Although by 2060 African Americans, Hispanics, and residents of rural communities will constitute themajority of US patients with Alzheimer's disease (AD), these populations have long been neglected in AD research studies and clinical trials. In this large scale fast-track SBIR application, we propose to gather normative longitudinal California Cognitive Assessment Battery (CCAB) data from 300 healthy older (ages 60to 89) individuals in each of four underserved populations: (1) African Americans: (2) English-speaking USHispanics; (2) Spanish-speaking US Hispanics; and (4) non-Hispanic white (nHW) residents of ruralcommunities. Participants will be recruited in California and South Texas. We will compare the results fromeach group with existing normative data from a primarily suburban white population. The CCAB includes 34 innovative computerized cognitive tests and questionnaires that utilize cellphonenetworks to enable telemedical testing in patients' homes. CCAB test introductions and test materials aredelivered with AI-enhanced text-to-speech voices and verbal responses are analyzed with consensusautomatic speech recognition (CASR) with unexcelled transcription accuracy. Recruitment is facilitated andtesting throughput is increased because CCAB tests are administered in participants' homes. The CCAB hasbeen designed to facilitate translation into other languages. Here, we will test Spanish-speaking US residentswith CCAB-Español, a Spanish version of the CCAB optimized for US Spanish dialects. During Phase I, we will recruit African American and Hispanic examiners, assure that the Spanishtranslation of the CCAB is adapted for the US Hispanic population, and begin testing. During Phase II we willcontinue enrollment testing and thereafter test participants at one-year intervals to gather longitudinal normsand identify performance patterns that predict subsequent cognitive decline. Ethnoracial norms for each CCABtest will be developed using traditional analysis and supplemented with Item response theory factor analysis toimprove scoring sensitivity and eliminate score bias. The acquisition of normative CCAB data will lower accessbarriers to neuropsychological assessment among ethnoracial minorities for six reasons: (1) At-home CCABTesting will not be interrupted by COVID-19 lockdowns; (2) At-home CCAB testing minimizes mobility andtransportation challenges; (3) CCAB-Español will address the lack of well-normed, scalable Spanish-languagetests for the US Hispanic population and facilitate access to Spanish-speaking examiners; (4) CCABtelemedical testing will provide access to cognitive assessments in neglected urban and rural neighborhoods;(5) CCAB testing can reduce cost barriers to cognitive assessment by more than 70%; (6) The CCAB willreduce cultural barriers to research participation by testing participants in their familiar home surroundings andby using ethnoracially sensitive African American and Hispanic examiners.
Public Health Relevance Statement: Project Narrative Alzheimer's disease and related disorders (ADRDs) is a health care burden with enormous medical and personal cost that will affect an increasing number of Americans as the population ages. ADRDs disproportionately affect ethnoracial minorities who are expected to constitute half of all ADRD cases in the US by 2060. Unfortunately, the cognitive tests needed to identify at-risk patients are not available in most minority communities who have also been largely excluded from clinical trials evaluating new therapies to slow ADRD disease progression. Here we propose to gather normative data from minority cohorts of English-speaking African Americans and Hispanics, and Spanish-speaking Hispanics using a set of innovative, sensitive computerized cognitive tests that can be telemedically administered in patients' homes. These studies will facilitate the inclusion of minority populations in clinical trials and, in the future, improve minority access to cognitive testing at substantially reduced costs.
Project Terms: <21+ years old> 