Contributions of Clinical  Pathological Discordance Toward Health Disparities

 
   Lead Investigator:    Corey McMillan
   Institution      :    University of Pennsylvania
   E-Mail           :    mcmillac@upenn.edu
   Proposal ID      :    802



   Proposal Description:
   There is now extensive evidence for a discordance between pathological            diagnosis and clinical phenotype.  For example, many individuals with a           clinical diagnosis of Alzheimer???s disease (AD) may actually have pathology      consistent with frontotemporal lobar degeneration.  Moreover, mounting evidence   suggests that pathological diagnoses such as AD may associated with a             co-pathology such as Lewy body disease.  While there is increasing awareness of   these sources of clinical and pathological discordance, less is known about       clinical and pathological discordance in under-represented populations such as    Latinos that comprise >15 of the USA population.  A lack of knowledge about       diagnostic accuracy and co-pathologies in minority populations may                unintentionally lead to disparities in elder health care.   The goal of this      study is to:                                                                      (1) Evaluate the rate of pathological diagnosis of Non-Latinos and Latinos to     identify sources of underrepresented participation in NACC across ethnicities.    (2) Evaluate the frequency of clinical and pathological diagnosis discordance     in Non-Latinos and Latinos to identify key areas for diagnostic improvement in    minorities.                                                                       (3) Evaluate the rate of co-pathologies in Non-Latinos and Latinos to identify    biological factors (e.g., Lewy bodies) and potentially modifiable environmental   factors (e.g., vascular disease) that may contribute to disparities in            treatment strategies.                                                             To achieve this goal we will evaluate all individuals in the NACC                 neuropathological series who are self-reported Non-Latino or Latino.  We will     identify the proportion of individuals with AD-confirmed pathology who have a     clinical diagnosis of AD or a re