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Xue B, Luo C, Luo X. Attitudes toward dementia screening and influential factors in older adults in China. Psychogeriatrics 2023; 23:211-221. [PMID: 36457142 DOI: 10.1111/psyg.12918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 10/29/2022] [Accepted: 11/08/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Dementia will likely be an ongoing concern for future generations, and according to the World Health Organization, two-thirds of dementia cases are missed diagnoses. We aimed to explore the attitudes of older adults toward dementia screening and the related influencing factors. METHODS A multicentre cross-sectional study was conducted. Data were collected using questionnaires between 2020 December and 2021 June from five provinces in China. The study included older adults aged 60 years or older, living in China. A sociodemographic questionnaire and the Perceptions Regarding Investigational Screening for Memory in Primary Care scale were used to assess attitudes toward and influencing factors of dementia screening. RESULTS A total of 279 participants completed the questionnaires. The results revealed housing status as a positive factor in the acceptance dimension, while high income was the primary positive factor in the benefits of screening dimension. Having religious beliefs, low income, and never participating in social activities were positive factors for the stigma dimension. Widowed marital status and participation in social activities were negative factors for the independence dimension, while having religious beliefs positively influenced the suffering dimension. CONCLUSIONS This study showed that participants held a relatively positive attitude toward dementia screening, although they had concerns about stigma and negative impact on independence. Further studies are required to develop intervention strategies to help older adults improve their attitudes and quality of life, promote cognitive health, and facilitate healthy ageing.
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Affiliation(s)
- Bing Xue
- School of Nursing, Wuhan University, Wuhan, China
| | - Chang Luo
- School of Artificial Intelligence of Jianghan University, Wuhan, China
| | - Xianwu Luo
- School of Nursing, Wuhan University, Wuhan, China
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Kleiman MJ, Plewes AD, Owora A, Grout RW, Dexter PR, Fowler NR, Galvin JE, Miled ZB, Boustani M. Digital detection of dementia (D 3): a study protocol for a pragmatic cluster-randomized trial examining the application of patient-reported outcomes and passive clinical decision support systems. Trials 2022; 23:868. [PMID: 36221141 PMCID: PMC9552361 DOI: 10.1186/s13063-022-06809-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 09/30/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Early detection of Alzheimer's disease and related dementias (ADRD) in a primary care setting is challenging due to time constraints and stigma. The implementation of scalable, sustainable, and patient-driven processes may improve early detection of ADRD; however, there are competing approaches; information may be obtained either directly from a patient (e.g., through a questionnaire) or passively using electronic health record (EHR) data. In this study, we aim to identify the benefit of a combined approach using a pragmatic cluster-randomized clinical trial. METHODS We have developed a Passive Digital Marker (PDM), based on machine learning algorithms applied to EHR data, and paired it with a patient-reported outcome (the Quick Dementia Rating Scale or QDRS) to rapidly share an identified risk of impairment to a patient's physician. Clinics in both south Florida and Indiana will be randomly assigned to one of three study arms: 1200 patients in each of the two populations will be administered either the PDM, the PDM with the QDRS, or neither, for a total of 7200 patients across all clinics and populations. Both incidence of ADRD diagnosis and acceptance into ADRD diagnostic work-up regimens is hypothesized to increase when patients are administered both the PDM and QDRS. Physicians performing the work-up regimens will be blind to the study arm of the patient. DISCUSSION This study aims to test the accuracy and effectiveness of the two scalable approaches (PDM and QDRS) for the early detection of ADRD among older adults attending primary care practices. The data obtained in this study may lead to national early detection and management program for ADRD as an efficient and beneficial method of reducing the current and future burden of ADRD, as well as improving the annual rate of newly documented ADRD in primary care practices. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05231954 . Registered February 9, 2022.
