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Davis R, Sikorskii A. Recruitment of older adults from long-term care settings for a longitudinal clinical trial. Res Nurs Health 2024; 47:82-92. [PMID: 38095101 PMCID: PMC10843827 DOI: 10.1002/nur.22360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 10/19/2023] [Accepted: 11/23/2023] [Indexed: 01/19/2024]
Abstract
Recruitment of residents for research from long-term care settings is known to be difficult. The purpose of this study was to summarize the effectiveness and cost in terms of time and dollars of recruitment methods for a cluster-randomized controlled clinical trial conducted in long-term care settings. This study was a retrospective, exploratory, descriptive analysis of recruitment data. After recruitment of 15 independent and assisted living communities, residents at each site were recruited to participate in the study using combinations of 12 different recruitment methods. Recruitment methods, time spent screening, and enrollment data were collected. Recruitment data were analyzed at the levels of site, research staff member, and participant. Over the study period, 279 older adults were screened and 172 enrolled from the 15 sites. Many participants were cognitively impaired. Research staff spent 39-89 h recruiting at each site and utilized an average of four different recruitment methods per site. Introductions of participants by site contacts yielded the most consented participants compared to other recruitment methods. Sites that had a dedicated recruiter utilized more recruiting methods and enrolled more participants than those without a dedicated recruiter. The cost of recruiting averaged $1490 per site and $93-$258 per enrollee (mean $144, standard deviation $58), but was more costly in larger facilities. Recruitment of older adults from long-term care communities requires multiple methods of recruitment, skilled recruitment staff, and trust with the staff and potential participants.
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Affiliation(s)
- Rebecca Davis
- Grand Valley State University, Allendale, Michigan, USA
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Zhao Z, Wang J, Wang Y, Liu X, He K, Guo Q, Xie F, Huang Q, Li Z. 18F-AV45 PET and MRI Reveal the Influencing Factors of Alzheimer's Disease Biomarkers in Subjective Cognitive Decline Population. J Alzheimers Dis 2023; 93:585-594. [PMID: 37066915 DOI: 10.3233/jad-221251] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
BACKGROUND Subjective cognitive decline (SCD) is a self-perceived decline in cognitive ability, which exhibits no objective impairment but increased risk of conversion to mild cognitive impairment and Alzheimer's disease (AD). OBJECTIVE To investigate how influencing factors (risk gene, age, sex, and education) affect amyloid-β (Aβ) deposition and gray matter (GM) atrophy in SCD population. METHODS 281 SCD subjects were included in this study, who underwent clinical evaluation, cognitive ability assessment, apolipoprotein E (APOE) genotyping, 18F-Florbetapir positron emission computed tomography, and magnetic resonance imaging screening. Two-sample t tests and analysis of variance were performed based on voxel-wise outcome. RESULTS In 281 SCD subjects with an average age of 63.86, 194 subjects (69.04%) were female, and 56 subjects carried APOE ɛ4 genes. Statistical results revealed APOE ɛ4 gene, age, and sex influenced Aβ deposition in different brain regions; moreover, only the interaction exhibited between age and APOE ɛ4 genes. The GM atrophy of hippocampal, amygdala, precentral, and occipital lobes occurred in the group age over 60. The GM volume of the hippocampal, frontal, and occipital lobe in females was less than males. Education has an effect only on cognitive function. CONCLUSION In SCD, APOE ɛ4 gene, age, and sex significantly influenced Aβ deposition and APOE ɛ4 gene can interact with age in impacting Aβ deposition. Both age and sex can affect GM atrophy. The results suggested that female SCD with APOE ɛ4 genes and aged more than 60 years old might exhibit advanced AD biomarkers.
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Affiliation(s)
- Zixiao Zhao
- Center for Molecular Imaging and Translational Medicine, State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, Department of Laboratory Medicine, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Jie Wang
- Department of Nuclear Medicine & PET Center, Huashan Hospital, Fudan University, Shanghai, China
| | - Ying Wang
- Department of Gerontology, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Xia Liu
- Center for Molecular Imaging and Translational Medicine, State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, Department of Laboratory Medicine, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Kun He
- Department of Nuclear Medicine & PET Center, Huashan Hospital, Fudan University, Shanghai, China
| | - Qihao Guo
- Department of Gerontology, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Fang Xie
- Department of Nuclear Medicine & PET Center, Huashan Hospital, Fudan University, Shanghai, China
| | - Qi Huang
- Department of Nuclear Medicine & PET Center, Huashan Hospital, Fudan University, Shanghai, China
| | - Zijing Li
- Center for Molecular Imaging and Translational Medicine, State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, Department of Laboratory Medicine, School of Public Health, Xiamen University, Xiamen, Fujian, China
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Abstract
Recruitment of persons with dementia into research studies is essential to provide evidence for effective care and treatment. However, recruitment is known to be difficult for this population. The current integrative review was undertaken to synthesize evidence surrounding best practices for recruiting older adults with dementia into research. Fourteen studies were identified that examined recruitment strategies for persons with cognitive impairment over a 10-year time period. Most studies were retrospective and descriptive. Studies revealed three facilitators and three barriers for recruitment. Facilitators included community partnerships and trust, incentives, and use of multiple recruitment methods. Barriers included non-targeted recruitment methods, gatekeepers, and mistrust. Further studies, including randomized controlled trials, are needed to determine specific strategies that yield effective recruitment. Theoretically based recruitment strategies need to be defined and tested and the measures of recruitment efforts standardized to compare effectiveness and build a science of recruitment. [Research in Gerontological Nursing, 15(5), 255-264.].
