Community-based approach to Early Identification of transitions to Mild Cognitive Impairment (MCI) and Alzheimer's Disease (AD) in African Americans

随着寿命的快速增长和老年人在人口中所占比例的大幅扩大，它 理解与年龄相关的认知衰退的潜在机制变得越来越重要 指导老年人的环境和临床干预，并更准确地预测 痴呆症[如阿尔茨海默病(AD)]。衰老研究的一个关键挑战是提高对 导致痴呆症的条件的神经生物学基础，以便完善诊断程序和 针对新的行为和药物干预措施。了解神经生物学的主要途径 导致痴呆症的非常早期的风险过程将是通过以下方式对大量处于危险中的人群进行筛查 快速、低成本和广泛可用的程序。本提案将测试电脑化程度 认知测试和便携式脑电(EEG)可以方便、准确和高效地用于 评估有阿尔茨海默病风险的老年人的早期认知功能减退。 健康差距是减轻早期保健的社会和财政利益的关键障碍。 不仅对个别患者和家属，而且对州和联邦一级的身份识别和护理。 居住在社区的非裔美国老年人表现出更快的认知衰退速度，几乎是 像老年美国白人一样，可能会患上轻度认知障碍(MCI)和阿尔茨海默病。然而，他们是 在这些疾病的早期阶段被诊断或接受治疗的可能性较小。发展中的 在少数群体中，经济上可行和文化上可接受的早期检测方法至关重要。 我们建议在有主观记忆的高危非裔美国人中识别痴呆症的第一个迹象 通过使用计算机化认知测试，在底特律大都市区内的社区中进行投诉(SMC) CogState和NIH工具箱和便携式脑电图仪。我们计划将横断面研究与纵向研究相结合： 在最初的两年内，我们将对总共500名患有SMC的高危非裔美国人进行认知评估。从… 我们将从这些参与者中选择200人，他们在进入纵向研究时不会被诊断为 然而，痴呆症或MCI将在3年内每6个月接受一次重复的认知和脑电测试 句号。我们将比较这些重复认知和脑电/事件相关电位(ERP)的方法。 测试其对识别将发展为MCI和/或AD的已有风险的人的敏感性。 我们建议的基于社区的评估将结合行为和EEG/ERP方法 生成高危健康老年非裔美国人的档案，他们可能在短时间内发展成 MCI或AD。我们期望通过行为和EEG/ERP方法的结合，我们将能够 开发客观的标记物，它将可靠地识别认知衰退的早期迹象。这样的标记将是 用于识别显著的认知功能减退，并用于评估新药的有效性 方法，这将导致开发新的治疗干预措施和疾病修改。

With the rapid increase in longevity and considerable expansion of the share of elderly in the population, it is becoming ever important to understand the mechanisms underlying age-related cognitive declines in order to guide environmental and clinical interventions for older adults and for more accurate prediction of risk for dementia [e.g., Alzheimer’s disease (AD)]. A crucial challenge of aging research is improving understanding of the neurobiological basis of conditions leading to dementia, in order to refine the diagnostic procedures and to target new behavioral and pharmacological interventions. A main avenue for the neurobiological understanding of very early risk processes leading to dementia would be the screening of large populations at risk by means of quick, low-cost, and widely available procedures. The present proposal will test to what extent computerized cognitive tests and portable electroencephalography (EEG) can be used to easily, accurately and efficiently evaluate early cognitive decline in elderly at risk for developing AD. Health disparities represent a critical roadblock mitigating the social and fiscal benefits of early identification and care, not only to the individual patient and family, but also at the state and federal levels. Community-dwelling, African-American elders show faster rates of cognitive decline and are almost twice as likely to develop mild cognitive impairment (MCI) and AD as are older, white Americans. However, they are less likely to be diagnosed or receive treatment in the early stages of these disorders. Development of economically viable and culturally acceptable methods of early detection is critical in minority populations. We propose to identify the first signs of dementia in at risk African Americans with subjective memory complaints (SMC) in their communities within the Detroit metro area by using computerized cognitive tests CogState and NIH Toolbox and a portable EEG. We plan to combine cross-sectional with longitudinal studies: within the first two years, we will cognitively evaluate a total of 500 at risk African Americans with SMC. From these participants we will select 200 who at entry to the longitudinal study will not be diagnosed with either dementia or MCI but will, however, undergo repeated cognitive and EEG testing every 6 months over a 3 year period. We will compare these approaches of repeated cognitive and EEG/ Event-Related Potentials (ERP) testing in terms of their sensitivity of identifying persons already at risk who will progress to MCI and/or AD. Our proposed community based evaluation that combines behavioral and EEG/ERP methods will be used to generate profiles of at risk healthy elderly African-Americans, who may within a short period of time develop MCI or AD. We expect that with the combination of behavioral and EEG/ERP methods, we will be able to develop objective markers, which will reliably identify early signs of cognitive decline. Such markers will be used for identification of significant cognitive decline, and to evaluate efficiency of new pharmacological approaches, which will lead to the development of new therapeutic interventions and disease modification.