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Reddy JS, Heath L, Linden AV, Allen M, Lopes KDP, Seifar F, Wang E, Ma Y, Poehlman WL, Quicksall ZS, Runnels A, Wang Y, Duong DM, Yin L, Xu K, Modeste ES, Shantaraman A, Dammer EB, Ping L, Oatman SR, Scanlan J, Ho C, Carrasquillo MM, Atik M, Yepez G, Mitchell AO, Nguyen TT, Chen X, Marquez DX, Reddy H, Xiao H, Seshadri S, Mayeux R, Prokop S, Lee EB, Serrano GE, Beach TG, Teich AF, Haroutunian V, Fox EJ, Gearing M, Wingo A, Wingo T, Lah JJ, Levey AI, Dickson DW, Barnes LL, De Jager P, Zhang B, Bennett D, Seyfried NT, Greenwood AK, Ertekin-Taner N. Bridging the gap: Multi-omics profiling of brain tissue in Alzheimer's disease and older controls in multi-ethnic populations. Alzheimers Dement 2024. [PMID: 39215503 DOI: 10.1002/alz.14208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Revised: 07/24/2024] [Accepted: 07/27/2024] [Indexed: 09/04/2024]
Abstract
INTRODUCTION Multi-omics studies in Alzheimer's disease (AD) revealed many potential disease pathways and therapeutic targets. Despite their promise of precision medicine, these studies lacked Black Americans (BA) and Latin Americans (LA), who are disproportionately affected by AD. METHODS To bridge this gap, Accelerating Medicines Partnership in Alzheimer's Disease (AMP-AD) expanded brain multi-omics profiling to multi-ethnic donors. RESULTS We generated multi-omics data and curated and harmonized phenotypic data from BA (n = 306), LA (n = 326), or BA and LA (n = 4) brain donors plus non-Hispanic White (n = 252) and other (n = 20) ethnic groups, to establish a foundational dataset enriched for BA and LA participants. This study describes the data available to the research community, including transcriptome from three brain regions, whole genome sequence, and proteome measures. DISCUSSION The inclusion of traditionally underrepresented groups in multi-omics studies is essential to discovering the full spectrum of precision medicine targets that will be pertinent to all populations affected with AD. HIGHLIGHTS Accelerating Medicines Partnership in Alzheimer's Disease Diversity Initiative led brain tissue profiling in multi-ethnic populations. Brain multi-omics data is generated from Black American, Latin American, and non-Hispanic White donors. RNA, whole genome sequencing and tandem mass tag proteomicsis completed and shared. Multiple brain regions including caudate, temporal and dorsolateral prefrontal cortex were profiled.
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Affiliation(s)
| | | | | | | | - Katia de Paiva Lopes
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Fatemeh Seifar
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - Erming Wang
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Mount Sinai Center for Transformative Disease Modeling, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Yiyi Ma
- Columbia University Irving Medical Center, New York, New York, USA
| | | | | | | | - Yanling Wang
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Duc M Duong
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - Luming Yin
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - Kaiming Xu
- Emory University School of Medicine, Atlanta, Georgia, USA
| | | | | | - Eric B Dammer
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - Lingyan Ping
- Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Jo Scanlan
- Sage Bionetworks, Seattle, Washington, USA
| | | | | | - Merve Atik
- Mayo Clinic Florida, Jacksonville, Florida, USA
| | | | | | | | | | - David X Marquez
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA
- University of Illinois Chicago, Chicago, Illinois, USA
| | - Hasini Reddy
- Columbia University Irving Medical Center, New York, New York, USA
| | - Harrison Xiao
- Columbia University Irving Medical Center, New York, New York, USA
| | - Sudha Seshadri
- The Glen Biggs Institute for Alzheimer's & Neurodegenerative Diseases, University of Texas, San Antonio, Texas, USA
| | - Richard Mayeux
- Columbia University Irving Medical Center, New York, New York, USA
| | | | - Edward B Lee
- Center for Neurodegenerative Disease Brain Bank at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Geidy E Serrano
- Banner Sun Health Research Institute, Sun City, Arizona, USA
| | - Thomas G Beach