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Ryan MM, Gillen DL, Grill JD. Reasons for undergoing amyloid imaging among cognitively unimpaired older adults. Ann Clin Transl Neurol 2021; 8:1646-1655. [PMID: 34227249 PMCID: PMC8351390 DOI: 10.1002/acn3.51414] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/14/2021] [Accepted: 06/06/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Preclinical Alzheimer's disease (AD) clinical trials screen cognitively unimpaired older adults for biomarker criteria and disclose their results. We examined whether participants in the Anti-Amyloid Treatment in Asymptomatic Alzheimer's disease Study with "elevated" and "not elevated" amyloid differed in scores on the "Views and Perceptions of Amyloid Imaging" questionnaire. We hypothesized that, prior to disclosure, those with elevated amyloid would score higher than those with not elevated amyloid. We also quantified how responses changed after result disclosure. METHODS We assessed data from 4327 individuals who completed the questionnaire at screening visit 1 and after amyloid disclosure. We used linear regression models to assess the relationship between questionnaire category scores and amyloid status. We also quantified the relationship between category score changes and amyloid status. RESULTS Overall, participants scored altruism and contribution to research as the strongest motivations for undergoing amyloid imaging. Those with elevated amyloid scored 0.23 points higher in the Perceived Risk category, on average, than those who had not elevated amyloid prior to disclosure; this effect attenuated towards zero after adjusting for Cognitive Function Instrument score. After disclosure, participants with elevated amyloid demonstrated less within-subject change in Perceived Risk, on average, compared to those with similar pre-disclosure scores who had not elevated amyloid, while demonstrating greater changes in the altruism and planning categories. INTERPRETATION Altruism and learning disease risk motivated enrollment in this preclinical AD trial. Participants with elevated amyloid differed from their not elevated counterparts in their perceptions of amyloid imaging, even before undergoing the procedure.
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Affiliation(s)
- Mary M. Ryan
- Institute for Memory Impairments and Neurological DisordersUniversity of CaliforniaIrvineCaliforniaUSA
- Department of StatisticsUniversity of CaliforniaIrvineCaliforniaUSA
| | - Daniel L. Gillen
- Institute for Memory Impairments and Neurological DisordersUniversity of CaliforniaIrvineCaliforniaUSA
- Department of StatisticsUniversity of CaliforniaIrvineCaliforniaUSA
| | - Joshua D. Grill
- Institute for Memory Impairments and Neurological DisordersUniversity of CaliforniaIrvineCaliforniaUSA
- Department of Psychiatry and Human BehaviorUniversity of CaliforniaIrvineCaliforniaUSA
- Department of Neurobiology and BehaviorUniversity of CaliforniaIrvineCaliforniaUSA
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5
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Hammers DB, Duff K. Application of Different Standard Error Estimates in Reliable Change Methods. Arch Clin Neuropsychol 2021; 36:339-346. [PMID: 31732736 PMCID: PMC8060987 DOI: 10.1093/arclin/acz054] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 08/16/2019] [Accepted: 09/04/2019] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE This study attempted to clarify the applicability of standard error (SE) terms in clinical research when examining the impact of short-term practice effects on cognitive performance via reliable change methodology. METHOD This study compared McSweeney's SE of the estimate (SEest) to Crawford and Howell's SE for prediction of the regression (SEpred) using a developmental sample of 167 participants with either normal cognition or mild cognitive impairment (MCI) assessed twice over 1 week. One-week practice effects in older adults: Tools for assessing cognitive change. Using these SEs, previously published standardized regression-based (SRB) reliable change prediction equations were then applied to an independent sample of 143 participants with MCI. RESULTS This clinical developmental sample yielded nearly identical SE values (e.g., 3.697 vs. 3.719 for HVLT-R Total Recall SEest and SEpred, respectively), and the resultant SRB-based discrepancy z scores were comparable and strongly correlated (r = 1.0, p < .001). Consequently, observed follow-up scores for our sample with MCI were consistently below expectation compared to predictions based on Duff's SRB algorithms. CONCLUSIONS These results appear to replicate and extend previous work showing that the calculation of the SEest and SEpred from a clinical sample of cognitively intact and MCI participants yields similar values and can be incorporated into SRB reliable change statistics with comparable results. As a result, neuropsychologists utilizing reliable change methods in research investigation (or clinical practice) should carefully balance mathematical accuracy and ease of use, among other factors, when determining which SE metric to use.
