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Redvers N, Larson S, Rajpathy O, Olson D. American Indian and Alaska Native recruitment strategies for health-related randomized controlled trials: A scoping review. PLoS One 2024; 19:e0302562. [PMID: 38687762 PMCID: PMC11060564 DOI: 10.1371/journal.pone.0302562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 04/08/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Significant health disparities exist among American Indian and Alaska Natives (AI/ANs), yet AI/ANs are substantially underrepresented within health-related research, including randomized controlled trials (RCTs). Although research has previously charted representation inequities, there is however a gap in the literature documenting best practice for recruitment techniques of AI/ANs into RCTs. Therefore, the aim of this review was to systematically gather and analyze the published literature to identify common strategies for AI/AN participant recruitment for RCTs in the US. METHODS A scoping review methodology was engaged with a systematic search operationalized within relevant databases to February 19, 2022, with an additional updated search being carried out up until January 1, 2023: PubMed, Embase, Web of Science, PsycINFO, CINAHL, and Google Scholar. A two-stage article review process was engaged with double reviewers using Covidence review software. Content analysis was then carried out within the included articles by two reviewers using NVivo software to identify common categories within the data on the topic area. RESULTS Our review identified forty-one relevant articles with the main categories of recruitment strategies being: 1) recruitment methods for AI/ANs into RCTs (passive advertising recruitment approaches, individual-level recruitment approaches, relational methods of recruitment); 2) recruitment personnel used within RCTs; and, 3) relevant recruitment setting. The majority of the included studies used a culturally relevant intervention, as well as a community-involved approach to operationalizing the research. CONCLUSION Increasing AI/AN representation in RCTs is essential for generating evidence-based interventions that effectively address health disparities and improve health outcomes. Researchers and funding agencies should prioritize the engagement, inclusion, and leadership of AI/AN communities throughout the RCT research process. This includes early community involvement in study design, implementation of culturally tailored recruitment strategies, and dissemination of research findings in formats accessible to AI/AN communities.
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Affiliation(s)
- Nicole Redvers
- Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
- Department of Indigenous Health, School of Medicine & Health Sciences, University of North Dakota, Grand Forks, ND, United States of America
| | - Sarah Larson
- Department of Indigenous Health, School of Medicine & Health Sciences, University of North Dakota, Grand Forks, ND, United States of America
| | - Olivia Rajpathy
- Department of Population Health, School of Medicine & Health Sciences, University of North Dakota, Grand Forks, ND, United States of America
| | - Devon Olson
- Library Resources, School of Medicine & Health Sciences, University of North Dakota, Grand Forks, ND, United States of America
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2
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Casagrande CC, Rempe MP, Springer SD, Wilson TW. Comprehensive review of task-based neuroimaging studies of cognitive deficits in Alzheimer's disease using electrophysiological methods. Ageing Res Rev 2023; 88:101950. [PMID: 37156399 PMCID: PMC10261850 DOI: 10.1016/j.arr.2023.101950] [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: 12/16/2022] [Revised: 03/27/2023] [Accepted: 05/05/2023] [Indexed: 05/10/2023]
Abstract
With an aging population, cognitive decline and neurodegenerative disorders are an emerging public health crises with enormous, yet still under-recognized burdens. Alzheimer's disease (AD) is the most common type of dementia, and the number of cases is expected to dramatically rise in the upcoming decades. Substantial efforts have been placed into understanding the disease. One of the primary avenues of research is neuroimaging, and while positron emission tomography (PET) and functional magnetic resonance imaging (fMRI) are most common, crucial recent advancements in electrophysiological methods such as magnetoencephalography (MEG) and electroencephalography (EEG) have provided novel insight into the aberrant neural dynamics at play in AD pathology. In this review, we outline task-based M/EEG studies published since 2010 using paradigms probing the cognitive domains most affected by AD, including memory, attention, and executive functioning. Furthermore, we provide important recommendations for adapting cognitive tasks for optimal use in this population and adjusting recruitment efforts to improve and expand future neuroimaging work.
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Affiliation(s)
- Chloe C Casagrande
- Institute for Human Neuroscience, Boys Town National Research Hospital, Boys Town, NE 68010, USA
| | - Maggie P Rempe
- Institute for Human Neuroscience, Boys Town National Research Hospital, Boys Town, NE 68010, USA; College of Medicine, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Seth D Springer
- Institute for Human Neuroscience, Boys Town National Research Hospital, Boys Town, NE 68010, USA; College of Medicine, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Tony W Wilson
- Institute for Human Neuroscience, Boys Town National Research Hospital, Boys Town, NE 68010, USA; Department of Pharmacology & Neuroscience, Creighton University, Omaha, NE 68178, USA.
