Alzheimer Screening in Primary Care: PRISM-PC Study
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DESCRIPTION (provided by applicant): Background: In a systematic review of the evidence for dementia screening in the primary care setting to support recommendations from the U.S. Preventive Services Task Force, we found insufficient evidence to estimate the potential harms of dementia screening. An accounting of potential harm is a fundamental requirement before one can assess the value of a routine screening maneuver. In the absence of such information, the balance between the benefit of dementia screening and its possible harms can't be evaluated. Evidence from preliminary studies suggests that older adults may refuse screening for dementia due to perceived harms, the magnitude and source of these fears is undocumented. Thus, one of the areas of research suggested by the US Preventive Services Task Force is documentation of the potential harms of dementia screening. As a first step to fill this gap in the literature, we are seeking support for a study that will capture older adults' sentiments about dementia screening and evaluate the impact of such attitudes on their acceptance of dementia screening. Study design: A cross-sectional study that will randomly select 1200 individuals aged 55 and older attending primary care clinics in Indianapolis. Participants will not have a diagnosis of dementia. Each participant will complete the PRISM-PC instrument and the 5-item MOS social support instrument delivered by a research assistant in a face-to-face interview. The PRISM-PC instrument consists of 38 Likert scale type questions that measure the patients' acceptability of dementia screening and their perceived benefits and harms of such a screening. The PRISM-PC instrument also include 12 Yes-No questions that collect demographic data. Following the completion of the PRISM-PC and the MOS instruments, the participants will be asked to undergo a dementia screening using the Community Screening Instrument for Dementia (CSI-D). Participants with screened positive results on the CSI-D will be offered to have a confirmatory diagnostic assessment at a local memory clinic. Primary Outcome: Patients' perceived benefits and harms of dementia as measured by the PRISM-PC. Secondary Outcomes: Patients' acceptability of dementia screening (PRISM-PC), their acceptance of dementia screening, and their acceptance of dementia diagnosis following positive screening results. Future directions: We anticipate that participants' responses could guide the design of specific counseling and educational interventions to overcome a patients' reluctance to accept dementia screening.
