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Bustamante C, Martinez JF, Navarro A, Lopera M, Villegas G, Duque S, Acosta-Baena N, Ríos-Romenets S, Lopera F. Strategies to promote contraception use by female volunteers in Alzheimer's Prevention Initiative Autosomal-Dominant Alzheimer's Disease (API ADAD) Colombia trial. Clin Trials 2024:17407745241264217. [PMID: 39143683 DOI: 10.1177/17407745241264217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2024]
Abstract
BACKGROUND/AIMS Including women of childbearing age in a clinical trial makes it necessary to consider two factors from a bioethical perspective: first, the lack of knowledge about the potential teratogenic effects of an investigational product, and also, the principle of justice not to exclude any population from the benefits of research. The most common way to address this issue is by requiring volunteers to use contraceptives before, during, and a few weeks after the clinical trial. This work presents all the strategies used to promote contraception use and prevent pregnancy during the Alzheimer's Prevention Initiative Autosomal-Dominant Alzheimer's Disease (API ADAD) Colombia clinical trial. Two characteristics of this trial make it of special interest for closely monitoring contraception use. One is that the trial lasted more than 7 years, and the other is that participants could be carriers of the E280A PSEN1 mutation, leading to a mild cognitive impairment as early as their late 30s. METHODS An individual medical evaluation to select the contraception method that best fits the volunteer was carried out during the screening visit, remitting to the gynecologist when necessary. All non-surgical contraception methods were supplied by the sponsor. Staff were trained on contraception counseling, correctly dispensing contraceptive drugs to volunteers, and identifying, reporting, and following up on pregnancies. Two comprehensive educational campaigns on contraception use were performed, and the intervention included all volunteers. In addition, volunteers were asked on an annual survey to evaluate the dispensing procedure. Finally, the effectiveness of these strategies was retrospectively evaluated, comparing by extrapolation the number of pregnancies presented throughout the trial with the General Fertility Rate in Colombia. RESULTS A total of 159 female volunteers were recruited. All strategies were implemented as planned, even during the COVID-19 contingency. Ten pregnancies occurred during the evaluation period (2015-2021). Two were planned; the rest were associated with a potential therapeutic failure or incorrect use of contraceptive methods for a contraceptive failure of 0.49% per year. Sixty percent of pregnancies led to an abortion, either miscarriage or therapeutic abortion. However, there was not enough data to associate the pregnancy outcome with the administration of the investigational product. Finally, we observed a lower fertility rate in women participating in the trial compared to the Colombian population. CONCLUSION The lower rates of contraceptive failure and the decrease in the incidence of pregnancies in women participating in the trial compared to the Colombian population across the 7 years of evaluation suggest that the strategies used in API ADAD Colombia were adequate and effective in addressing contraception use.
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Affiliation(s)
| | - Juan F Martinez
- Neurosciences Group of Antioquia, University of Antioquia, Medellin, Colombia
| | - Alexander Navarro
- Neurosciences Group of Antioquia, University of Antioquia, Medellin, Colombia
| | - Margarita Lopera
- Neurosciences Group of Antioquia, University of Antioquia, Medellin, Colombia
| | - Gustavo Villegas
- Neurosciences Group of Antioquia, University of Antioquia, Medellin, Colombia
| | - Sindy Duque
- Neurosciences Group of Antioquia, University of Antioquia, Medellin, Colombia
| | | | | | - Francisco Lopera
- Neurosciences Group of Antioquia, University of Antioquia, Medellin, Colombia
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Fittipaldi S, Baez S, Gonzalez-Silva C, Duran-Aniotz C. Latin American women in dementia research: outstanding contributions, barriers, and opportunities from Argentinian, Chilean, and Colombian colleagues. Front Aging Neurosci 2023; 15:1168414. [PMID: 37358953 PMCID: PMC10285056 DOI: 10.3389/fnagi.2023.1168414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 05/19/2023] [Indexed: 06/28/2023] Open
Abstract
Women's contributions to science have been consistently underrepresented throughout history. Despite many efforts and some progresses being made to reduce gender inequity in science, pursuing an academic career across disciplines, including Alzheimer's disease (AD) and other dementias, remains challenging for women. Idiosyncratic difficulties of Latin American countries likely accentuate the gender gap. In this Perspective, we celebrate outstanding contributions from Argentinian, Chilean, and Colombian colleagues in dementia research and discuss barriers and opportunities identified by them. We aim to acknowledge Latin American women's work and bring visibility to the challenges they face throughout their careers in order to inform potential solutions. Also, we highlight the need to perform a systematic assessment of the gender gap in the Latin American dementia community of researchers.