- Banner Sun Health Research Institute, Sun City, Arizona, USA
| | - Andrew F Teich
- Columbia University Irving Medical Center, New York, New York, USA
| | - Varham Haroutunian
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Edward J Fox
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - Marla Gearing
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - Aliza Wingo
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - Thomas Wingo
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - James J Lah
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - Allan I Levey
- Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Lisa L Barnes
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Philip De Jager
- Columbia University Irving Medical Center, New York, New York, USA
| | - Bin Zhang
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Mount Sinai Center for Transformative Disease Modeling, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - David Bennett
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA
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Okonkwo OC, Rivera Mindt M, Ashford MT, Conti C, Strong J, Raman R, Donohue MC, Nosheny RL, Flenniken D, Miller MJ, Diaz A, Soto AM, Ances BM, Beigi MR, Doraiswamy PM, Duara R, Farlow MR, Grossman HT, Mintzer JE, Reist C, Rogalski EJ, Sabbagh MN, Salloway S, Schneider LS, Shah RC, Petersen RC, Aisen PS, Weiner MW. A Protocol for the Inclusion of Minoritized Persons in Alzheimer Disease Research From the ADNI3 Diversity Taskforce. JAMA Netw Open 2024; 7:e2427073. [PMID: 39120898 PMCID: PMC11316236 DOI: 10.1001/jamanetworkopen.2024.27073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 06/04/2024] [Indexed: 08/10/2024] Open
Abstract
Importance Black or African American (hereinafter, Black) and Hispanic or Latino/a/x (hereinafter, Latinx) adults are disproportionally affected by Alzheimer disease, but most research studies do not enroll adequate numbers of both of these populations. The Alzheimer's Disease Neuroimaging Initiative-3 (ADNI3) launched a diversity taskforce to pilot a multipronged effort to increase the study inclusion of Black and Latinx older adults. Objective To describe and evaluate the culturally informed and community-engaged inclusion efforts to increase the screening and enrollment of Black and Latinx older adults in ADNI3. Design, Setting, and Participants This cross-sectional study used baseline data from a longitudinal, multisite, observational study conducted from January 15, 2021, to July 12, 2022, with no follow-up. The study was conducted at 13 ADNI3 sites in the US. Participants included individuals aged 55 to 90 years without cognitive impairment and those with mild cognitive impairment or Alzheimer disease. Exposures Efforts included (1) launch of an external advisory board, (2) changes to the study protocol, (3) updates to the digital prescreener, (4) selection and deployment of 13 community-engaged research study sites, (5) development and deployment of local and centralized outreach efforts, and (6) development of a community-science partnership board. Main Outcomes and Measures Screening and enrollment numbers from centralized and local outreach efforts, digital advertisement metrics, and digital prescreener completion. Results A total of 91 participants enrolled in the trial via centralized and local outreach efforts, of which 22 (24.2%) identified as Latinx and 55 (60.4%) identified as Black (median [IQR] age, 65.6 [IQR, 61.5-72.5] years; 62 women [68.1%]). This represented a 267.6% increase in the monthly rate of enrollment (before: 1.11 per month; during: 4.08 per month) of underrepresented populations. For the centralized effort, social media advertisements were run between June 1, 2021, and July 31, 2022, which resulted in 2079 completed digital prescreeners, of which 1289 met criteria for subsequent site-level screening. Local efforts were run between June 1, 2021, to July 31, 2022. A total of 151 participants underwent site-level screening (100 from local efforts, 41 from centralized efforts, 10 from other sources). Conclusions and Relevance In this cross-sectional study of pilot inclusion efforts, a culturally informed, community-engaged approach increased the inclusion of Black and Latinx participants in an Alzheimer disease cohort study.