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Affiliation(s)
- Dustin B Hammers
- Center for Alzheimer’s Care, Imaging, and Research, Department of Neurology, University of Utah, Salt Lake City, UT, USA
- Center on Aging, University of Utah, Salt Lake City, UT, USA
| | - Kevin Duff
- Center for Alzheimer’s Care, Imaging, and Research, Department of Neurology, University of Utah, Salt Lake City, UT, USA
- Center on Aging, University of Utah, Salt Lake City, UT, USA
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Creese B, Vassos E, Bergh S, Athanasiu L, Johar I, Rongve A, Medbøen IT, Vasconcelos Da Silva M, Aakhus E, Andersen F, Bettella F, Braekhus A, Djurovic S, Paroni G, Proitsi P, Saltvedt I, Seripa D, Stordal E, Fladby T, Aarsland D, Andreassen OA, Ballard C, Selbaek G. Examining the association between genetic liability for schizophrenia and psychotic symptoms in Alzheimer's disease. Transl Psychiatry 2019; 9:273. [PMID: 31641104 PMCID: PMC6805870 DOI: 10.1038/s41398-019-0592-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 09/06/2019] [Accepted: 09/23/2019] [Indexed: 01/09/2023] Open
Abstract
Psychosis (delusions or hallucinations) in Alzheimer's disease (AD + P) occurs in up to 50% of individuals and is associated with significantly worse clinical outcomes. Atypical antipsychotics, first developed for schizophrenia, are commonly used in AD + P, suggesting shared mechanisms. Despite this implication, little empirical research has been conducted to examine whether there are mechanistic similarities between AD + P and schizophrenia. In this study, we tested whether polygenic risk score (PRS) for schizophrenia was associated with AD + P. Schizophrenia PRS was calculated using Psychiatric Genomics Consortium data at ten GWAS p value thresholds (PT) in 3111 AD cases from 11 cohort studies characterized for psychosis using validated, standardized tools. Association between PRS and AD + P status was tested by logistic regression in each cohort individually and the results meta-analyzed. The schizophrenia PRS was associated with AD + P at an optimum PT of 0.01. The strongest association was for delusions where a one standard deviation increase in PRS was associated with a 1.18-fold increased risk (95% CI: 1.06-1.3; p = 0.001). These new findings point towards psychosis in AD-and particularly delusions-sharing some genetic liability with schizophrenia and support a transdiagnostic view of psychotic symptoms across the lifespan.
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Affiliation(s)
- Byron Creese
- University of Exeter Medical School, Exeter, UK.
- Norwegian, Exeter and King's College Consortium for Genetics of Neuropsychiatric Symptoms in Dementia, Exeter, UK.
| | - Evangelos Vassos
- Social Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Sverre Bergh
- Norwegian, Exeter and King's College Consortium for Genetics of Neuropsychiatric Symptoms in Dementia, Exeter, UK
- Research Centre of Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Pb 68, 2312, Ottestad, Norway
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
| | - Lavinia Athanasiu
- NORMENT, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Iskandar Johar
- Norwegian, Exeter and King's College Consortium for Genetics of Neuropsychiatric Symptoms in Dementia, Exeter, UK
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Arvid Rongve
- Norwegian, Exeter and King's College Consortium for Genetics of Neuropsychiatric Symptoms in Dementia, Exeter, UK
- Department of Research and Innovation, Helse Fonna, Haugesund, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Ingrid Tøndel Medbøen
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Miguel Vasconcelos Da Silva
- University of Exeter Medical School, Exeter, UK
- Norwegian, Exeter and King's College Consortium for Genetics of Neuropsychiatric Symptoms in Dementia, Exeter, UK
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Eivind Aakhus
- Research Centre of Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Pb 68, 2312, Ottestad, Norway
| | - Fred Andersen
- Department of Community Medicine, University of Tromsø, Tromsø, Norway
| | - Francesco Bettella
- NORMENT, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Anne Braekhus
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Srdjan Djurovic
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- NORMENT, Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Medical Genetics, Oslo University Hospital, Oslo, Norway
| | - Giulia Paroni
- Complex Structure of Geriatrics, Department of Medical Sciences, Fondazione IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, FG, Italy
| | - Petroula Proitsi
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ingvild Saltvedt
- Geriatric Department, St. Olav Hospital, University Hospital of Trondheim, Trondheim, Norway
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Davide Seripa
- Complex Structure of Geriatrics, Department of Medical Sciences, Fondazione IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, FG, Italy
| | - Eystein Stordal
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Psychiatry, Namsos Hospital, Namsos, Norway
| | - Tormod Fladby
- Department of Neurology, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, Campus Ahus, University of Oslo, Oslo, Norway
| | - Dag Aarsland
- Norwegian, Exeter and King's College Consortium for Genetics of Neuropsychiatric Symptoms in Dementia, Exeter, UK
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Ole A Andreassen
- NORMENT, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Clive Ballard
- University of Exeter Medical School, Exeter, UK
- Norwegian, Exeter and King's College Consortium for Genetics of Neuropsychiatric Symptoms in Dementia, Exeter, UK
| | - Geir Selbaek
- Norwegian, Exeter and King's College Consortium for Genetics of Neuropsychiatric Symptoms in Dementia, Exeter, UK
- Research Centre of Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Pb 68, 2312, Ottestad, Norway
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
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Lam HR, Chow S, Taylor K, Chow R, Lam H, Bonin K, Rowbottom L, Herrmann N. Challenges of conducting research in long-term care facilities: a systematic review. BMC Geriatr 2018; 18:242. [PMID: 30314472 PMCID: PMC6186062 DOI: 10.1186/s12877-018-0934-9] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Accepted: 10/03/2018] [Indexed: 11/16/2022] Open
Abstract
Background The aim of this review is to describe the challenges and barriers to conducting research in long-term care facilities. Methods A literature search was conducted in Ovid MEDLINE, Embase, Cochrane Central, PsycINFO and CINAHL. Keywords used included “long term care”, “nursing home”, “research”, “trial”, “challenge” and “barrier”, etc. Resulting references were screened in order to identify relevant studies that reported on challenges derived from first-hand experience of empirical research studies. Challenges were summarized and synthesized. Results Of 1723 references, 39 articles were selected for inclusion. To facilitate understanding we proposed a classification framework of 8 main themes to categorize the research challenges presented in the 39 studies, relating to the characteristics of facility/owner/administrator, resident, staff caregiver, family caregiver, investigator, ethical or legal concerns, methodology, and budgetary considerations. Conclusions Conducting research in long-term care facilities is full of challenges which can be categorized into 8 main themes. Investigators should be aware of all these challenges and specifically address them when planning their studies. Stakeholders should be involved from an early stage and flexibility should be built into both the methodology and research budget. Electronic supplementary material The online version of this article (10.1186/s12877-018-0934-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Helen R Lam
- Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Selina Chow
- Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.,Division of Geriatric Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Room FG19, Toronto, ON, M4N 3M5, Canada
| | - Kate Taylor
- Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Ronald Chow
- Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Henry Lam
- Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Katija Bonin
- Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Leigha Rowbottom
- Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Nathan Herrmann
- Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada. .,Division of Geriatric Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Room FG19, Toronto, ON, M4N 3M5, Canada.
