磁共振和脑脊液生物标记物。这个项目的影响是对 医疗改革时代的医学实践。

PROJECT SUMMARY 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 detect 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.