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Affiliation(s)
- Ozioma C. Okonkwo
- Department of Medicine and Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison
| | - Monica Rivera Mindt
- Department of Psychology, Latin American Latinx Studies Institute, and African and African American Studies, Fordham University, Bronx, New York
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Miriam T. Ashford
- Northern California Institute for Research and Education, Department of Veterans Affairs Medical Center, San Francisco
- VA Advanced Imaging Research Center, San Francisco Veteran’s Administration Medical Center, San Francisco, California
| | - Catherine Conti
- Northern California Institute for Research and Education, Department of Veterans Affairs Medical Center, San Francisco
- VA Advanced Imaging Research Center, San Francisco Veteran’s Administration Medical Center, San Francisco, California
| | - Joe Strong
- Department of Medicine and Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison
| | - Rema Raman
- Alzheimer’s Therapeutic Research Institute, University of Southern California, San Diego
| | - Michael C. Donohue
- Alzheimer’s Therapeutic Research Institute, University of Southern California, San Diego
| | - Rachel L. Nosheny
- VA Advanced Imaging Research Center, San Francisco Veteran’s Administration Medical Center, San Francisco, California
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco
| | - Derek Flenniken
- Northern California Institute for Research and Education, Department of Veterans Affairs Medical Center, San Francisco
- VA Advanced Imaging Research Center, San Francisco Veteran’s Administration Medical Center, San Francisco, California
| | - Melanie J. Miller
- Northern California Institute for Research and Education, Department of Veterans Affairs Medical Center, San Francisco
- VA Advanced Imaging Research Center, San Francisco Veteran’s Administration Medical Center, San Francisco, California
| | - Adam Diaz
- Northern California Institute for Research and Education, Department of Veterans Affairs Medical Center, San Francisco
- VA Advanced Imaging Research Center, San Francisco Veteran’s Administration Medical Center, San Francisco, California
| | - Annabelle M. Soto
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Beau M. Ances
- Department of Neurology, Washington University in Saint Louis, Saint Louis, Missouri
| | - Maryam R. Beigi
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles
| | - P. Murali Doraiswamy
- Departments of Psychiatry and Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Ranjan Duara
- Wein Center for Alzheimer’s Disease and Memory Disorders, Mount Sinai Medical Center, Miami Beach, Florida
- Herbert Wertheim College of Medicine, Florida International University, Miami
- Alzheimer’s Disease Research Center, University of Florida College of Medicine, Gainesville
| | - Martin R. Farlow
- Department of Neurology, Indiana University Health, Indianapolis
| | - Hillel T. Grossman
- The Alzheimer Disease Research Center, Mount Sinai School of Medicine, New York, New York
| | - Jacobo E. Mintzer
- Medical University of South Carolina, Ralph H. Johnson VA Healthcare Center, Charleston
| | - Christopher Reist
- MindX Sciences Inc, Indianapolis, Indiana
- Science 37 Inc, Durham, North Carolina
- Department of Psychiatry, University of California Irvine, Long Beach
| | | | - Marwan N. Sabbagh
- Alzheimer’s and Memory Disorders Division, Department of Neurology, Barrow Neurological Institute, Phoenix, Arizona
| | - Stephen Salloway
- Memory and Aging Program, Butler Hospital, Alpert Medical School, Brown University, Providence, Rhode Island
| | - Lon S. Schneider
- Department of Psychiatry and Behavioral Sciences, Department of Neurology, Alzheimer’s Disease Research Center, Keck School of Medicine of USC, Los Angeles, California
| | - Raj C. Shah
- Department of Family and Preventive Medicine and the Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois
| | - Ronald C. Petersen
- Alzheimer’s Disease Research Center, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Paul S. Aisen
- Alzheimer’s Therapeutic Research Institute, University of Southern California, San Diego
| | - Michael W. Weiner
- Northern California Institute for Research and Education, Department of Veterans Affairs Medical Center, San Francisco
- VA Advanced Imaging Research Center, San Francisco Veteran’s Administration Medical Center, San Francisco, California
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
- Department of Medicine, University of California, San Francisco
- Department of Neurology, University of California, San Francisco
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Kuchenbecker LA, Thompson KJ, Hurst CD, Opdenbosch BM, Heckman MG, Reddy JS, Nguyen T, Casellas HL, Sotelo KD, Reddy DJ, Lucas JA, Day GS, Willis FB, Graff-Radford N, Ertekin-Taner N, Kalari KR, Carrasquillo MM. Nomination of a novel plasma protein biomarker panel capable of classifying Alzheimer's disease dementia with high accuracy in an African American cohort. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.07.27.605373. [PMID: 39131392 PMCID: PMC11312441 DOI: 10.1101/2024.07.27.605373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/13/2024]
Abstract
Introduction African Americans (AA) are widely underrepresented in plasma biomarker studies for Alzheimer's disease (AD) and current diagnostic biomarker candidates do not reflect the heterogeneity of AD. Methods Untargeted proteome measurements were obtained using the SomaScan 7k platform to identify novel plasma biomarkers for AD in a cohort of AA clinically diagnosed as AD dementia (n=183) or cognitively unimpaired (CU, n=145). Machine learning approaches were implemented to identify the set of plasma proteins that yields the best classification accuracy. Results A plasma protein panel achieved an area under the curve (AUC) of 0.91 to classify AD dementia vs CU. The reproducibility of this finding was observed in the ANMerge plasma and AMP-AD Diversity brain datasets (AUC=0.83; AUC=0.94). Discussion This study demonstrates the potential of biomarker discovery through untargeted plasma proteomics and machine learning approaches. Our findings also highlight the potential importance of the matrisome and cerebrovascular dysfunction in AD pathophysiology.