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Misiura MB, Butts B, Hammerschlag B, Munkombwe C, Bird A, Fyffe M, Hemphill A, Dotson VM, Wharton W. Intersectionality in Alzheimer's Disease: The Role of Female Sex and Black American Race in the Development and Prevalence of Alzheimer's Disease. Neurotherapeutics 2023; 20:1019-1036. [PMID: 37490246 PMCID: PMC10457280 DOI: 10.1007/s13311-023-01408-x] [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] [Accepted: 07/07/2023] [Indexed: 07/26/2023] Open
Abstract
It is well known that vascular factors and specific social determinants of health contribute to dementia risk and that the prevalence of these risk factors differs according to race and sex. In this review, we discuss the intersection of sex and race, particularly female sex and Black American race. Women, particularly Black women, have been underrepresented in Alzheimer's disease clinical trials and research. However, in recent years, the number of women participating in clinical research has steadily increased. A greater prevalence of vascular risk factors such as hypertension and type 2 diabetes, coupled with unique social and environmental pressures, puts Black American women particularly at risk for the development of Alzheimer's disease and related dementias. Female sex hormones and the use of hormonal birth control may offer some protective benefits, but results are mixed, and studies do not consistently report the demographics of their samples. We argue that as a research community, greater efforts should be made to not only recruit this vulnerable population, but also report the demographic makeup of samples in research to better target those at greatest risk for the disease.
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Affiliation(s)
- Maria B Misiura
- Department of Psychology, Georgia State University, Atlanta, GA, USA.
- Center for Translational Research in Neuroimaging & Data Science, Georgia State University, Georgia Institute of Technology, Emory University, Atlanta, GA, USA.
| | - Brittany Butts
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Bruno Hammerschlag
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Chinkuli Munkombwe
- Department of Psychology, Georgia State University, Atlanta, GA, USA
- Center for Translational Research in Neuroimaging & Data Science, Georgia State University, Georgia Institute of Technology, Emory University, Atlanta, GA, USA
- Neuroscience Institute, Georgia State University, Atlanta, GA, USA
| | - Arianna Bird
- Department of Psychology, Georgia State University, Atlanta, GA, USA
| | - Mercedes Fyffe
- Department of Psychology, Georgia State University, Atlanta, GA, USA
| | - Asia Hemphill
- Department of Psychology, Georgia State University, Atlanta, GA, USA
- Center for Translational Research in Neuroimaging & Data Science, Georgia State University, Georgia Institute of Technology, Emory University, Atlanta, GA, USA
| | - Vonetta M Dotson
- Department of Psychology, Georgia State University, Atlanta, GA, USA
- Gerontology Institute, Georgia State University, Atlanta, GA, USA
| | - Whitney Wharton
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
- Goizueta Alzheimer's Disease Research Center, Emory University, Atlanta, GA, USA
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Langbaum JB, Zissimopoulos J, Au R, Bose N, Edgar CJ, Ehrenberg E, Fillit H, Hill CV, Hughes L, Irizarry M, Kremen S, Lakdawalla D, Lynn N, Malzbender K, Maruyama T, Massett HA, Patel D, Peneva D, Reiman EM, Romero K, Routledge C, Weiner MW, Weninger S, Aisen PS. Recommendations to address key recruitment challenges of Alzheimer's disease clinical trials. Alzheimers Dement 2023; 19:696-707. [PMID: 35946590 PMCID: PMC9911558 DOI: 10.1002/alz.12737] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 05/26/2022] [Accepted: 06/14/2022] [Indexed: 11/10/2022]
Abstract
Clinical trials for Alzheimer's disease (AD) are slower to enroll study participants, take longer to complete, and are more expensive than trials in most other therapeutic areas. The recruitment and retention of a large number of qualified, diverse volunteers to participate in clinical research studies remain among the key barriers to the successful completion of AD clinical trials. An advisory panel of experts from academia, patient-advocacy organizations, philanthropy, non-profit, government, and industry convened in 2020 to assess the critical challenges facing recruitment in Alzheimer's clinical trials and develop a set of recommendations to overcome them. This paper briefly reviews existing challenges in AD clinical research and discusses the feasibility and implications of the panel's recommendations for actionable and inclusive solutions to accelerate the development of novel therapies for AD.
