Screening the community for Alzheimer's disease (AD) has become a public health priority as new treatments emerge. Screening for preclinical AD is a research priority to understanding early disease course and conducting secondary prevention studies to delay or prevent the onset of clinically diagnosable disease. Phase I research aims to use CD-ROM (CD) tedunology to further develop a short dementia screen with enhanced utility in clinical settings with a decision support tool for physicians. The Buschke Memory Inpairment Screen (MIS), validated in paper & pencil and telephone forms, shows high reliability, validity, sensitivity and specificity for preclinical AD and vascular dementia (VaD). The CD form e-MIS, extends the paper-and-pencil form by incorporating standard test administration, automated scoring, a larger sample of categories and exemplars for the list-learning task, and replacing the repetitive counting filler task of the onginat MIS with a go/no-go executive function task. The e-MIS holds great potential as a screening tool for both early AD and preclinical AD. Preliminary e-MIS validation will be conducted in the context of the ongoing longitudinal population-based Einstein Aging Study (EAS). We propose, via EAS's medical research staff, to test e-MIS in a well defined subgroup of EAS participants through clinical assessments to determine dementia status. We will examine the cross-sectional and predictive validity of the e- MIS on this subgroup. While Phase I provides only preliminary validation of the e-MIS, Phase II will modify and refine the e-MIS for full-scale validation. The resulting e-MIS screen and decision support tool has promise for immediate research application and for future public health interventions. Under guidance of an Expert Advisory Panel, and tested in primary care physician (PCP) focus groups, the Phase I e-MIS will develop basic decision support modules far the PCP. Phase II will fully develop and validate the e-MIS with a goal of achieving a national standard, required to accomplish national screening called for by a growing chorus of healthcare options concerned with AD and the huge threat to the healthcare system that aging 'baby-boom' cohorts pose. Commercial potential for a validated early dementia screen and decision support tool is substantial and is of interest to clinicians and pharmaceutical companies alike.
COMPACT has been in contact with selected clinicians and pharmaceutical companies regarding interest in purchasing the proposed e-MIS dementia screen with 'decision support' features for physicians. The final product will be marketed to pharmaceutical manufacturers who make treatments for dementia, to health plans with substantial geriatric populations and to a domestic market of approximately 200,000 physicians in primary care, psychiatry, gerontology and neurology.
| Timchenko, N A; Iakova, P; Cai, Z J et al. (2001) Molecular basis for impaired muscle differentiation in myotonic dystrophy. Mol Cell Biol 21:6927-38 |
