Developing a performance-based measure of daily function for screening Hispanic/Latino older adults for Alzheimer's disease risk - Hispanic/Latino older adults are 1.5 times more likely to develop Alzheimer’s disease (AD) than White non-Hispanic older adults, yet they are diagnosed substantially later in the disease process, missing the early-stage window in which emerging therapies are most effective. Furthermore, they are excluded from AD clinical trials at nearly twice the rate of White non-Hispanic participants, often for being considered as too progressed. Although these disparities exist for a number of reasons, a contributing factor is that existing tests that are feasible for use in primary care to screening patients for the early signs of AD show worse diagnostic accuracy for Hispanics/Latinos, even when using normative data and controlling for differences in education. Thus, there is an urgent need for more universal screening tools, especially in preclinical stages of AD. The long-term goal of this research is to develop convenient methods for assessing and screening patients for AD risk across varying demographics. To meet this goal, an objective behavioral test has been newly developed that is associated with cognition and measures daily functioning, and has been shown to be sensitive and specific to AD staging. The brevity and simplicity of the test make it an ideal assessment to be paired with emerging blood tests for screening and monitoring in primary care. The central hypothesis is that the novel test (herein, bean game) proposed here will not vary significantly between Hispanic/Latino and White non-Hispanic adults within the current AT(N) framework of AD, and may be more acceptable, appropriate, and preferable than traditional cognitive tests. The overall objective of this R01 application is to leverage the existing MindCrowd electronic cohort to test this hypothesis. MindCrowd was developed to improve accessibility and inclusion in AD research, and collects lifestyle, health, cognitive, genetic, and medical history data via the internet to study AD risk. The latest MindCrowd cohort has an average monthly recruitment rate of 901 Hispanic/Latino adults over age 40. Consistent with the general U.S. population, 19.5% of the current MindCrowd cohort over age 40 identifies as Hispanic/Latinos, with countries of origin similar to the general Hispanic/Latino population, providing sufficient samples sizes for pursuing the proposed aims. In addition, the research proposed in this R01 application is innovative and rigorous because it utilizes an affordable version of the novel test that can be self-administered in-home and that is offered in English and Spanish, opening up alternative applications outside of primary care. Thus, the proposed research is significant because it offers a more universally applicable alternative to existing assessments used in AD care and research, which will lead to a clearer and more accurate understanding about AD.