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Affiliation(s)
- Michael J Kleiman
- Comprehensive Center for Brain Health, Department of Neurology, University of Miami Miller School of Medicine, 7700 W Camino Real, Suite 200, Boca Raton, FL, 33433, USA.
| | - Abbi D Plewes
- Indiana University School of Medicine, Indianapolis, IN, 46202, USA
- Center for Health Innovation and Implementation Science, Indiana Clinical and Translational Science Institute, Indianapolis, IN, 46202, USA
| | - Arthur Owora
- Indiana University Bloomington School of Public Health, Bloomington, IN, 47405, USA
| | - Randall W Grout
- Indiana University School of Medicine, Indianapolis, IN, 46202, USA
- Regenstrief Institute, Inc., Indianapolis, IN, 46202, USA
| | - Paul Richard Dexter
- Indiana University School of Medicine, Indianapolis, IN, 46202, USA
- Regenstrief Institute, Inc., Indianapolis, IN, 46202, USA
| | - Nicole R Fowler
- Indiana University School of Medicine, Indianapolis, IN, 46202, USA
- Center for Health Innovation and Implementation Science, Indiana Clinical and Translational Science Institute, Indianapolis, IN, 46202, USA
- Regenstrief Institute, Inc., Indianapolis, IN, 46202, USA
- Indiana University Center for Aging Research, Indianapolis, IN, 46202, USA
| | - James E Galvin
- Comprehensive Center for Brain Health, Department of Neurology, University of Miami Miller School of Medicine, 7700 W Camino Real, Suite 200, Boca Raton, FL, 33433, USA
| | - Zina Ben Miled
- Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Malaz Boustani
- Indiana University School of Medicine, Indianapolis, IN, 46202, USA
- Center for Health Innovation and Implementation Science, Indiana Clinical and Translational Science Institute, Indianapolis, IN, 46202, USA
- Regenstrief Institute, Inc., Indianapolis, IN, 46202, USA
- Indiana University Center for Aging Research, Indianapolis, IN, 46202, USA
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Lee S, Kim D, Lee H. Examine Race/Ethnicity Disparities in Perception, Intention, and Screening of Dementia in a Community Setting: Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148865. [PMID: 35886711 PMCID: PMC9321249 DOI: 10.3390/ijerph19148865] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 07/07/2022] [Accepted: 07/14/2022] [Indexed: 12/24/2022]
Abstract
Background: Delayed detection and diagnosis of Alzheimer’s Disease and related dementia (ADRD) can lead to suboptimal care and socioeconomic burdens on individuals, families, and communities. Our objective is to investigate dementia screening behavior focusing on minority older populations and assess whether there are ethnic differences in ADRD screening behavior. Methods: The scoping review method was utilized to examine ADRD screening behavior and contributing factors for missed and delayed screening/diagnosis focusing on race/ethnicity. Results: 2288 papers were identified, of which 21 met the inclusion criteria. We identified six dimensions of ADRD screening behavior: Noticing Symptoms, Recognizing a problem, Accepting Screen, Intending Screen, Action, and Integrating with time. Final findings were organized into study race/ethnicity, theoretical background, the methods of quantitative and qualitative studies, description and measures of ADRD screening behavior, and racial/ethnic differences in ADRD screening behavior. Conclusions: A trend in ethnic disparities in screening for ADRD was observed. Our findings point to the fact that there is a scarcity of studies focusing on describing ethnic-specific ADRD screening behavior as well as a lack of those examining the impact of ethnicity on ADRD screening behavior, especially studies where Asian Americans are almost invisible.
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Peters Settje KL, Yap TL, Chapman S, Brooks K, Sabol VK. Implementation of Nurse-Led Cognitive Screening During Medicare Annual Wellness Visits. J Nurse Pract 2022. [DOI: 10.1016/j.nurpra.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Wiese LK, Williams I, Williams CL, Galvin JE. Discerning rural Appalachian stakeholder attitudes toward memory screening. Aging Ment Health 2021; 25:797-806. [PMID: 32081028 PMCID: PMC8456570 DOI: 10.1080/13607863.2020.1725739] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Accepted: 01/18/2020] [Indexed: 01/15/2023]
Abstract
OBJECTIVE The aim of this descriptive study was to examine Appalachian stakeholder attitudes toward routine memory screening, and to compare and contrast results from a similar study conducted in an ethnically diverse rural Florida cohort. Determining perceptions about memory screening is essential prior to developing culturally relevant programs for increasing early dementia detection and management among rural underserved older adults at risk of cognitive impairment. Benefits of early detection include ruling out other causes of illness and treating accordingly, delaying onset of dementia symptoms through behavior management and medications, and improving long-term care planning (Dubois, Padovani, Scheltens, Rossi, & Dell'Agnello, 2016). These interventions can potentially help to maintain independence, decrease dementia care costs, and reduce family burdens (Frisoni, et al., 2017). METHOD Researchers applied a parallel mixed method design (Tashakkori & Newman, 2010) of semi-structured interviews, measurements of health literacy (REALM-SF) (Arozullah, et al., 2007), sociodemographics, and cognitive screening perceptions (PRISM-PC) (Boustani, et al., 2008), to examine beliefs and attitudes about memory screening among 22 FL and 21 WV rural stakeholders (residents, health providers, and administrators). RESULTS Findings included that > 90% participants across both cohorts were highly supportive of earlier dementia detection through routine screening regardless of sample characteristics. However, half of those interviewed were doubtful that provider care or assistance would be adequate for this terminal illness. Despite previous concerns of stigma associated with an Alzheimer's disease diagnosis, rural providers are encouraged to educate patients and community members regarding Alzheimer's disease and offer routine cognitive screening and follow-through.
