5-Cog Battery to improve detection of cognitive impairment and dementia

与痴呆症相关的认知障碍在初级保健环境中经常诊断不足， 提供多种评估工具。漏诊也会延迟可逆性疾病的治疗 提供支持服务和重要规划。这个问题在非洲老年人中更为普遍- 美国人和西班牙裔比年长的白人。我们团队有二十年的开发工具经验 来检测不同健康人群中的痴呆症。值得注意的是，我们开发了基于图片的记忆， 损伤筛查（PMIS）依赖于文化展览会图片，不需要由 医学专业人士。我们还验证了运动认知风险综合征（MCR）。这个高度可及的 测试依赖于缓慢的步态和认知自我投诉的存在，以识别高风险的个体。 转变成痴呆症PMIS和MCR都是高灵敏度和特异性的一线检测试剂盒， 随后进行更全面、更复杂的认知测试。 在我们工作的基础上，我们建议开发和验证一个5分钟的屏幕（5-Cog）， 发展成痴呆症的风险，并标记他们作进一步评估。我们建议在城市，多民族， 布朗克斯初级保健人口的社会经济挑战。5-Cog电池将包括PMIS， MCR综合征诊断和2项抑郁筛查。 在为期18个月的UG 3阶段，我们建议对5-Cog的组件进行微调， 布朗克斯的健康不同人群，并可扩展到本RFA下的其他参与地点。我们 我还将测试非医生管理5-Cog的可行性，以增加我们电池的可及性 在初级保健环境中。 在为期42个月的UH 3阶段，我们提出了一个单盲，随机临床试验，在1,200老年初级保健 将随机接受5-Cog组合治疗的有认知主诉的患者 （干预组）或5分钟健康素养问卷（对照组）。非医生将管理 在初级保健场所进行干预和控制测试，并将测试结果提供给初级保健机构。 医生采取进一步行动。“改善痴呆症护理”将通过使用复合终点来衡量 包括新的轻度认知障碍综合征（MCI）或痴呆诊断，实验室检查， 排除认知障碍的可逆原因，新的痴呆症药物处方，专家或 社工推荐将使用我们的电子健康记录系统跟踪结局事件。我们将 还进行卫生保健利用和成本效益分析的5-Cog干预在现实世界中 设置.在UH 3阶段结束时，我们将创建一个Web注册表，以制作5-Cog测试项目和程序 供医护人员下载。 5-Cog电池将克服以前认知屏幕的许多实现障碍;它将是 快速，低成本，易于实施（只需要笔，纸和秒表），可以通过非 经过最低限度培训的临床医生，没有教育或文化偏见，不被抑郁症混淆， 不需要线人。

Cognitive impairment related to dementia is frequently under-diagnosed in primary care settings despite the availability of numerous assessment tools. Missed detection delays treatment of reversible conditions as well as provision of support services and critical planning. This problem is more prevalent among older African- Americans and Hispanics than among older whites. Our group has two decades of experience developing tools to detect dementia in health disparate populations. Notably, we developed the Picture-based Memory Impairment Screen (PMIS) that relies on culture fair pictures and does not need to be administered by a medical professional. We also validated the Motoric Cognitive Risk syndrome (MCR). This highly accessible test relies on the presence of slow gait and cognitive self-complaints to identify individuals at high risk of converting to dementia. Both the PMIS and the MCR are highly sensitive and specific first-line assays that can be followed up with more thorough and complex cognitive testing. Building on our work, we propose to develop and validate a 5-minute screen (5-Cog) to identify persons at high risk of developing dementia and to flag them for further evaluation. We propose to do this in urban, multi-ethnic Bronx primary care populations with socio-economic challenges. The 5-Cog battery will include the PMIS, MCR syndrome diagnosis, and a 2-item depression screener. In the 18-month UG3 phase, we propose to fine-tune the components of the 5-Cog that will be tested in a health disparate population in the Bronx, and could be extended to other participating sites under this RFA. We will also test the feasibility of administering the 5-Cog by non-physicians to increase accessibility of our battery in primary care settings. In the 42-month UH3 phase, we propose a single-blind, randomized clinical trial in 1,200 older primary care patients presenting with cognitive complaints who will be randomized to receive either the 5-Cog battery (intervention group) or a 5-minute health literacy questionnaire (control group). Non-physicians will administer the intervention and control tests in primary care sites, and test results will be provided to primary care physicians for further action. ‘Improved dementia care’ will be measured by using a composite endpoint including new Mild Cognitive Impairment syndrome (MCI) or dementia diagnoses, laboratory investigations to rule out reversible causes of cognitive impairment, new dementia medication prescriptions, and specialist or social work referrals. The outcome events will be tracked using our electronic health record system. We will also conduct health care utilization and cost effectiveness analysis of the 5-Cog intervention in real-world settings. By the end of the UH3 phase, we will create a web registry to make 5-Cog test items and procedures available for download by health care professionals. The 5-Cog battery will overcome many of the implementation barriers of previous cognitive screens; it will be fast, low cost, easy to implement (requires only pen, paper and stopwatch), can be administered by non- clinicians after minimal training, not educationally or culturally biased, not confounded by depression and does not require informants.