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Affiliation(s)
- Sol Fittipaldi
- Latin American Brain Health Institute (BrainLat), Universidad Adolfo Ibañez, Santiago, Chile
- Global Brain Health Institute (GBHI), Trinity College Dublin (TCD), Dublin, Ireland
- Cognitive Neuroscience Center (CNC), Universidad de San Andres (UdeSA), Buenos Aires, Argentina
| | - Sandra Baez
- Departamento de Psicología, Universidad de los Andes, Bogotá, Colombia
| | - Carolina Gonzalez-Silva
- Latin American Brain Health Institute (BrainLat), Universidad Adolfo Ibañez, Santiago, Chile
| | - Claudia Duran-Aniotz
- Latin American Brain Health Institute (BrainLat), Universidad Adolfo Ibañez, Santiago, Chile
- Center for Social and Cognitive Neuroscience (CSCN), School of Psychology, Universidad Adolfo Ibañez, Santiago, Chile
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Acosta-Baena N, Lopera-Gómez CM, Jaramillo-Elorza MC, Velilla-Jiménez L, Villegas-Lanau CA, Sepúlveda-Falla D, Arcos-Burgos M, Lopera F. Early Depressive Symptoms Predict Faster Dementia Progression in Autosomal-Dominant Alzheimer's Disease. J Alzheimers Dis 2023; 92:911-923. [PMID: 36847011 DOI: 10.3233/jad-221294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
BACKGROUND Depression is associated with Alzheimer's disease (AD). OBJECTIVE To evaluate the association between depressive symptoms and age of onset of cognitive decline in autosomal dominant AD, and to determine possible factors associated to early depressive symptoms in this population. METHODS We conducted a retrospective study to identify depressive symptoms among 190 presenilin 1 (PSEN1) E280A mutation carriers, subjected to comprehensive clinical evaluations in up to a 20-year longitudinal follow-up. We controlled for the following potential confounders: APOE, sex, hypothyroidism, education, marital status, residence, tobacco, alcohol, and drug abuse. RESULTS PSEN1 E280A carriers with depressive symptoms before mild cognitive impairment (MCI) develop dementia faster than E280A carriers without depressive symptoms (Hazard Ratio, HR = 1.95; 95% CI, 1.15-3.31). Not having a stable partner accelerated the onset of MCI (HR = 1.60; 95 % CI, 1.03-2.47) and dementia (HR = 1.68; 95 % CI, 1.09-2.60). E280A carriers with controlled hypothyroidism had later age of onset of depressive symptoms (HR = 0.48; 95 % CI, 0.25-0.92), dementia (HR = 0.43; 95 % CI, 0.21-0.84), and death (HR = 0.35; 95 % CI, 0.13-0.95). APOEɛ2 significantly affected AD progression in all stages. APOE polymorphisms were not associate to depressive symptoms. Women had a higher frequency and developed earlier depressive symptoms than men throughout the illness (HR = 1.63; 95 % CI, 1.14-2.32). CONCLUSION Depressive symptoms accelerated progress and faster cognitive decline of autosomal dominant AD. Not having a stable partner and factors associated with early depressive symptoms (e.g., in females and individuals with untreated hypothyroidism), could impact prognosis, burden, and costs.