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Patrick F, Young AH, Williams SC, Perkins AM. Prescreening clinical trial volunteers using an online personality questionnaire. Neuropsychiatr Dis Treat 2018; 14:2297-2303. [PMID: 30233187 PMCID: PMC6130292 DOI: 10.2147/ndt.s169469] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The cost of a clinical trial is affected by the efficiency of participant recruitment. It would be desirable to create a prescreening method that identifies appropriate candidates for full screening, in order to prevent inconvenience for both trial and volunteers. This study presents an online prescreening tool for this purpose. METHODS In order to facilitate recruitment of 24 individuals meeting the criteria for generalized anxiety disorder to a pharmacological functional magnetic resonance imaging trial, we created an online personality questionnaire that generated a personality profile for each respondent and screened for the trial's basic criteria. RESULTS Our online platform screened 6,293 people for anxious personality traits in 1 year. A total of 862 eligible individuals were identified through this route, each of whom automatically received an email invitation to contact the study team for further telephone screening, if interested. Of those, 266 individuals contacted the team and 173 were telephone screened, with 53 attending the study site for medical checks. Twenty-eight individuals were fully eligible, and 24 completed the trial. This permitted completion on time and on budget. CONCLUSION Our online prescreening personality questionnaire platform did not remove the need for telephone screening or onsite medical checks, but increased the efficiency of recruitment through noninvasive identification of those meeting key requirements. Thus, our platform is a useful recruitment technique for clinical trials and is time-saving for both the trial and potential participants.
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Affiliation(s)
- Fiona Patrick
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK,
| | - Allan H Young
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK,
- National Institute for Health Research Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - Steven Cr Williams
- National Institute for Health Research Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Adam M Perkins
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK,
- National Institute for Health Research Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
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9
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Abdelnour C, Rodríguez-Gómez O, Alegret M, Valero S, Moreno-Grau S, Sanabria Á, Hernández I, Rosende-Roca M, Vargas L, Mauleón A, Sánchez D, Espinosa A, Ortega G, Pérez-Cordón A, Diego S, Gailhajanet A, Guitart M, Sotolongo-Grau Ó, Ruiz A, Tárraga L, Boada M. Impact of Recruitment Methods in Subjective Cognitive Decline. J Alzheimers Dis 2018; 57:625-632. [PMID: 28269773 DOI: 10.3233/jad-160915] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Recruitment methods can determine sample characteristics in mild cognitive impairment and Alzheimer's disease dementia, but little is known about its influence in subjective cognitive decline (SCD). OBJECTIVE To determine the influence of two types of recruitment methods in the characteristics of individuals with SCD. METHODS We select and compare clinical and neuropsychological features, and frequency of APOE ɛ4 allele of 326 subjects with SCD from two cohorts: Open House Initiative (OHI) versus Memory Unit (MU). A logistic regression analysis (LRA), using gender and years of education as covariates, was used to examine the neuropsychological variables. RESULTS The OHI sample were mostly women (75.9% versus 64.5%, p < 0.05), with higher educational level (12.15 [3.71] versus 10.70 [3.80] years, p = 0.001), and more family history of dementia (138 [62.7%] versus 44 [41.5%], p < 0.001) than the MU sample. Also, the OHI sample showed better overall neuropsychological performance than the MU sample, and after a LRA, this trend continued in automatic response inhibition capacity, abstract reasoning, and recognition memory. We did not find differences in age, depression history, and/or APOE ɛ4 allele frequency. CONCLUSION SCD subjects showed different demographic and neuropsychological characteristics depending on the recruitment method, which should be taken into account in the design of research studies with this target population.
