RF1AG096495

Tackling disparity with sound: Audio-recorded patient-clinician communication for early detection of mild cognitive impairment in Black older adults.

Mild cognitive impairment (MCI) and early-stage dementia (ED) affect one in five adults over 60.

Despite nationwide efforts, over 50% of these cases remain undiagnosed—63% within home healthcare (HHC).

Black older adults are at higher risk due to limited healthcare access, biases in medical examinations, and lower health literacy, leading to increased misdiagnosis rates.

The lack of culturally and linguistically appropriate diagnostic tools exacerbates these disparities.

Language impairment is an early sign of cognitive decline, making verbal communication a critical biomarker for MCI-ED diagnosis.

However, existing speech processing algorithms are generally not trained on Black verbal language (BVL)—a collective term encompassing diverse Black dialects like African American English, Caribbean English, and Nigerian English.

This oversight can lead to misinterpretation, delay essential care, and deepen health disparities.

To address these challenges, we propose to create the largest corpus of Black patient-nurse communications from VNS Health in New York City, capturing the city's rich sociolinguistic diversity.

Our multidisciplinary team—comprising experts in HHC nursing, automated speech processing, speech pathology, BVL linguistics, cognitive impairment, and clinical decision support (CDS)—aims to:

1) Refine speech-processing algorithms to enhance early detection of MCI-ED in older Black patients by analyzing audio-recorded patient-nurse communications from 500 Black patients (250 with MCI-ED and 250 cognitively normal);

2) Develop a multimodal screening algorithm, SpeechCare, by integrating electronic health record (EHR) data and MCI-ED risk factors extracted from clinical notes with verbal communication features; and

3) Assess the feasibility of implementing SpeechCare as a CDS tool within HHC EHR systems.

This study introduces several innovative features.

By creating the largest BVL speech corpus, we advance speech processing algorithms that account for often-overlooked linguistic diversity.

Our design goal for SpeechCare, a multimodal screening algorithm built on routinely generated HHC data, is to create a sensitive, inexpensive, non-invasive, easily accessible, and linguistically appropriate diagnostic tool to address critical gaps in MCI-ED detection among Black patients.

Assessing the practical implementation of SpeechCare within clinical workflows ensures its adaptability and real-world applicability.

The outcome will lay the foundation for an efficacy trial of SpeechCare in HHC, ultimately improving timely diagnosis and tailored interventions for Black patients, enhancing outcomes, and reducing disparities in care.

The Trustees Of Columbia University In The City Of New York

TO ENCOURAGE BIOMEDICAL, SOCIAL, AND BEHAVIORAL RESEARCH AND RESEARCH TRAINING DIRECTED TOWARD GREATER UNDERSTANDING OF THE AGING PROCESS AND THE DISEASES, SPECIAL PROBLEMS, AND NEEDS OF PEOPLE AS THEY AGE. THE NATIONAL INSTITUTE ON AGING HAS ESTABLISHED PROGRAMS TO PURSUE THESE GOALS. THE DIVISION OF AGING BIOLOGY EMPHASIZES UNDERSTANDING THE BASIC BIOLOGICAL PROCESSES OF AGING. THE DIVISION OF GERIATRICS AND CLINICAL GERONTOLOGY SUPPORTS RESEARCH TO IMPROVE THE ABILITIES OF HEALTH CARE PRACTITIONERS TO RESPOND TO THE DISEASES AND OTHER CLINICAL PROBLEMS OF OLDER PEOPLE. THE DIVISION OF BEHAVIORAL AND SOCIAL RESEARCH SUPPORTS RESEARCH THAT WILL LEAD TO GREATER UNDERSTANDING OF THE SOCIAL, CULTURAL, ECONOMIC AND PSYCHOLOGICAL FACTORS THAT AFFECT BOTH THE PROCESS OF GROWING OLD AND THE PLACE OF OLDER PEOPLE IN SOCIETY. THE DIVISION OF NEUROSCIENCE FOSTERS RESEARCH CONCERNED WITH THE AGE-RELATED CHANGES IN THE NERVOUS SYSTEM AS WELL AS THE RELATED SENSORY, PERCEPTUAL, AND COGNITIVE PROCESSES ASSOCIATED WITH AGING AND HAS A SPECIAL EMPHASIS ON ALZHEIMER'S DISEASE. SMALL BUSINESS INNOVATION RESEARCH (SBIR) PROGRAM: TO EXPAND AND IMPROVE THE SBIR PROGRAM, TO INCREASE PRIVATE SECTOR COMMERCIALIZATION OF INNOVATIONS DERIVED FROM FEDERAL RESEARCH AND DEVELOPMENT, TO INCREASE SMALL BUSINESS PARTICIPATION IN FEDERAL RESEARCH AND DEVELOPMENT, AND TO FOSTER AND ENCOURAGE PARTICIPATION OF SOCIALLY AND ECONOMICALLY DISADVANTAGED SMALL BUSINESS CONCERNS AND WOMEN-OWNED SMALL BUSINESS CONCERNS IN TECHNOLOGICAL INNOVATION. SMALL BUSINESS TECHNOLOGY TRANSFER (STTR) PROGRAM: TO STIMULATE AND FOSTER SCIENTIFIC AND TECHNOLOGICAL INNOVATION THROUGH COOPERATIVE RESEARCH DEVELOPMENT CARRIED OUT BETWEEN SMALL BUSINESS CONCERNS AND RESEARCH INSTITUTIONS, TO FOSTER TECHNOLOGY TRANSFER BETWEEN SMALL BUSINESS CONCERNS AND RESEARCH INSTITUTIONS, TO INCREASE PRIVATE SECTOR COMMERCIALIZATION OF INNOVATIONS DERIVED FROM FEDERAL RESEARCH AND DEVELOPMENT, AND TO FOSTER AND ENCOURAGE PARTICIPATION OF SOCIALLY AND ECONOMICALLY DISADVANTAGED SMALL BUSINESS CONCERNS AND WOMEN-OWNED SMALL BUSINESS CONCERNS IN TECHNOLOGICAL INNOVATION.

93.866 - Aging Research

National Institute on Aging (NIA) [HHS - NIH]

New York United States

State-Wide

Research on Current Topics in Alzheimer's Disease and Its Related Dementias (R01 Clinical Trial Optional) (PAR-22-093)