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Affiliation(s)
- Lisa Kirk Wiese
- C. E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, FL, USA
| | - Ishan Williams
- Family, Community, and Mental Health Systems, University of Virginia, Charlottesville, VA, USA
| | | | - James. E. Galvin
- Charles E Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
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Korthauer LE, Denby C, Molina D, Wanjiku J, Daiello LA, Drake JD, Grill JD, Ott BR. Pilot study of an Alzheimer's disease risk assessment program in a primary care setting. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2021; 13:e12157. [PMID: 33665347 PMCID: PMC7896638 DOI: 10.1002/dad2.12157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 12/15/2020] [Accepted: 12/29/2020] [Indexed: 01/18/2023]
Abstract
INTRODUCTION The goal of this study was to pilot a referral-based cognitive screening and genetic testing program for Alzheimer's disease (AD) risk assessment in a primary care setting. METHODS Primary care providers (PCPs; N = 6) referred patients (N = 94; M = 63 years) to the Rhode Island Alzheimer's Disease Prevention Registry for apolipoprotein E (APOE) genotyping and cognitive screening. PCPs disclosed test results to patients and counseled them about risk factor modification. RESULTS Compared to the Registry as a whole, participants were younger, more likely to be non-White, and had lower cognitive screening scores. Mild cognitive impairment participants correctly reported a higher perceived risk of developing AD. Patients who recalled being counseled about modifiable risk factors were more likely to report positive health behavior changes. DISCUSSION A referral-based program for cognitive and genetic AD risk assessment in a primary care setting is feasible, acceptable to patients, and yielded a more demographically diverse sample than an AD prevention registry.
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Affiliation(s)
- Laura E. Korthauer
- Department of Psychiatry and Human BehaviorAlpert Medical School of Brown UniversityRhode Island HospitalProvidenceRhode IslandUSA
- Department of NeurologyAlpert Medical School of Brown UniversityRhode Island HospitalProvidenceRhode IslandUSA
| | - Charles Denby
- Department of NeurologyAlpert Medical School of Brown UniversityRhode Island HospitalProvidenceRhode IslandUSA
| | - David Molina
- Department of NeurologyAlpert Medical School of Brown UniversityRhode Island HospitalProvidenceRhode IslandUSA
| | - Janet Wanjiku
- Department of NeurologyAlpert Medical School of Brown UniversityRhode Island HospitalProvidenceRhode IslandUSA
| | - Lori A. Daiello
- Department of NeurologyAlpert Medical School of Brown UniversityRhode Island HospitalProvidenceRhode IslandUSA
| | - Jonathan D. Drake
- Department of NeurologyAlpert Medical School of Brown UniversityRhode Island HospitalProvidenceRhode IslandUSA
| | - Josh D. Grill
- Institute of Memory Impairments and Neurological DisordersDepartment of Psychiatry and Human BehaviorDepartment of Neurobiology and BehaviorUniversity of California IrvineIrvineCaliforniaUSA
| | - Brian R. Ott
- Department of NeurologyAlpert Medical School of Brown UniversityRhode Island HospitalProvidenceRhode IslandUSA
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Galvin JE, Tolea MI, Chrisphonte S. Using a patient-reported outcome to improve detection of cognitive impairment and dementia: The patient version of the Quick Dementia Rating System (QDRS). PLoS One 2020; 15:e0240422. [PMID: 33057404 PMCID: PMC7561106 DOI: 10.1371/journal.pone.0240422] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 09/27/2020] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION Community detection of mild cognitive impairment (MCI) and Alzheimer's disease and related disorders (ADRD) is a challenge. While Gold Standard assessments are commonly used in research centers, these methods are time consuming, require extensive training, and are not practical in most clinical settings or in community-based research projects. Many of these methods require an informant (e.g., spouse, adult child) to provide ratings of the patients' cognitive and functional abilities. A patient-reported outcome that captures the presence of cognitive impairment and corresponds to Gold Standard assessments could improve case ascertainment, clinical care, and recruitment into clinical research. We tested the patient version of the Quick Dementia Rating System (QDRS) as a patient-reported outcome to detect MCI and ADRD. METHODS The patient QDRS was validated in a sample of 261 consecutive patient-caregiver dyads compared with the informant version of the QDRS, the Clinical Dementia Rating (CDR), neuropsychological