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Affiliation(s)
- Lindsey A. Kuchenbecker
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
- Center for Clinical and Translational Science, Mayo Clinic, Rochester, MN, USA
| | - Kevin J. Thompson
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | | | | | - Michael G. Heckman
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Joseph S. Reddy
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL, USA
| | - Thuy Nguyen
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
| | | | - Katie D. Sotelo
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
| | - Delila J. Reddy
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
| | - John A. Lucas
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL, USA
| | - Gregory S. Day
- Department of Neurology, Mayo Clinic, Jacksonville, FL, USA
| | - Floyd B. Willis
- Department of Family Medicine, Mayo Clinic, Jacksonville, FL USA
| | | | - Nilufer Ertekin-Taner
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
- Department of Neurology, Mayo Clinic, Jacksonville, FL, USA
| | - Krishna R. Kalari
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
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Molina‐Henry DP, Raman R, Liu A, Langford O, Johnson K, Shum LK, Glover CM, Dhadda S, Irizarry M, Jimenez‐Maggiora G, Braunstein JB, Yarasheski K, Venkatesh V, West T, Verghese PB, Rissman RA, Aisen P, Grill JD, Sperling RA. Racial and ethnic differences in plasma biomarker eligibility for a preclinical Alzheimer's disease trial. Alzheimers Dement 2024; 20:3827-3838. [PMID: 38629508 PMCID: PMC11180863 DOI: 10.1002/alz.13803] [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: 12/26/2023] [Revised: 02/27/2024] [Accepted: 02/28/2024] [Indexed: 06/18/2024]
Abstract
INTRODUCTION In trials of amyloid-lowering drugs for Alzheimer's disease (AD), differential eligibility may contribute to under-inclusion of racial and ethnic underrepresented groups. We examined plasma amyloid beta 42/40 and positron emission tomography (PET) amyloid eligibility for the ongoing AHEAD Study preclinical AD program (NCT04468659). METHODS Univariate logistic regression models were used to examine group differences in plasma and PET amyloid screening eligibility. RESULTS Of 4905 participants screened at time of analysis, 1724 were plasma eligible to continue in screening: 13.3% Hispanic Black, 24.7% Hispanic White, 20.8% non-Hispanic (NH) Asian, 24.7% NH Black, and 38.9% NH White. Plasma eligibility differed across groups in models controlling for covariates (odds ratio from 1.9 to 4.0 compared to the NH White reference group, P < 0.001). Among plasma eligible participants, PET eligibility did not differ by group. DISCUSSION These results suggest that prevalence of brain amyloid pathology differed, but that eligibility based on plasma was equally effective across racial and ethnic group members. HIGHLIGHTS Plasma amyloid eligibility is lower in underrepresented racial and ethnic groups. In plasma eligible adults, positron emission tomography eligibility rates are similar across race and ethnicity. Plasma biomarker tests may be similarly effective across racial and ethnic groups.
