Multicultural Community Dementia Screening

项目摘要 轻度认知障碍（MCI）、阿尔茨海默病（AD）和相关痴呆症具有有限的 由于缺乏足够的简单筛查测试， 最早的迹象，是被发现的。临床、流行病学和社会- 行为研究也受到缺乏有效筛选工具的阻碍， 应用于社区设置。最近的医疗保健改革（责任医疗法案）提出了一个 个性化预防计划，包括认知障碍筛查，可通过 医疗保险不幸的是，目前还没有明确的计划如何最好地筛查老年痴呆症， 如果MMSE继续被使用，现存的文献表明，许多老年人 MCI和早期痴呆的患者会有假阴性结果。虽然生物标记， 因为MRI、PET扫描和脑脊液（CSF）增加了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， 不适合广泛使用。我们的初步数据支持筛查MCI、AD和 使用可靠和有效的措施可以改善痴呆症的检测， 在尽可能早的阶段，以廉价、快捷和文化敏感的方式，我们提出 解决最佳实践中的差距，以尽早诊断MCI、AD和相关疾病 在社区环境中的可能阶段，并提供跨文化的方法验证， 生物标志物测定。我们提出了三个具体的目的：1）测试患者是否AD 8 +/-简短 在150名白人、非洲裔美国人和100名非裔美国人的样本中， 和居住在社区的西班牙裔老年人。2)测试对以下内容的接受度、偏好 以及对痴呆症筛查建议的依从性;以及3）确认筛查结果 采用金标准临床和认知评估，并验证AD的生物学证据 做了核磁共振和脑脊液生物标记该项目的影响是对环境的持续影响。 医疗保健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.