tests, and Gold Standard measures of function, behavior, and mood. Psychometric properties including item variability, floor and ceiling effects, construct, concurrent, and known-groups validity, and internal consistency were determined. RESULTS The patient QDRS strongly correlated with Gold Standard measures of cognition, function, mood, behavior, and global staging methods (p-values < .001) and had strong psychometric properties with excellent data quality and internal consistency (Cronbach alpha = 0.923, 95%CI:0.91-0.94). The patient QDRS had excellent agreement with the informant QDRS, the CDR and its sum of boxes (Intraclass Correlation Coefficients: 9.781-0.876). Receiver operator characteristic curves showed excellent discrimination between normal controls from CDR 0.5 (AUC:0.820;95% CI: 0.74-0.90) and for normal controls from any cognitive impairment (AUC:0.885;95% CI: 0.83-0.94). DISCUSSION The patient QDRS validly and reliably differentiates individuals with and without cognitive impairment and can be completed by patients through all stages of dementia. The patient QDRS is highly correlated with Gold Standard measures of cognitive, function, behavior, and global staging. The patient QDRS provides a rapid method to screen patients for MCI and ADRD in clinical practice, determine study eligibility, improve case ascertainment in community studies.
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Affiliation(s)
- James E. Galvin
- Comprehensive Center for Brain Health, Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Magdalena I. Tolea
- Comprehensive Center for Brain Health, Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Stephanie Chrisphonte
- Comprehensive Center for Brain Health, Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida, United States of America
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Galvin JE, Tolea MI, Chrisphonte S. What older adults do with the results of dementia screening programs. PLoS One 2020; 15:e0235534. [PMID: 32609745 PMCID: PMC7329076 DOI: 10.1371/journal.pone.0235534] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 06/17/2020] [Indexed: 12/13/2022] Open
Abstract
Introduction Alzheimer’s disease and related dementias (ADRD) and mild cognitive impairment (MCI) are often under-recognized in the community. MCI/ADRD screening could offer benefits such as early treatment, research participation, lifestyle modification, and advanced care planning. To date, there are no clear guidelines regarding the benefits vs. harms of dementia screening or whether a dementia screening program could be successful. Methods A community-based study was conducted to evaluate an MCI/ADRD screening program and determine what older adults would do with the information. Measures of cognition, physical health, functionality, and mood were collected. Participants met with a health professional, were given screening results with recommendations, and then contacted 60 days later to determine what was done with the results. Logistic regression models were used to build predictive models. Results Participants (n = 288) had a mean age of 71.5±8.3y, mean education of 13.3±4.8y, and were 70% female, 67% White, 26% African American, and 48% Hispanic. After 60 days, 75% of participants were re-contacted; 54% shared results with family, 33% shared results with health care providers (HCPs), and 52% initiated behavioral change. Among participants sharing results with HCPs, 51% reported HCPs did not follow-up on the results, and 18% that HCPs did not show any interest in the screening visit or its results. Predictors of sharing results with HCPs were elevated hemoglobin A1C (OR = 1.85;95%CI:1.19–2.88), uncontrolled hypertension (OR = 2.73;95%CI:1.09–6.83), and mobility issues (OR = 2.43;95%CI: 1.93–5.54). Participant behavioral changes included lifestyle modification (58%), social engagement (10%), cognitive stimulation (5%), and advanced care planning (4%). The most significant predictors of sharing with family were better overall mental health (OR = 0.19; 95%CI: 0.06–0.59) and better physical function (OR = 0.38; 95%CI: 0.17–0.81). Discussion MCI/ADRD screening was well-received by a diverse community sample. Participants showed interest in sharing the results with their family and HCPs and many attempted behavioral change. While HCPs did not always act on screening results, 25% ordered further testing and evaluation. Efforts need to be directed toward (1) increasing self-efficacy of older adults to discuss screening results with their HCPs, and (2) educating HCPs on the value of early detection of MCI/ADRD. Community dementia screening programs can increase MCI/ADRD detection and improve patient-centered outcomes and medical decision-making.