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Affiliation(s)
| | - Julie Zissimopoulos
- Sol Price School of Public Policy and Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, California, USA
| | - Rhoda Au
- Departments of Anatomy & Neurobiology, Neurology and Epidemiology, Boston University Schools of Medicine and Public Health, Boston, Massachusetts, USA
| | | | | | | | - Howard Fillit
- Alzheimer’s Drug Discovery Foundation, New York, New York, USA
| | | | | | | | - Sarah Kremen
- The Jona Goldrich Center for Alzheimer’s and Memory Disorders, Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Darius Lakdawalla
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, California, USA
| | - Nancy Lynn
- BrightFocus Foundation, Clarksburg, Maryland, USA
| | | | | | | | | | - Desi Peneva
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, California, USA
| | | | | | | | - Michael W. Weiner
- Departments of Radiology and Biomedical Imaging, Medicine, Psychiatry, and Neurology, University of California San Francisco, San Francisco, California, USA
| | | | - Paul S. Aisen
- Alzheimer’s Therapeutic Research Institute, University of Southern California, San Diego, California, USA
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Bonnechère B, Liu J, Thompson A, Amin N, van Duijn C. Does ethnicity influence dementia, stroke and mortality risk? Evidence from the UK Biobank. Front Public Health 2023; 11:1111321. [PMID: 37124771 PMCID: PMC10140594 DOI: 10.3389/fpubh.2023.1111321] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 03/10/2023] [Indexed: 05/02/2023] Open
Abstract
Introduction The number of people with dementia and stroke is increasing worldwide. There is increasing evidence that there are clinically relevant genetic differences across ethnicities. This study aims to quantify risk factors of dementia, stroke, and mortality in Asian and black participants compared to whites. Methods 272,660 participants from the UK Biobank were included in the final analysis, among whom the vast majority are white (n = 266,671, 97.80%), followed by Asian (n = 3,790, 1.35%), and black (n = 2,358, 0.84%) participants. Cumulative incidence risk was calculated based on all incident cases occurring during the follow-up of the individuals without dementia and stroke at baseline. We compared the allele frequency of variants in Asian and black participants with the referent ethnicity, whites, by chi-square test. Hierarchical cluster analysis was used in the clustering analysis. Significance level corrected for the false discovery rate was considered. Results After adjusting for risk factors, black participants have an increased risk of dementia and stroke compared to white participants, while Asians has similar odds to the white. The risk of mortality is not different in blacks and white participants but Asians have a decreased risk. Discussion The study provides important insights into the potential differences in the risk of dementia and stroke among different ethnic groups. Specifically, the study found that black individuals had a higher incidence of dementia and stroke compared to white individuals living in the UK. These findings are particularly significant as they suggest that there may be underlying factors that contribute to these differences, including genetic, environmental, and social factors. By identifying these differences, the study helps to inform interventions and policies aimed at reducing the risk of dementia and stroke, particularly among high-risk populations.
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Affiliation(s)
- Bruno Bonnechère
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
- Technology-Supported and Data-Driven Rehabilitation, Data Science Institute, Hasselt University, Diepenbeek, Belgium
| | - Jun Liu
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Alexander Thompson
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Najaf Amin
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Cornelia van Duijn
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- *Correspondence: Cornelia van Duijn,
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Kim Y, Zhang K, Savitz SI, Chen L, Schulz PE, Jiang X. Counterfactual analysis of differential comorbidity risk factors in Alzheimer's disease and related dementias. PLOS DIGITAL HEALTH 2022; 1:e0000018. [PMID: 36812506 PMCID: PMC9931358 DOI: 10.1371/journal.pdig.0000018] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 01/21/2022] [Indexed: 11/19/2022]
Abstract
Alzheimer's disease and related dementias (ADRD) is a multifactorial disease that involves several different etiologic mechanisms with various comorbidities. There is also significant heterogeneity in the prevalence of ADRD across diverse demographics groups. Association studies on such heterogeneous comorbidity risk factors are limited in their ability to determine causation. We aim to compare counterfactual treatment effects of various comorbidity in ADRD in different racial groups (African Americans and Caucasians). We used 138,026 ADRD and 1:1 matched older adults without ADRD from nationwide electronic health records, which extensively cover a large population's long medical history in breadth. We matched African Americans and Caucasians based on age, sex, and high-risk comorbidities (hypertension, diabetes, obesity, vascular disease, heart disease, and head injury) to build two comparable cohorts. We derived a Bayesian network of 100 comorbidities and selected comorbidities with potential causal effect to ADRD. We estimated the average treatment effect (ATE) of the selected comorbidities on ADRD using inverse probability of treatment weighting. Late effects of cerebrovascular disease significantly predisposed older African Americans (ATE = 0.2715) to ADRD, but not in the Caucasian counterparts; depression significantly predisposed older Caucasian counterparts (ATE = 0.1560) to ADRD, but not in the African Americans. Our extensive counterfactual analysis using a nationwide EHR discovered different comorbidities that predispose older African Americans to ADRD compared to Caucasian counterparts. Despite the noisy and incomplete nature of the real-world data, the counterfactual analysis on the comorbidity risk factors can be a valuable tool to support the risk factor exposure studies.