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Affiliation(s)
- Carla Abdelnour
- Alzheimer Research Center and Memory Clinic of Fundació ACE, Institut Catalá de Neurociències Aplicades, Barcelona, Spain
| | - Octavio Rodríguez-Gómez
- Alzheimer Research Center and Memory Clinic of Fundació ACE, Institut Catalá de Neurociències Aplicades, Barcelona, Spain
| | - Montserrat Alegret
- Alzheimer Research Center and Memory Clinic of Fundació ACE, Institut Catalá de Neurociències Aplicades, Barcelona, Spain
| | - Sergi Valero
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, CIBERSAM, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Sonia Moreno-Grau
- Alzheimer Research Center and Memory Clinic of Fundació ACE, Institut Catalá de Neurociències Aplicades, Barcelona, Spain
| | - Ángela Sanabria
- Alzheimer Research Center and Memory Clinic of Fundació ACE, Institut Catalá de Neurociències Aplicades, Barcelona, Spain
| | - Isabel Hernández
- Alzheimer Research Center and Memory Clinic of Fundació ACE, Institut Catalá de Neurociències Aplicades, Barcelona, Spain
| | - Maitee Rosende-Roca
- Alzheimer Research Center and Memory Clinic of Fundació ACE, Institut Catalá de Neurociències Aplicades, Barcelona, Spain
| | - Liliana Vargas
- Alzheimer Research Center and Memory Clinic of Fundació ACE, Institut Catalá de Neurociències Aplicades, Barcelona, Spain
| | - Ana Mauleón
- Alzheimer Research Center and Memory Clinic of Fundació ACE, Institut Catalá de Neurociències Aplicades, Barcelona, Spain
| | - Domingo Sánchez
- Alzheimer Research Center and Memory Clinic of Fundació ACE, Institut Catalá de Neurociències Aplicades, Barcelona, Spain
| | - Ana Espinosa
- Alzheimer Research Center and Memory Clinic of Fundació ACE, Institut Catalá de Neurociències Aplicades, Barcelona, Spain
| | - Gemma Ortega
- Alzheimer Research Center and Memory Clinic of Fundació ACE, Institut Catalá de Neurociències Aplicades, Barcelona, Spain
| | - Alba Pérez-Cordón
- Alzheimer Research Center and Memory Clinic of Fundació ACE, Institut Catalá de Neurociències Aplicades, Barcelona, Spain
| | - Susana Diego
- Alzheimer Research Center and Memory Clinic of Fundació ACE, Institut Catalá de Neurociències Aplicades, Barcelona, Spain
| | - Anna Gailhajanet
- Alzheimer Research Center and Memory Clinic of Fundació ACE, Institut Catalá de Neurociències Aplicades, Barcelona, Spain
| | - Marina Guitart
- Alzheimer Research Center and Memory Clinic of Fundació ACE, Institut Catalá de Neurociències Aplicades, Barcelona, Spain
| | - Óscar Sotolongo-Grau
- Alzheimer Research Center and Memory Clinic of Fundació ACE, Institut Catalá de Neurociències Aplicades, Barcelona, Spain
| | - Agustín Ruiz
- Alzheimer Research Center and Memory Clinic of Fundació ACE, Institut Catalá de Neurociències Aplicades, Barcelona, Spain
| | - Lluís Tárraga
- Alzheimer Research Center and Memory Clinic of Fundació ACE, Institut Catalá de Neurociències Aplicades, Barcelona, Spain
| | - Mercè Boada
- Alzheimer Research Center and Memory Clinic of Fundació ACE, Institut Catalá de Neurociències Aplicades, Barcelona, Spain
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Rodríguez-Gómez O, Abdelnour C, Jessen F, Valero S, Boada M. Influence of Sampling and Recruitment Methods in Studies of Subjective Cognitive Decline. J Alzheimers Dis 2016; 48 Suppl 1:S99-S107. [PMID: 26402087 DOI: 10.3233/jad-150189] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Subjective cognitive decline (SCD) has been proposed as a marker of neurodegeneration in cognitively normal elderly. This idea is supported by the growing evidence that SCD is associated with Alzheimer's disease (AD) biomarkers and increases the risk of future cognitive impairment. Nevertheless, this evidence is not complete, since other studies have not found these associations. This discrepancy could have a methodological basis. It is well known that across the broad spectrum of degenerative disease from healthy controls to dementia, the research setting affects key characteristics of the sample such as age, educational level, or family history of dementia. However, virtually no studies have specifically tested the influence of sampling and recruitment methods in SCD research. Population-based samples are less biased and therefore they probably are more suitable for the study of memory complaints as a symptom at the population level. On the other hand, the memory clinic setting could introduce a set of biases that make these patients more likely to develop cognitive impairment. Thus, memory clinic would be the most cost-effective context in which to study the phenomenology of SCD due to AD and eventually recruit patients for secondary prevention trials. However, this general hypothesis needs to be tested. Studies that compare samples of patients with SCD from different settings are necessary. Sometimes it is difficult for patients with subtle forms of cognitive impairment to access specialized diagnostic centers. Based in our experience we state that Open House type initiatives may be useful for attracting these individuals to memory clinics.
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Affiliation(s)
| | - Carla Abdelnour
- Fundació ACE, Institut Català de Neurociències Aplicades, Barcelona, Spain
| | - Frank Jessen
- Department of Psychiatry, Medical Faculty, University of Cologne, German Center for Neurodegenerative Diseases (DZNE), Cologne, Germany
| | - Sergi Valero
- Psychiatry Department, Hospital Universitari Vall d'Hebron, CIBERSAM, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Merçé Boada
- Fundació ACE, Institut Català de Neurociències Aplicades, Barcelona, Spain
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Serna A, Contador I, Bermejo-Pareja F, Mitchell AJ, Fernández-Calvo B, Ramos F, Villarejo A, Benito-León J. Accuracy of a Brief Neuropsychological Battery for the Diagnosis of Dementia and Mild Cognitive Impairment: An Analysis of the NEDICES Cohort. J Alzheimers Dis 2016; 48:163-73. [PMID: 26401937 DOI: 10.3233/jad-150086] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Early separation of mild cognitive impairment (MCI) from normal aging and mild cases of dementia remains a challenge, especially in the general population. We aimed to analyze the diagnostic accuracy of a brief neuropsychological battery (BNB) in dementia and MCI cases from the Neurological Disorders in Central Spain (NEDICES) population-based cohort study. We screened 3,891 participants into dementia and non-dementia groups using a two-phase procedure: screening (MMSE-37 and Pfeffer-11) and clinical diagnosis by specialists (DSM-IV criteria). We selected subsequently a subsample of dementia (n = 98), MCI (n = 71), and cognitively healthy (n = 123) participants matched in socio-demographic characteristics. The clinical validity of each test of the BNB was determined by the area under the ROC curve. We determined the best combination of tests to classify individuals into the diagnostic groups by logistic regression analyses. The results indicated that dementia and MCI groups could be best discriminated from the healthy control group on the basis of their scores on the semantic verbal fluency and delayed recall subtests of the BNB. As for discriminating the MCI group from the dementia group, immediate recall tasks (stories and pictures) yielded the highest level of accuracy. Probably the most interesting finding is that the verbal fluency task consistently allowed discrimination among the diagnostic groups. Overall, subtests of the BNB are more accurate in differentiating dementia patients than MCI patients from healthy controls. In this population-based sample, a more fine-grained discrimination that includes MCI patients should follow a systematic subtest-wise analysis and decision.