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Affiliation(s)
- Natalia Acosta-Baena
- Grupo de Neurociencias de Antioquia (GNA), Universidad de Antioquia, Medellín, Colombia
- Grupo de Genética Molecular (GENMOL), Universidad de Antioquia, Medellín, Colombia
| | - Carlos M Lopera-Gómez
- Escuela de estadística, Facultad de Ciencias, Universidad Nacional de Colombia, Medellín, Colombia
| | - Mario C Jaramillo-Elorza
- Escuela de estadística, Facultad de Ciencias, Universidad Nacional de Colombia, Medellín, Colombia
| | - Lina Velilla-Jiménez
- Grupo de Neurociencias de Antioquia (GNA), Universidad de Antioquia, Medellín, Colombia
| | | | - Diego Sepúlveda-Falla
- Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Mauricio Arcos-Burgos
- Instituto de Investigaciones Médicas, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
- Grupo GIPSI, Departamento de Psiquiatría, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
| | - Francisco Lopera
- Grupo de Neurociencias de Antioquia (GNA), Universidad de Antioquia, Medellín, Colombia
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Quiroz YT, Zetterberg H, Reiman EM, Chen Y, Su Y, Fox-Fuller JT, Garcia G, Villegas A, Sepulveda-Falla D, Villada M, Arboleda-Velasquez JF, Guzmán-Vélez E, Vila-Castelar C, Gordon BA, Schultz SA, Protas HD, Ghisays V, Giraldo M, Tirado V, Baena A, Munoz C, Rios-Romenets S, Tariot PN, Blennow K, Lopera F. Plasma neurofilament light chain in the presenilin 1 E280A autosomal dominant Alzheimer's disease kindred: a cross-sectional and longitudinal cohort study. Lancet Neurol 2020; 19:513-521. [PMID: 32470423 DOI: 10.1016/s1474-4422(20)30137-x] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 04/03/2020] [Accepted: 04/09/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Neurofilament light chain (NfL) is a promising biomarker of active axonal injury and neuronal degeneration. We aimed to characterise cross-sectional and longitudinal plasma NfL measurements and determine the age at which NfL concentrations begin to differentiate between carriers of the presenilin 1 (PSEN1) E280A (Glu280Ala) mutation and age-matched non-carriers from the Colombian autosomal dominant Alzheimer's disease kindred. METHODS In this cross-sectional and longitudinal cohort study, members of the familial Alzheimer's disease Colombian kindred aged 8-75 years with no other neurological or health conditions were recruited from the Alzheimer's Prevention Initiative Registry at the University of Antioquia (Medellín, Colombia) between Aug 1, 1995, and Dec 15, 2018. We used a single molecule array immunoassay and log-transformed data to examine the relationship between plasma NfL concentrations and age, and establish the earliest age at which NfL concentrations begin to diverge between mutation carriers and non-carriers. FINDINGS We enrolled a cohort of 1070 PSEN1 E280A mutation carriers and 1074 non-carriers with baseline assessments; of these participants, longitudinal measures (with a mean follow-up of 6 years) were available for 242 mutation carriers and 262 non-carriers. Plasma NfL measurements increased with age in both groups (p<0·0001), and began to differentiate carriers from non-carriers when aged 22 years (22 years before the estimated median age at mild cognitive impairment onset of 44 years), although the ability of plasma NfL to discriminate between carriers and non-carriers only reached high sensitivity close to the age of clinical onset. INTERPRETATION Our findings further support the promise of plasma NfL as a biomarker of active neurodegeneration in the detection and tracking of Alzheimer's disease and the evaluation of disease-modifying therapies. FUNDING National Institute on Aging, National Institute of Neurological Disorders and Stroke, Banner Alzheimer's Foundation, COLCIENCIAS, the Torsten Söderberg Foundation, the Swedish Research Council, the Swedish Alzheimer Foundation, the Swedish Brain Foundation, and the Swedish state under the ALF-agreement.