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Affiliation(s)
- Doris Patricia Molina‐Henry
- Alzheimer's Therapeutic Research InstituteKeck School of Medicine of the University of Southern CaliforniaSan DiegoCaliforniaUSA
- Present address:
Alzheimer's Therapeutic Research InstituteKeck School of Medicine of the University of Southern California, 9860 Mesa Rim Rd, San Diego, CA, 92121
| | - Rema Raman
- Alzheimer's Therapeutic Research InstituteKeck School of Medicine of the University of Southern CaliforniaSan DiegoCaliforniaUSA
| | - Andy Liu
- Alzheimer's Therapeutic Research InstituteKeck School of Medicine of the University of Southern CaliforniaSan DiegoCaliforniaUSA
| | - Oliver Langford
- Alzheimer's Therapeutic Research InstituteKeck School of Medicine of the University of Southern CaliforniaSan DiegoCaliforniaUSA
| | - Keith Johnson
- Massachusetts General Hospital, Harvard Medical SchoolBostonMassachusettsUSA
- Brigham and Women's HospitalBostonMassachusettsUSA
| | - Leona K. Shum
- Alzheimer's Therapeutic Research InstituteKeck School of Medicine of the University of Southern CaliforniaSan DiegoCaliforniaUSA
| | - Crystal M. Glover
- Rush Alzheimer's Disease CenterChicagoIllinoisUSA
- Department of Psychiatry and Behavioral SciencesRush University Medical CollegeChicagoIllinoisUSA
- Department of Neurological SciencesRush Medical CollegeChicagoIllinoisUSA
| | | | | | - Gustavo Jimenez‐Maggiora
- Alzheimer's Therapeutic Research InstituteKeck School of Medicine of the University of Southern CaliforniaSan DiegoCaliforniaUSA
| | | | | | | | - Tim West
- C2N DiagnosticsSt. LouisMissouriUSA
| | | | - Robert A. Rissman
- Department of Physiology and NeuroscienceAlzheimer's Therapeutic Research InstituteKeck School of Medicine of the University of Southern CaliforniaSan DiegoCaliforniaUSA
| | - Paul Aisen
- Alzheimer's Therapeutic Research InstituteKeck School of Medicine of the University of Southern CaliforniaSan DiegoCaliforniaUSA
| | - Joshua D. Grill
- Institute for Memory Impairments and Neurological DisordersUniversity of California IrvineIrvineCaliforniaUSA
| | - Reisa A. Sperling
- Massachusetts General Hospital, Harvard Medical SchoolBostonMassachusettsUSA
- Brigham and Women's HospitalBostonMassachusettsUSA
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Adhikari A, Nwosu A, Qian M, Hellegers C, Devanand DP, Doraiswamy PM. Characterizing Neighborhood Vulnerabilities in Mild Cognitive Impairment using the Environmental Justice Index. J Alzheimers Dis Rep 2024; 8:793-804. [PMID: 38910939 PMCID: PMC11191642 DOI: 10.3233/adr-240020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 04/10/2024] [Indexed: 06/25/2024] Open
Abstract
Background There is a need for integration and comprehensive characterization of environmental determinants of Alzheimer's disease. The Environmental Justice Index (EJI) is a new measure that consolidates multiple environmental health hazards. Objective This analysis aims to explore how environmental vulnerabilities vary by race/ethnicity and whether they predict cognitive outcomes in a clinical trial of mild cognitive impairment (MCI). Methods We used data from a clinical trial of 107 MCI participants (28% minorities). Using the EJI, we extracted 40 measures of neighborhood environmental and social vulnerability including air and water pollution, access to recreational spaces, exposure to coal and lead mines, and area poverty. We also examined the relationship of the EJI to the Area Deprivation Index (ADI). Data was analyzed using regressions, correlations, and t-tests. Results Environmental Burden Rank (EBR) across the sample (0.53±0.32) was near the 50th percentile nationally. When divided by race/ethnicity, environmental (p = 0.025) and social (p < 0.0001) vulnerabilities were significantly elevated for minorities, specifically for exposure to ozone, diesel particulate matter, carcinogenic air toxins, and proximity to treatment storage and disposal sites. ADI state decile was not correlated with the EBR. Neither EBR nor ADI were a significant predictor of cognitive decline. Conclusions To our knowledge, this is the first study to link the EJI to an MCI trial. Despite limitations of a relatively small sample size, the study illustrates the potential of the EJI to provide deeper phenotyping of the exposome and diversity in clinical trial subjects.