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Affiliation(s)
- Adriana Serna
- Department of Personality, Evaluation and Psychological Treatment, University of Salamanca, Salamanca, Spain
| | - Israel Contador
- Department of Basic Psychology, Psychobiology and Methodology of Behavioral Science, University of Salamanca, Salamanca, Spain
| | - Félix Bermejo-Pareja
- Research Institute (Imas12), University Hospital "12 de Octubre", Madrid, Spain.,Department of Medicine, Faculty of Medicine, Complutense University, Madrid, Spain.,Center for Networked Biomedical Research on Neurodegenerative Diseases (CIBERNED), Madrid, Spain
| | - Alex J Mitchell
- Leicestershire Partnership NHS Trust and University of Leicester, UK
| | | | - Francisco Ramos
- Department of Personality, Evaluation and Psychological Treatment, University of Salamanca, Salamanca, Spain
| | - Alberto Villarejo
- Center for Networked Biomedical Research on Neurodegenerative Diseases (CIBERNED), Madrid, Spain.,Department of Neurology, University Hospital "12 de Octubre", Madrid, Spain
| | - Julián Benito-León
- Center for Networked Biomedical Research on Neurodegenerative Diseases (CIBERNED), Madrid, Spain.,Department of Neurology, University Hospital "12 de Octubre", Madrid, Spain
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12
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Phillips LA, Cohen J, Burns E, Abrams J, Renninger S. Self-management of chronic illness: the role of 'habit' versus reflective factors in exercise and medication adherence. J Behav Med 2016; 39:1076-1091. [PMID: 26980098 DOI: 10.1007/s10865-016-9732-z] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Accepted: 03/04/2016] [Indexed: 12/22/2022]
Abstract
Non-adherence to health behaviors required for chronic illness self-management is pervasive. Advancing health-behavior theory to include behavioral initiation and maintenance factors, including reflective (e.g., belief- and feedback-based) and automatic (e.g., habit-based) mechanisms of adherence to different treatment-related behaviors could improve non-adherence prediction and intervention efforts. To test behavioral initiation and maintenance factors from an extended common sense self-regulation theoretical framework for predicting medication adherence and physical activity among patients with Type 2 diabetes. Patients (n = 133) in an in-person (n = 80) or online (n = 53) version of the study reported treatment-related (1) barriers, (2) beliefs and experiential feedback (reflective mechanisms of treatment-initiation and short-term repetition), and (3) habit strength (automatic mechanism of treatment-maintenance) for taking medication and engaging in regular physical activity at baseline. Behaviors were assessed via self-reports (n = 133) and objectively (electronic monitoring pill bottles, accelerometers; n = 80) in the subsequent month. Treatment-specific barriers and habit strength predicted self-reported and objective adherence for both behaviors. Beliefs were inconsistently related to behavior, even when habits were "weak". Experiential feedback from behavior was not related to adherence. Among patients with Type 2 diabetes diagnosis, medication and physical activity adherence were better predicted by their degree of automatic behavioral repetition than their beliefs/experiences with the treatment-actions. Habit strength should be an intervention target for chronic illness self-management; assessing it in practice settings may effectively detect non-adherence to existing treatment-regimens. However, future research and further refining of CS-SRM theory regarding the processes required for such habit development are needed.
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Affiliation(s)
- L Alison Phillips
- Department of Psychology, Iowa State University, W112 Lagomarcino Hall, Ames, IA, 50011, USA.
| | - Joshua Cohen
- Division of Endocrinology, Medical Faculty Associates, The George Washington University, 22nd & I Street, NW, 3rd Floor, Washington, DC, 20037, USA
| | - Edith Burns
- Division of Geriatrics and Gerontology, Department of Medicine, Medical College of Wisconsin, 9200 W. Wisconsin Ave., Milwaukee, WI, 53226, USA
| | - Jessica Abrams
- Department of Psychology, The George Washington University, 2125 G Street NW, Washington, DC, 20052, USA
| | - Steffi Renninger
- Department of Psychology, The George Washington University, 2125 G Street NW, Washington, DC, 20052, USA
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Abstract
Alzheimer disease (AD) research faces challenges to successful enrollment, especially to clinical trials and biomarker studies. Failure to recruit the planned number of participants in a timely manner threatens the internal validity and success of clinical research, raising concerns about external validity and generalizability of results, and possibly leading to disparities in disease treatment. Methods to improve recruitment exist, but require varying levels of staff effort and financial resources, and evidence of effectiveness is often lacking or inconsistent. In this review, we summarize some of the available methods to improve AD research recruitment, the available literature to support or refute these strategies, and some of the experiences at the authors' AD Research Centers. We discuss the use of community-based participatory research principles and participant registries as a means to enhance research enrollment and increase diversity of research samples.
