Five years ago, the Alzheimer Association warned of a """"""""looming"""""""" crisis in the Latino/Hispanic community due to a projected six-fold increase in the number of Latino/Hispanic elders suffering from AD and related dementias by 2050. Vascular risk factors, which are elevated in Latino/Hispanic patients, are associated with cognitive decline and the risk of AD, VaD and concomitant AD and VaD (AD/VaD). Access to diagnosis and treatment is hampered by language proficiency, personal beliefs, and economic status, delaying diagnosis by as many as five years. Because most elderly patients see a primary care physician several times a year, there is an opportunity to identify patients with mild AD and related dementias. Unfortunately, recognition of mild dementia in primary care is poor because accurate and efficient case finding methods are lacking to identify mild dementia in disparity groups. Misclassification rates are high for Latino/Hispanic patients and for patients with low education when the Mini Mental Status Exam (MMSE) is used to identify cases. The need for a case finding tool that works equally well in disparity groups prompted our development of the two-stage Alzheimer's Disease Screen for Primary Care (ADS-PC) to identify mild dementia and AD in disparity groups. The first stage takes just five minutes and is designed for high sensitivity. The second stage is given only to the 30% of patients who fail the first stage and takes just 12 minutes. The ADS-PC has better operating characteristics and is more time efficient than the MMSE. It works equally well in African American and Caucasian individuals and in those with low and high education. In this R21, we extend our case-finding efforts to Spanish speaking elders from a federally qualified community health center that serves a largely Latino/Hispanic community in the South Bronx. 500 Spanish speaking patients will be screened with the ADS-PC to identify individuals likely to have dementia. Screen positive patients (~75) and a random sample of screen negative controls (~75) will undergo a research quality evaluation to determine the clinical standard (dementia, no dementia) against which the concurrent construct validity of the ADS-PC will be assessed. We will compare the operating characteristics of ADS-PC and the MMSE and determine the most accurate and efficient way to identify cases of mild dementia and AD. Diagnostic information and treatment recommendations will be provided to the patient's physician. Unless recognition of mild dementia in primary care improves, the current generation of proven pharmacological and behavioral interventions and future disease modifying treatments will not be available to minority patients and individuals with low education, ensuring a disparity in dementia treatment and prevention.
Five years ago, the Alzheimer Association warned of a looming crisis in the Latino/Hispanic community due to a projected six-fold increase in the number of Latino elders suffering from AD and related dementias by 2050. Unfortunately, recognition of mild dementia is poor in primary care settings where most Latino/Hispanic elders receive their care. Prompted by the lack of accurate and efficient case finding methods to identify mild dementia in disparity groups, we have developed and validated an efficient and cost-effective tool to identify patients with early dementia and AD in primary care settings. In this R21, we extend our case-finding efforts to Spanish speaking patients from a federally qualified community health center that serves a largely Latino/Hispanic community in the South Bronx. Screen positive patients and a random sample of screen negative controls will undergo a research quality evaluation to determine dementia status. This will be the standard against which the accuracy of our case finding tool will be assessed. We will compare the operating characteristics of our case finding tool with the most widely used dementia screening test and determine the most accurate and efficient way to identify cases of mild dementia in Latino/Hispanic elders. Diagnostic information and treatment recommendations will be provided to the patient's physician.
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