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Affiliation(s)
- Yejin Kim
- School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, Texas, United States of America
- Institute for Stroke and Cerebrovascular Disease, University of Texas Health Science Center at Houston, Houston, Texas, United States of America
| | - Kai Zhang
- School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, Texas, United States of America
| | - Sean I. Savitz
- Institute for Stroke and Cerebrovascular Disease, University of Texas Health Science Center at Houston, Houston, Texas, United States of America
| | - Luyao Chen
- School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, Texas, United States of America
| | - Paul E. Schulz
- Department of Neurology, University of Texas Health Science Center at Houston, Houston, Texas, United States of America
| | - Xiaoqian Jiang
- School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, Texas, United States of America
- Institute for Stroke and Cerebrovascular Disease, University of Texas Health Science Center at Houston, Houston, Texas, United States of America
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Preventive Drugs for Huntington’s Disease: A Choice-Based Conjoint Survey of Patient Preferences. J Clin Transl Sci 2022; 6:e35. [PMID: 35433035 PMCID: PMC9003635 DOI: 10.1017/cts.2022.372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 02/23/2022] [Accepted: 02/24/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction: This research examined the perspective of the Huntington’s disease (HD) community regarding the use of predictive biomarkers as endpoints for regulatory approval of therapeutics to prevent or delay the onset of clinical HD in asymptomatic mutation carriers. Methods: An online, choice-based conjoint survey was shared with HD community members including untested at-risk individuals, presymptomatic mutation carriers, and symptomatic individuals. Across 15 scenarios, participants chose among two proposed therapies with differing degrees of biomarker improvement and side effects or a third option of no treatment. Results: Two hundred and thirty-eight responses were received. Attributes reflecting biomarker efficacy (e.g., prevention of brain atrophy on magnetic resonance imaging, reduced mutant huntingtin, or reduced inflammation biomarkers) had 3- to 7-fold greater importance than attributes representing side effects (e.g., increased risk of heart disease, cancer, and stroke over 20 years) and were more influential in directing choice of treatments. Reduction in mutant huntingtin protein was the most valued attribute overall. Multinomial logit model simulations based on survey responses demonstrated high interest among respondents (87–99% of the population) for drugs that might prevent or delay HD solely based upon biomarker evidence, even at the risk of serious side effects. Conclusion: These results indicate a strong desire among members of the HD community for preventive therapeutics and a willingness to accept significant side effects, even before the drug has been shown to definitively delay disease onset if the drug improves biomarker evidence of HD progression. Preferences of the HD community should inform regulatory policies for approving preventive therapies.
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Genetic risk scores and dementia risk across different ethnic groups in UK Biobank. PLoS One 2022; 17:e0277378. [PMID: 36477264 PMCID: PMC9728885 DOI: 10.1371/journal.pone.0277378] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 10/26/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Genetic Risk Scores (GRS) for predicting dementia risk have mostly been used in people of European ancestry with limited testing in other ancestry groups. METHODS We conducted a logistic regression with all-cause dementia as the outcome and z-standardised GRS as the exposure across diverse ethnic groups. FINDINGS There was variation in frequency of APOE alleles across ethnic groups. Per standard deviation (SD) increase in z-GRS including APOE, the odds ratio (OR) for dementia was 1.73 (95%CI 1.69-1.77). Z-GRS excluding APOE also increased dementia risk (OR 1.21 per SD increase, 95% CI 1.18-1.24) and there was no evidence that ethnicity modified this association. Prediction of secondary outcomes was less robust in those not of European ancestry when APOE was excluded from the GRS. INTERPRETATION z-GRS derived from studies in people of European ancestry can be used to quantify genetic risk in people from more diverse ancestry groups. Urgent work is needed to include people from diverse ancestries in future genetic risk studies to make this field more inclusive.
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