Community-Based Early Identification of MCI in at Risk African Americans

描述（由申请人提供）：社区居住的非洲裔美国老年人的认知能力下降速度比老年白色美国人快，患轻度认知障碍（MCI）和阿尔茨海默病（AD）的可能性几乎是老年人的两倍。然而，在这些疾病的早期阶段，非洲裔美国老年人不太可能被诊断或接受治疗。这种健康差异是早期识别和护理MCI和痴呆症的关键障碍，这不仅减少了对个体患者和家庭的医疗和社会福利，而且还减少了州和联邦一级的财政节省。发展 早期发现认知变化的经济上可行和文化上可接受的方法对少数群体至关重要。 随着寿命的延长和老年人在人口中所占比例的迅速增加，评估痴呆的最早风险非常重要 更准确地指导老年人的环境和临床干预。MCI是一种限制日常生活的疾病，在大多数情况下是AD的前兆，其特征在于认知困难而没有明显的功能障碍。接触有MCI风险的特征明确的老年人（例如，记忆力有问题，但其他方面健康）提供了一个独特的机会来研究患痴呆症风险最高的个体认知能力加速下降的最早迹象。 拟议的横断面研究将测试计算机化认知测试和便携式脑电图（EEG/ERP）方法在多大程度上可以用于轻松，准确和有效地识别社区环境中老年非裔美国人的早期认知衰退和MCI。此外，我们还将评估这些基于计算机和电生理方法的可行性和可接受性。 我们建议通过从底特律市区内社区的更健康的黑人老年人中心（HBEC）的1，100名参与者中招募总共200名处于风险中的非洲裔美国人（年龄65岁）来实现上述目标。我们将使用MCI丰富的抽样，只招募那些在最近表达主观记忆投诉的老年非裔美国人。这200名有风险的非洲裔美国老年人将通过两项计算机化测试进行广泛评估（即，CogState和NIH的研究），EEG/ERP记录，以及结构化的医学/神经心理学检查和共识。 我们基于社区的建议，结合行为和EEG/ERP方法，将用于建立这些措施的实用性和可接受性，并可能产生有风险的健康老年非裔美国人的概况，这些人可能在短时间内发展MCI（参与者将在研究结束后进行纵向随访）。 这个项目）。我们预测，行为和EEG/ERP方法的组合将允许开发客观的标记物，这些标记物将可靠地识别认知能力下降的早期迹象。等 除了识别显著的认知能力下降外，标记物在招募更大、更多样化的人群以评估新药理学方法的有效性方面也可能发挥重要作用。

DESCRIPTION (provided by applicant): Community-dwelling, African-American elders show faster rates of cognitive decline than elderly white Americans and are almost twice as likely to develop mild cognitive impairment (MCI) and Alzheimer's disease (AD). However, in the early stages of these disorders, African-American elders are less likely to be diagnosed or receive treatment. Such health disparities represent a critical roadblock to early identification and care for MCI and dementia, which not only diminishes the medical and social benefits to the individual patient and family, but also fiscal savings at the state and federal levels. Development of economically viable and culturally acceptable methods of early detection of cognitive change is critical in minority populations. With the increase in longevity and the rapid increase in the proportion of elderly in the population, it is important to evaluate the earliest risk for dementia more accurately in order to guide environmental and clinical interventions for older adults. MCI, characterized by cognitive difficulties without clear functional impairment, is a daily-life-limitig condition that in most cases is a precursor to AD. Access to well characterized elderly who are at risk for MCI (e.g., memory complaint, but otherwise healthy) provides a unique opportunity to study the earliest signs of accelerated cognitive decline in individuals at highest risk for developing dementia. The proposed cross-sectional study will test to what extent computerized cognitive tests and portable electroencephalography (EEG/ERP) methodology can be used to easily, accurately and efficiently identify early cognitive decline and MCI in elderly African-Americans within their community setting. Additionally, we will also evaluate feasibility and acceptability of these computer-based and electrophysiological methods. We propose to accomplish the above aims by recruiting a total of 200 at risk African Americans (age e 65 years) from among the 1,100 participants in the Healthier Black Elders Center (HBEC) in their communities within the Detroit metro area. We will use an MCI-enriched sampling by recruiting only those older African Americans who in the recent past expressed subjective memory complaints. These 200 at risk elder African Americans will be extensively evaluated with two computerized tests (i.e., CogState and NIH Toolbox), EEG/ERP recordings, and a structured medical/neuropsychological exam and consensus. Our community based proposal, combining behavioral and EEG/ERP methods, will be used to establish the utility and acceptability of these measures and to potentially generate profiles of at risk healthy, elderly African-Americans, who may, within a short period of time, develop MCI (participants will be longitudinally followed after this project). We predict that a combination of behavioral and EEG/ERP methods will allow development of objective markers that will reliably identify early signs of cognitive decline. Such markers, in addition to identification of significant cognitive decline, may also play a significan role in the recruitment of larger, more diverse populations in order to evaluate the efficiency of new pharmacological approaches.