Mild Cognitive Impairment (MCI), Alzheimer disease (AD) and related dementias have limited detection in the community due to the lack of brief screening tests that have been adequately validated to detect the earliest signs of impairment. Clinical, epidemiological and social- behavioral research is also hampered by the lack of valid screening instruments that can be applied in community settings. Recent healthcare reform (Accountable Care Act) proposes a Personalized Prevention Plan including screening for cognitive disorders, reimbursable through Medicare. Unfortunately, there is no clear plan how best to screen older adults for dementia, and if the MMSE continues to be utilized the extant literature suggests that many older adults with MCI and early dementia will have false negative results. Although biological markers such as MRI, PET scans, and cerebrospinal fluid (CSF) increase the diagnostic likelihood that AD is present;biomarkers are invasive, uncomfortable, expensive, and may not be readily available to rural areas, underserved communities, underinsured individuals or developing countries making them impractical for broad use. Our preliminary data support that screening for MCI, AD and related dementias using reliable and validated measures can improve dementia detection in an inexpensive, quick and culturally-sensitive manner at the earliest possible stages. We propose to address the gap in the best practice to diagnose MCI, AD and related disorders at the earliest possible stage in community settings and provide cross-cultural validation of methodology and biomarker assays. We propose three Specific Aims: 1) test whether the patient AD8 +/- brief performance tests detect cognitive impairment in a sample of 150 Caucasian, African American and Hispanic community-dwelling older adults. 2) test the acceptance of, preferences about, and compliance with dementia screening recommendations;and 3) confirm screening results with a Gold Standard clinical and cognitive assessment and validate biological evidence of AD with MRI and CSF biomarkers. The impact of this project is the sustained influence on the practice of medicine in the Health Care Reform era.
It is important given the recent efforts to develop biomarkers for Alzheimer disease to determine how this information can more readily be translated for use in the busy primary practice setting. This project has potential to address the unmet needs of how to improve community detection of MCI, AD and related disorders, provide cross-cultural validation of screening programs, and increase minority participation in research.
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