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Affiliation(s)
- Yakeel T Quiroz
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Grupo de Neurociencias de Antioquia of Universidad de Antioquia, Medellín, Colombia.
| | - Henrik Zetterberg
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden; Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, University of Gothenburg, Mölndal, Sweden
| | - Eric M Reiman
- Banner Alzheimer's Institute, Phoenix, AZ, USA; University of Arizona College of Medicine, Phoenix AZ, USA; Arizona State University, Tempe, AZ, USA; Translational Genomics Research Institute, Phoenix, AZ, USA
| | | | - Yi Su
- Banner Alzheimer's Institute, Phoenix, AZ, USA
| | - Joshua T Fox-Fuller
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Gloria Garcia
- Grupo de Neurociencias de Antioquia of Universidad de Antioquia, Medellín, Colombia
| | - Andres Villegas
- Grupo de Neurociencias de Antioquia of Universidad de Antioquia, Medellín, Colombia
| | - Diego Sepulveda-Falla
- Grupo de Neurociencias de Antioquia of Universidad de Antioquia, Medellín, Colombia; Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marina Villada
- Grupo de Neurociencias de Antioquia of Universidad de Antioquia, Medellín, Colombia
| | | | | | | | - Brian A Gordon
- Knight Alzheimer's Disease Research Center, Washington University in St Louis, St Louis, MO, USA
| | - Stephanie A Schultz
- Knight Alzheimer's Disease Research Center, Washington University in St Louis, St Louis, MO, USA
| | | | | | - Margarita Giraldo
- Grupo de Neurociencias de Antioquia of Universidad de Antioquia, Medellín, Colombia
| | - Victoria Tirado
- Grupo de Neurociencias de Antioquia of Universidad de Antioquia, Medellín, Colombia
| | - Ana Baena
- Grupo de Neurociencias de Antioquia of Universidad de Antioquia, Medellín, Colombia
| | - Claudia Munoz
- Grupo de Neurociencias de Antioquia of Universidad de Antioquia, Medellín, Colombia
| | - Silvia Rios-Romenets
- Grupo de Neurociencias de Antioquia of Universidad de Antioquia, Medellín, Colombia
| | - Pierre N Tariot
- Banner Alzheimer's Institute, Phoenix, AZ, USA; University of Arizona College of Medicine, Phoenix AZ, USA
| | - Kaj Blennow
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Francisco Lopera
- Grupo de Neurociencias de Antioquia of Universidad de Antioquia, Medellín, Colombia
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Abstract
Alzheimer's disease (AD) dementia refers to a particular onset and course of cognitive and functional decline associated with age together with a particular neuropathology. It was first described by Alois Alzheimer in 1906 about a patient whom he first encountered in 1901. Modern clinical diagnostic criteria have been developed, and criteria have also been proposed to recognize preclinical (or presymptomatic) stages of the disease with the use of biomarkers. The primary neuropathology was described by Alzheimer, and in the mid-1980s subsequently evolved into a more specific neuropathologic definition that recognizes the comorbid neuropathologies that frequently contribute to clinical dementia. Alzheimer's disease is now the most common form of neurodegenerative dementia in the United States with a disproportionate disease burden in minority populations. Deficits in the ability to encode and store new memories characterizes the initial stages of the disease. Subsequent progressive changes in cognition and behavior accompany the later stages. Changes in amyloid precursor protein (APP) cleavage and production of the APP fragment beta-amyloid (Aβ) along with hyperphosphorylated tau protein aggregation coalesce to cause reduction in synaptic strength, synaptic loss, and neurodegeneration. Metabolic, vascular, and inflammatory changes, as well as comorbid pathologies are key components of the disease process. Symptomatic treatment offers a modest, clinically measurable effect in cognition, but disease-modifying therapies are desperately needed.
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Affiliation(s)
- Jose A Soria Lopez
- Department of Neurosciences, University of California San Diego, La Jolla, CA, United States; Shiley-Marcos Alzheimer's Disease Research Center, University of California San Diego, La Jolla, CA, United States
| | - Hector M González
- Department of Neurosciences, University of California San Diego, La Jolla, CA, United States; Shiley-Marcos Alzheimer's Disease Research Center, University of California San Diego, La Jolla, CA, United States
| | - Gabriel C Léger
- Department of Neurosciences, University of California San Diego, La Jolla, CA, United States; Shiley-Marcos Alzheimer's Disease Research Center, University of California San Diego, La Jolla, CA, United States.
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