Behavioral Change Following Culturally-Informed Biomarker Disclosure in Alzheimer’s Disease

项目摘要 阿尔茨海默病(AD)和痴呆症-阿尔茨海默病(DAT)在老年人中的患病率正在上升， 在黑人老年人中，这一比例更高。科学的进步使蛋白质的检测成为可能 与AD相关的生物标志物和增加DAT的风险。认知健康且有症状的老年人 成年人对他们个性化的PET、淀粉样蛋白和tau信息感兴趣。然而，生物标记物的披露 在临床或研究环境中很少发生，部分原因是担心患者对 在没有有效的DAT治疗方法的情况下使用此信息。虽然有几项研究支持 正电子发射断层扫描(PET)淀粉样蛋白披露在心理反应方面的安全性，非常 很少有人研究风险反馈后的实际行为，也没有研究研究长期的 行为改变的时间表。健康行为和生活方式改变对认知功能障碍的治疗作用 功能已经确立；然而，披露是否会促使与健康相关的变化尚不清楚。 此外，到目前为止，还没有研究调查tau的披露。这些问题与两个问题最为相关 人群：遗忘性轻度认知障碍(AMCI)患者，对他们来说，这种反馈可能是 激励，和黑人个体，他们可能面临执行适应性健康相关的生物-心理-社会障碍 改变，即使有动机这样做。到目前为止，还没有一项研究系统地解决 对风险披露的反应或这些差异背后的机制。这一经验差距突显了一个 及时了解和解决阿尔茨海默病诊断和治疗中存在差异的潜在根源。 拟议的项目和密切协调一致的培训计划将通过比较行为变化来响应这一呼吁 接受“标准护理”诊断信息披露或通过以下方式增强诊断反馈的个人 披露PET淀粉样蛋白和tau的联合成像。我们将在密歇根州强大的框架基础上 阿尔茨海默病研究中心(MADRC)的纵向队列和两项由NIA资助的相关研究 招募50%黑人和50%白人患者的生物标志物特征和严格诊断的样本 有一个MCI。该样本将被随机分配到治疗条件下，然后进行两年一次的随访 两年多了。具体地说，我们将使用混合方法来评估健康行为变化(AIM 1a)、高级规划(目标1b)和研究参与(目标1c)，以及已知的社会 健康的决定因素(医疗保健可获得性)影响种族群体这些结果的变化(目标2)。这个 AD生物标记物测量和验证、生物标记物的伦理和公共健康影响方面的培训 除了关键概念外，还包括披露、老龄化方面的种族-民族差异和混合方法方法 这项研究中探索的，将为首席调查员作为独立的 少数民族认知老龄化领域的早期职业研究者。

Project Summary Alzheimer’s Disease (AD) and Dementia-Alzheimer’s Type (DAT) prevalence is growing among older adults, and disproportionately so in Black seniors. Scientific advances have allowed for detection of protein biomarkers associated with AD and increased risk for DAT. Both cognitively healthy and symptomatic older adults are interested in their personalized PET amyloid and tau information. However, biomarker disclosure rarely occurs in either clinical or research settings, in part due to concerns about how patients will react to and use this information in the absence of validated treatments for DAT. While several studies have supported the safety of positron emission tomography (PET) amyloid disclosure in regards to psychological reactions, very few have examined actual behavior following risk feedback, and no studies have examined a prolonged timeline of behavior change. The therapeutic effect of health behavior and lifestyle change on cognition and functioning is well-established; however, whether disclosure may precipitate health-related change is unknown. Furthermore, no study to date has investigated tau disclosure. These questions are most pertinent to two populations: patients with amnestic Mild Cognitive Impairment (aMCI), for whom this feedback may be most motivating, and Black individuals, who may face biopsychosocial barriers to executing adaptive health related changes, even if motivated to do so. To date, no study has systematically addressed racial differences in reactions to risk disclosure or the mechanisms underlying these differences. This empirical gap highlights a timely opportunity to understand and address a potential source of disparity in AD diagnosis and treatment. The proposed project and closely aligned training plan will respond to this call by comparing behavior change in individuals who receive either ‘standard of care’ diagnostic disclosure, or diagnostic feedback enhanced by disclosure of combined PET amyloid and tau imaging. We will build from the robust framework of the Michigan Alzheimer’s Disease Research Center’s (MADRC) longitudinal cohort and two associated NIA-funded studies to recruit a biomarker-characterized and rigorously diagnosed sample of 50% Black and 50% White patients with aMCI. This sample will be randomly assigned to treatment condition, and then followed for bi-annual visits over two years. Specifically, we will use a mixed-methods approach to assess health behavior change (Aim 1a), advanced planning (Aim 1b), and research participation (Aim 1c), as well as how a known social determinant of health (healthcare access) influences change in these outcomes by racial group (Aim 2). The training in AD biomarker measurement and validation, ethical and public health implications of biomarker disclosure, racial-ethnic disparities in aging, and mixed methods approaches, in addition to the critical concepts explored in this study, will create the ideal foundation for the principal investigator to excel as an independent early career researcher in the field of minority cognitive aging.