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Affiliation(s)
- James E. Galvin
- Department of Neurology, Comprehensive Center for Brain Health, University of Miami Miller School of Medicine, Miami, Florida, United States of America
- * E-mail:
| | - Magdalena I. Tolea
- Department of Neurology, Comprehensive Center for Brain Health, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Stephanie Chrisphonte
- Department of Neurology, Comprehensive Center for Brain Health, University of Miami Miller School of Medicine, Miami, Florida, United States of America
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Boustani M, Perkins AJ, Khandker RK, Duong S, Dexter PR, Lipton R, Black CM, Chandrasekaran V, Solid CA, Monahan P. Passive Digital Signature for Early Identification of Alzheimer's Disease and Related Dementia. J Am Geriatr Soc 2019; 68:511-518. [PMID: 31784987 DOI: 10.1111/jgs.16218] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 09/13/2019] [Accepted: 09/16/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Developing scalable strategies for the early identification of Alzheimer's disease and related dementia (ADRD) is important. We aimed to develop a passive digital signature for early identification of ADRD using electronic medical record (EMR) data. DESIGN A case-control study. SETTING The Indiana Network for Patient Care (INPC), a regional health information exchange in Indiana. PARTICIPANTS Patients identified with ADRD and matched controls. MEASUREMENTS We used data from the INPC that includes structured and unstructured (visit notes, progress notes, medication notes) EMR data. Cases and controls were matched on age, race, and sex. The derivation sample consisted of 10 504 cases and 39 510 controls; the validation sample included 4500 cases and 16 952 controls. We constructed models to identify early 1- to 10-year, 3- to 10-year, and 5- to 10-year ADRD signatures. The analyses included 14 diagnostic risk variables and 10 drug classes in addition to new variables produced from unstructured data (eg, disorientation, confusion, wandering, apraxia, etc). The area under the receiver operating characteristics (AUROC) curve was used to determine the best models. RESULTS The AUROC curves for the validation samples for the 1- to 10-year, 3- to 10-year, and 5- to 10-year models that used only structured data were .689, .649, and .633, respectively. For the same samples and years, models that used both structured and unstructured data produced AUROC curves of .798, .748, and .704, respectively. Using a cutoff to maximize sensitivity and specificity, the 1- to 10-year, 3- to 10-year, and 5- to 10-year models had sensitivity that ranged from 51% to 62% and specificity that ranged from 80% to 89%. CONCLUSION EMR-based data provide a targeted and scalable process for early identification of risk of ADRD as an alternative to traditional population screening. J Am Geriatr Soc 68:511-518, 2020.
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Affiliation(s)
- Malaz Boustani
- Indiana University Center for Health Innovation and Implementation Science, Indiana Clinical Translational Science Institute, Indianapolis, Indiana.,Sandra Eskenazi Center for Brain Care Innovation, Eskenazi Health, Indianapolis, Indiana.,Indiana University Center for Aging Research, Regenstrief Institute, Inc, Indianapolis, Indiana
| | - Anthony J Perkins
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Rezaul Karim Khandker
- Center for Observational and Real-World Evidence, Merck & Co., Inc., Kenilworth, Indiana
| | - Stephen Duong
- The Gerontology Institute, Georgia State University, Atlanta, Georgia
| | - Paul R Dexter
- Indiana University Center for Aging Research, Regenstrief Institute, Inc, Indianapolis, Indiana
| | - Richard Lipton
- Department of Neurology, Albert Einstein College of Medicine, Bronx, New York
| | - Christopher M Black
- Center for Observational and Real-World Evidence, Merck & Co., Inc., Kenilworth, Indiana
| | - Vasu Chandrasekaran
- Center for Observational and Real-World Evidence, Merck & Co., Inc., Boston, Massachusetts
| | | | - Patrick Monahan
- Department of Biostatistics, Indiana University School of Medicine and School of Public Health, Indianapolis, Indiana
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