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Affiliation(s)
- Alisa Adhikari
- Department of Psychiatry, Neurocognitive Disorders Program, Duke University School of Medicine, Durham, NC, USA
| | - Adaora Nwosu
- Department of Psychiatry, Neurocognitive Disorders Program, Duke University School of Medicine, Durham, NC, USA
| | - Min Qian
- Department of Biostatistics, Mailman School of Public Health, Columbia University Medical Center, New York, NY, USA
| | - Caroline Hellegers
- Department of Psychiatry, Neurocognitive Disorders Program, Duke University School of Medicine, Durham, NC, USA
| | - Davangere P. Devanand
- Department of Psychiatry, Columbia University Medical Center, and the New York State Psychiatric Institute, New York, NY, USA
| | - P. Murali Doraiswamy
- Department of Psychiatry, Neurocognitive Disorders Program, Duke University School of Medicine, Durham, NC, USA
- Center for the Study of Aging and the Duke Institute for Brain Sciences, Durham, NC, USA
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Reddy JS, Heath L, Vander Linden A, Allen M, de Paiva Lopes K, Seifar F, Wang E, Ma Y, Poehlman WL, Quicksall ZS, Runnels A, Wang Y, Duong DM, Yin L, Xu K, Modeste ES, Shantaraman A, Dammer EB, Ping L, Oatman SR, Scanlan J, Ho C, Carrasquillo MM, Atik M, Yepez G, Mitchell AO, Nguyen TT, Chen X, Marquez DX, Reddy H, Xiao H, Seshadri S, Mayeux R, Prokop S, Lee EB, Serrano GE, Beach TG, Teich AF, Haroutunian V, Fox EJ, Gearing M, Wingo A, Wingo T, Lah JJ, Levey AI, Dickson DW, Barnes LL, De Jager P, Zhang B, Bennett D, Seyfried NT, Greenwood AK, Ertekin-Taner N. Bridging the Gap: Multi-Omics Profiling of Brain Tissue in Alzheimer's Disease and Older Controls in Multi-Ethnic Populations. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.04.16.589592. [PMID: 38659743 PMCID: PMC11042309 DOI: 10.1101/2024.04.16.589592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
INTRODUCTION Multi-omics studies in Alzheimer's disease (AD) revealed many potential disease pathways and therapeutic targets. Despite their promise of precision medicine, these studies lacked African Americans (AA) and Latin Americans (LA), who are disproportionately affected by AD. METHODS To bridge this gap, Accelerating Medicines Partnership in AD (AMP-AD) expanded brain multi-omics profiling to multi-ethnic donors. RESULTS We generated multi-omics data and curated and harmonized phenotypic data from AA (n=306), LA (n=326), or AA and LA (n=4) brain donors plus Non-Hispanic White (n=252) and other (n=20) ethnic groups, to establish a foundational dataset enriched for AA and LA participants. This study describes the data available to the research community, including transcriptome from three brain regions, whole genome sequence, and proteome measures. DISCUSSION Inclusion of traditionally underrepresented groups in multi-omics studies is essential to discover the full spectrum of precision medicine targets that will be pertinent to all populations affected with AD.
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Affiliation(s)
- Joseph S Reddy
- Mayo Clinic Florida, 4500 San Pablo Rd S, Jacksonville, FL 32224
| | - Laura Heath
- Sage Bionetworks, 2901 3rd Ave #330, Seattle, WA 98121
| | | | - Mariet Allen
- Mayo Clinic Florida, 4500 San Pablo Rd S, Jacksonville, FL 32224
| | - Katia de Paiva Lopes
- Rush Alzheimer's Disease Center, Rush University Medical Center, 1750 W Harrison St, Chicago, IL 60612
| | - Fatemeh Seifar
- Emory University School of Medicine, 1440 Clifton Rd, Atlanta, GA 30322
| | - Erming Wang
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, 1428 Madison Ave, New York, NY 10029
- Mount Sinai Center for Transformative Disease Modeling, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY 10029
| | - Yiyi Ma
- Columbia University Irving Medical Center, 622 W 168th St, New York, NY 10032
| | | | | | - Alexi Runnels
- New York Genome Center, 101 6th Ave, New York, NY 10013
| | - Yanling Wang
- Rush Alzheimer's Disease Center, Rush University Medical Center, 1750 W Harrison St, Chicago, IL 60612
| | - Duc M Duong
- Emory University School of Medicine, 1440 Clifton Rd, Atlanta, GA 30322
| | - Luming Yin