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Cooper C, Ketley D, Livingston G. Systematic review and meta-analysis to estimate potential recruitment to dementia intervention studies. Int J Geriatr Psychiatry 2014; 29:515-25. [PMID: 24706605 DOI: 10.1002/gps.4034] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Revised: 09/08/2013] [Accepted: 09/12/2013] [Indexed: 11/06/2022]
Abstract
OBJECTIVE We investigated the proportion of people with dementia who are eligible for and willing to participate in intervention studies. METHODS We systematically reviewed 12 studies fitting predetermined criteria, reporting eligibility or participation rates for dementia intervention trials or intervention studies that sought to increase recruitment. We assessed the study validity using a checklist, reported trial eligibility and participation rates and meta-analysed these where appropriate. RESULTS In higher quality studies, 26% [95% confidence interval 19-35%] of people with Alzheimer's disease (AD) attending memory clinics or receiving antidementia medication were eligible for industry drug trials, and 43% of eligible people agreed to participate in one study, suggesting 11% of these populations would take part in drug trials if approached. There was replicated, higher quality evidence that younger people, men and those with more education were more likely to be eligible for AD drug trials. No randomised controlled trials have investigated how to increase recruitment to dementia intervention studies. CONCLUSION One in 10 people with AD or taking donepezil would, according to best available evidence, take part in industry drug trials if approached. We found no data regarding non-pharmacological intervention or pragmatic drug trial recruitment, but eligibility and participation rates for these studies are probably higher. If international studies are extrapolated to the UK, they suggest the national target of recruiting 10% of people with dementia diagnoses to research may be achieved through a nationwide policy of asking all people with dementia and their carers for consent to be approached for research participation.
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Affiliation(s)
- Claudia Cooper
- Mental Health Sciences Unit, University College London, London, UK
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Andersen F, Viitanen M, Halvorsen DS, Straume B, Wilsgaard T, Engstad TA. The effect of stimulation therapy and donepezil on cognitive function in Alzheimer's disease. A community based RCT with a two-by-two factorial design. BMC Neurol 2012; 12:59. [PMID: 22813231 PMCID: PMC3481364 DOI: 10.1186/1471-2377-12-59] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Accepted: 06/29/2012] [Indexed: 11/11/2022] Open
Abstract
Background Progressive neurodegeneration in Alzheimer’s disease (AD) induces cognitive deterioration, and there is controversy regarding the optimal treatment strategy in early AD. Stimulation therapy, including physical exercise and cholinesterase inhibitors are both reported to postpone cognitive deterioration in separate studies. We aimed to study the effect of stimulation therapy and the additional effect of donepezil on cognitive function in early AD. Method Design: A two-by-two factorial trial comprising stimulation therapy for one year compared to standard care to which a randomized double-blinded placebo controlled trial with donepezil was added. Setting: Nine rural municipalities in Northern Norway. Participants: 187 participants 65 years and older with a recent diagnosis of mild or moderate AD were included in the study of which 146 completed a one-year follow-up. INTERVENTIONS: In five municipalities the participants received stimulation therapy whereas participants in four received standard care. All participants were randomised double-blindly to donepezil or placebo and tested with three different cognitive tests four times during the one-year study period. Main outcome: Changes in MMSE sum score. Secondary outcome: Changes in ADAS-Cog and Clock Drawing Test. Results MMSE scores remained unchanged amongst AD participants receiving stimulation therapy and those receiving standard care. The results were consistent for ADAS-Cog and Clock Drawing Test. No time trend differences were found during one-year follow-up between groups receiving stimulation therapy versus standard care or between donepezil versus placebo. Conclusion In rural AD patients non-pharmacological and pharmacological therapy did not improve outcome compared with standard care but all groups retained cognitive function during one year follow-up. Other studies are needed to confirm these results. Trial registration ClinicalTrials.gov (Identifier: NCT00443014). EudraCT database (no 2004-002613-37).
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Affiliation(s)
- Fred Andersen
- Department of Community Medicine, University of Tromsø, Norway.
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Hallikainen I, Koivisto AM, Paajanen T, Hiltunen A, Karppi P, Vanhanen M, Välimäki T, Herukka SK, Soininen H, Hänninen T. Cognitive and Neuropsychiatric Symptom Differences in Early Stages of Alzheimer's Disease: Kuopio ALSOVA Study. Dement Geriatr Cogn Dis Extra 2012; 2:209-18. [PMID: 22719747 PMCID: PMC3379731 DOI: 10.1159/000338231] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background/Aim Alzheimer's disease (AD) causes impairment in memory and other cognitive functions as well as neuropsychiatric symptoms and limitations in the activities of daily living (ADL). The aim of this study was to examine whether demographic variables, dementia severity, ADL and neuropsychiatric symptoms are associated with cognition in very mild or mild AD. Methods We analyzed the baseline data of 236 patients with very mild or mild AD participating in a prospective AD follow-up study (ALSOVA). The Consortium to Establish a Registry for Alzheimer's Disease neuropsychological battery total score was used in the evaluation of the global cognitive performance. Results Cognition was associated with dementia severity and ADL but not with neuropsychiatric symptoms. ADL functions were associated with both cognitive performance and neuropsychiatric symptoms. Conclusion Even patients with very mild or mild AD may exhibit neuropsychiatric symptoms not related to cognitive impairment. The results of this study emphasize the importance of taking a multidimensional approach to the diagnostic and prognostic evaluation of AD patients already in the early stages of the disease.
