Research Background

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Asian Americans represent the fastest-growing group in the US, with their numbers increasing by 81% from 2000 to 2019, in which Asians of Chinese descent represent the largest subgroup. Relatively little is known about the brain health of older US Chinese, even though Asians as a “monolith” were found to have the lowest rates of dementia diagnosis among major racial groups based on insurance claims data. A significant challenge is the scarcity of validated tools to assess cognition in Chinese of limited English proficiency. 

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With the expertise of bilingual US-trained behavioral neurologists and cognitive neuroscientists from two centers with access to large Chinese populations (Rutgers which hosts the Asian Resource Center for Minority Aging Research and Stanford ADRC), we have developed and piloted seven new neuropsychological tests for older Mandarin speakers aligned to the National Alzheimer’s Coordinating Center’s Uniform Data Set (UDS): articulation-adjusted logical memory and forward digit span; frequency-adjusted word list recall; character-, phoneme/pinyin-, and homonym-guided fluency; and modified Trail Making Test B (TMTB) according to the knowledge of three 12-item sequences. 

 

To further advance their roles in assessing cognition, we need to establish these novel tests’ reliability in healthy older Mandarin speakers with normal cognition; compare performance in Mandarin and English tests among bilingual older adults; and analyze their diagnostic value by correlating performance on these tests with language-independent tests, functional scales, brain MRI markers of neurodegeneration, and plasma biomarkers of neurodegeneration.

Study Aims

• Expand further their reliability and relationship to performance using English instruments by bilingual older adults.

• Determine construct and diagnostic validity analysis accounting for imaging and plasma biomarkers of neurodegeneration.

• Determine if bilingualism mediates the effects of neurodegeneration.

• Transfer additionally these tests onto a digital platform for clinical utility.

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Recruitment will occur at Stanford University. ​

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Study Participation 

The COAST study is recruiting adults aged 55 to 90 years who are able to travel to local study sites for visits, complete the Mandarin, self-reported normal cognitive health or qualifying diagnosis (mild cognitive impairment, AD, FTLD-TDP, FTLD-Tau, LBD), and undergo the following procedures:

• Questionnaires (45-60 minutes).

• cognitive testing (60-75 minutes)

• Brain MRI (60 minutes; except AD/ADRD subjects who have already undergone clinical MRI)

• Neurological examination

• blood collection (45-60 minutes)

 

Participants will receive $50 in the form of check after completing the MRI portion of this study.

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Supplemental Studies

2-Year Follow-up study (optional)

• All participants will be invited to return in 2 years for repeat brain MRI, and blood collection. The 2-year follow-up is voluntary, and participants can withdraw from the study at any time.

 

Supplemental Study Participation

If you are enrolled in the COAST study, you may also participate in the 2-year follow-up study.

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