Improving the measurement of everyday functional outcomes in diverse populations of older adults with Alzheimer's disease and related disorders

项目摘要 美国的老龄化人口正变得比以往任何时候都更具种族和民族多样性。 在不同的老年人口中，健康差异已经有很好的记录，包括有证据表明 提示在一些人中，阿尔茨海默病(AD)和相关疾病的发病率可能会增加 组。旨在了解、预防和改善阿尔茨海默病健康差距的研究是一个主要的 公共卫生优先事项。然而，要研究和解决这些健康差距，需要心理测量学上的健全。 以及文化上适当的评估工具，以敏感地测量与AD和 为跟踪疾病进展和治疗反应提供良好的结果衡量标准。测量 这种评估工具的属性在概念上和心理测量学上必须在不同的 人口。利用之前的NIA资金(法里亚斯，AG 0215111，AG 031252)，我们开发了一种新的 基于问卷的评估工具(日常认知量表(ECOG)，用于测量非常早期的限制 在日常活动中。我们的研究表明，日常功能的细微变化，通过 ECOG，可用于识别患轻度认知障碍(MCI)风险增加的老年人 和痴呆症。然而，我们最新的工作表明，当前版本的经社理事会不那么敏感 预测少数民族/种族亚群(拉丁裔和非裔美国人)的疾病进展 在非拉丁裔高加索人中。这些发现为需要调整和进一步完善这一点提供了明确的理由 提高其作为疾病早期指标和不同疾病之间的结果衡量标准的效用的工具 人口。拟议的研究将利用多种方法(定量和定性)进行评估 并在不同的老年人口中提高ECOG的测量等价性。的目标是 这项研究包括两个方面。在目标1中，我们将利用加州大学戴维斯·阿尔茨海默分校的现有数据 疾病中心的多民族纵向队列，以定量评估ECOG显示的哪些项目 三个种族/民族(非洲裔美国人、拉美裔美国人和 非拉丁裔高加索人)使用复杂的分析方法。受目标1的结果影响，目标2将聘用 完善的认知面谈方法，以进一步评估和确定特定原因 经社理事会的项目对特定的种族/族裔群体来说是有问题的。例如，有些物品可能不是很容易 被理解为意向和/或某些项目可能不适合某些人的文化背景和生活方式 组。这些项目将进行相应的修改，第二波认知访谈将进一步 评估物料版本。这项研究的完成将提供关键的形成工作，以提高我们的能力 在不同的老年人之间，以相当的精确度和精确度衡量日常功能的早期变化 成年人口。

Project Summary The aging population in the United States is becoming more racially and ethnically diverse than ever before. Health disparities have been well documented across diverse older adult populations, including evidence to suggest that there may be increased rates of Alzheimer's disease (AD) and related disorders among some groups. Researched aimed at understanding, preventing and ameliorating health disparities in AD is a major public health priority. However, to study and address these health disparities requires psychometrically sound and culturally appropriate assessment tools to sensitively measure early clinical signs associated with AD and to provide good outcome measures to track disease progression and response to treatment. The measurement properties of such assessment tools must be conceptually and psychometrically equivalent across diverse populations. With previous NIA funding (Farias, AG 0215111, AG 031252) we developed a novel questionnaire-based assessment tool (the Everyday Cognition scales (ECog) to measure very early limitations in everyday functions. Our work has shown that subtle changes in everyday functions, as measured by the ECog, can be used to identify older adults at increased risk for developing Mild Cognitive Impairment (MCI) and dementia. However, our most recent work has shown that the current version of the ECog is less sensitive to predicting disease progression in ethnic/racial minority subgroups (Latinos and African Americans) than it is in non-Latino Caucasians. Such findings provide clear rationale for the need to adapt and further refine this instrument to improve its utility as an early indicator of disease and as an outcome measure among diverse populations. The proposed study will utilize a multi-method (quantitative and qualitative) approach to evaluate and improve the measurement equivalence of the ECog among diverse older adult populations. The aims of this study are twofold. In Aim 1 we will utilize existing data from the University of California, Davis Alzheimer Disease Center's multiethnic longitudinal cohort to quantitatively evaluate which items of the ECog display evidence of poor measurement equivalence across three racial/ethnic groups (African Americans, Latinos, and non-Latino Caucasians) using sophisticated analytic methods. Informed by results of Aim 1, Aim 2 will employ well-established cognitive interviewing methods to further evaluate and identify the reasons why particular ECog items are problematic for specific racial/ethnic groups. For example, some items may not be readily understood as intended and/or some items may not be appropriate the cultural context and lifestyle of some groups. These items will be modified accordingly and a second wave of cognitive interviews will further evaluate item revisions. Completion of this study will provide the critical formative work to improve our ability to measure early changes in everyday function with comparable accuracy and precision across diverse older adult populations.