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Affiliation(s)
- Ilona Hallikainen
- Institute of Clinical Medicine, Neurology, University of Eastern Finland, Mikkeli, Finland
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Winhusen T, Winstanley EL, Somoza E, Brigham G. The potential impact of recruitment method on sample characteristics and treatment outcomes in a psychosocial trial for women with co-occurring substance use disorder and PTSD. Drug Alcohol Depend 2012; 120:225-8. [PMID: 21752556 PMCID: PMC3210936 DOI: 10.1016/j.drugalcdep.2011.06.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Revised: 06/16/2011] [Accepted: 06/17/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND Recruitment method can impact the sample composition of a clinical trial and, thus, the generalizability of the results, but the importance of recruitment method in substance use disorder trials has received little attention. The present paper sought to address this research gap by evaluating the association between recruitment method and sample characteristics and treatment outcomes in a substance use disorder trial. METHODS In a multi-site trial evaluating Seeking Safety (SS), relative to Women's Health Education (WHE), for women with co-occurring PTSD (either sub-threshold or full PTSD) and substance use disorders, one site assessed the method by which each participant was recruited. Data from this site (n=106), which recruited participants from newspaper advertising and clinic intakes, were analyzed. RESULTS Participants recruited through advertising, relative to those from the clinic, had significantly higher levels of baseline drug use and higher rates of meeting DSM-IV-TR criteria for full PTSD. Results suggest that the effectiveness of SS in decreasing PTSD symptoms was greater for participants recruited through advertising relative to those recruited from the clinic. Conversely, the results revealed a significant treatment effect in the clinic-recruited participants, not seen in the advertising-recruited participants, with SS, relative to WHE, participants being more likely to report past week drug use during the follow-up phase. CONCLUSION Recruitment method may impact sample composition and treatment effects. Replication of this finding would have important implications for substance use disorder efficacy trials which often utilize advertising to recruit participants.
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Affiliation(s)
- Theresa Winhusen
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, 3210 Jefferson Avenue, Cincinnati, OH 45220, USA.
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Andersen F, Viitanen M, Halvorsen DS, Straume B, Engstad TA. Co-morbidity and drug treatment in Alzheimer's disease. A cross sectional study of participants in the dementia study in northern Norway. BMC Geriatr 2011; 11:58. [PMID: 21970467 PMCID: PMC3204237 DOI: 10.1186/1471-2318-11-58] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2011] [Accepted: 10/04/2011] [Indexed: 11/27/2022] Open
Abstract
Background Inappropriate medical treatment of co-morbidities in Alzheimer's disease (AD) is an increasing concern in geriatric medicine. The objective of this study was to compare current drug use related to co-morbidity between individuals with a recent diagnosis of AD and a cognitively healthy control group in a population based clinical trial in Northern Norway. Methods Setting: Nine rural municipalities with 70 000 inhabitants in Northern Norway. Participants: Participants with and without AD recruited in general practice and by population based screening. 187 participants with a recent diagnosis of AD were recruited among community dwellers. Of 791 respondents without cognitive symptoms, 500 were randomly selected and invited to further clinical and cognitive testing. The final control group consisted of 200 cognitively healthy individuals from the same municipalities. Demographic characteristics, data on medical history and current medication were included, and a physical and cognitive examination was performed. The statistical analyses were carried out by independent sample t-test, chi-square, ANCOVA and logistic regression. Results A co-morbidity score was significantly higher in AD participants compared to controls. The mean number of drugs was higher for AD participants compared to controls (5.1 ± 3.6 and 2.9 ± 2.4 respectively, p < 0.001 age and gender adjusted), also when adjusted for co-morbidity. AD participants used significantly more anticholinergic, sedative and antidepressant drugs. For nursing home residents with AD the mean number of drugs was significantly higher compared to AD participants living at home (6.9 ± 3.9 and 4.5 ± 3.3, respectively, p < 0.001). Conclusions AD participants were treated with a significantly higher number of drugs as compared to cognitively healthy controls, even after adjustment for co-morbidity. An inappropriate use of anticholinergic and sedative drugs was identified, especially among nursing home residents with AD. The drug burden and the increased risk of adverse reactions among individuals suffering from AD need more attention from prescribing doctors.
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Affiliation(s)
- Fred Andersen
- Department of Community Medicine, University of Tromsø, and Department of Medicine, University Hospital, (Breivika), Tromsø, (9037), Norway.
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Macdonald M. Research Recruitment in Home Care in an Era of Scams and Advocacy. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2011. [DOI: 10.1177/1084822310388141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Recruitment is the cornerstone of research involving human beings. Most of what has been written involved institutional recruitment, yet the past two decades have seen an exponential rise in the delivery of home care. This shift has been accompanied by an increase in the volume of research conducted in homecare, and the majority of home care recipients are elderly. The elderly experience a disproportionate occurrence of consumer fraud and are increasingly reluctant to give strangers access to their homes. Advocacy groups have made formidable contributions to raising the awareness among older persons of risks to their person and finances. The aim of this article is to raise awareness of the importance of recruitment in the home care community and to recommend to researchers that they partner with community agencies and advocacy groups to inform citizens of the value of their participation in research in home care, and the benefits.
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