- Emory University School of Medicine, 1440 Clifton Rd, Atlanta, GA 30322
| | - Kaiming Xu
- Emory University School of Medicine, 1440 Clifton Rd, Atlanta, GA 30322
| | - Erica S Modeste
- Emory University School of Medicine, 1440 Clifton Rd, Atlanta, GA 30322
| | | | - Eric B Dammer
- Emory University School of Medicine, 1440 Clifton Rd, Atlanta, GA 30322
| | - Lingyan Ping
- Emory University School of Medicine, 1440 Clifton Rd, Atlanta, GA 30322
| | | | - Jo Scanlan
- Sage Bionetworks, 2901 3rd Ave #330, Seattle, WA 98121
| | - Charlotte Ho
- Mayo Clinic Florida, 4500 San Pablo Rd S, Jacksonville, FL 32224
| | | | - Merve Atik
- Mayo Clinic Florida, 4500 San Pablo Rd S, Jacksonville, FL 32224
| | - Geovanna Yepez
- Mayo Clinic Florida, 4500 San Pablo Rd S, Jacksonville, FL 32224
| | | | - Thuy T Nguyen
- Mayo Clinic Florida, 4500 San Pablo Rd S, Jacksonville, FL 32224
| | - Xianfeng Chen
- Mayo Clinic Florida, 4500 San Pablo Rd S, Jacksonville, FL 32224
| | - David X Marquez
- Rush Alzheimer's Disease Center, Rush University Medical Center, 1750 W Harrison St, Chicago, IL 60612
- University of Illinois Chicago, 1200 West Harrison St., Chicago, Illinois 60607
| | - Hasini Reddy
- Columbia University Irving Medical Center, 622 W 168th St, New York, NY 10032
| | - Harrison Xiao
- Columbia University Irving Medical Center, 622 W 168th St, New York, NY 10032
| | - Sudha Seshadri
- The Glen Biggs Institute for Alzheimer's & Neurodegenerative Diseases, University of Texas, 8300 Floyd Curl Drive, San Antonio TX 78229
| | - Richard Mayeux
- Columbia University Irving Medical Center, 622 W 168th St, New York, NY 10032
| | | | - Edward B Lee
- Center for Neurodegenerative Disease Brain Bank at the University of Pennsylvania, 3600 Spruce Street, Philadelphia, PA 19104-2676
| | - Geidy E Serrano
- Banner Sun Health Research Institute, 10515 W Santa Fe Dr, Sun City, AZ 85351
| | - Thomas G Beach
- Banner Sun Health Research Institute, 10515 W Santa Fe Dr, Sun City, AZ 85351
| | - Andrew F Teich
- Columbia University Irving Medical Center, 622 W 168th St, New York, NY 10032
| | - Varham Haroutunian
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, 1428 Madison Ave, New York, NY 10029
| | - Edward J Fox
- Emory University School of Medicine, 1440 Clifton Rd, Atlanta, GA 30322
| | - Marla Gearing
- Emory University School of Medicine, 1440 Clifton Rd, Atlanta, GA 30322
| | - Aliza Wingo
- Emory University School of Medicine, 1440 Clifton Rd, Atlanta, GA 30322
| | - Thomas Wingo
- Emory University School of Medicine, 1440 Clifton Rd, Atlanta, GA 30322
| | - James J Lah
- Emory University School of Medicine, 1440 Clifton Rd, Atlanta, GA 30322
| | - Allan I Levey
- Emory University School of Medicine, 1440 Clifton Rd, Atlanta, GA 30322
| | - Dennis W Dickson
- Mayo Clinic Florida, 4500 San Pablo Rd S, Jacksonville, FL 32224
| | - Lisa L Barnes
- Rush Alzheimer's Disease Center, Rush University Medical Center, 1750 W Harrison St, Chicago, IL 60612
| | - Philip De Jager
- Columbia University Irving Medical Center, 622 W 168th St, New York, NY 10032
| | - Bin Zhang
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, 1428 Madison Ave, New York, NY 10029
- Mount Sinai Center for Transformative Disease Modeling, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY 10029
| | - David Bennett
- Rush Alzheimer's Disease Center, Rush University Medical Center, 1750 W Harrison St, Chicago, IL 60612
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Shaaban CE, Lin HS, Terry M, Ren D, Lingler JH. COVID-19 pandemic's relationship with enrollment at US Alzheimer's Disease Research Centers. Alzheimers Dement 2024; 20:2408-2419. [PMID: 38298163 PMCID: PMC11032582 DOI: 10.1002/alz.13706] [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: 08/23/2023] [Revised: 11/13/2023] [Accepted: 12/14/2023] [Indexed: 02/02/2024]
Abstract
INTRODUCTION We aimed to characterize the COVID-19 pandemic's relationship with enrollment in US Alzheimer's Disease Research Centers (ADRCs). METHODS Using data on 10,105 participants from 30 ADRCs, we conducted interrupted time series analyses to assess the relationship of the pandemic with enrollment and calculate projected dates of enrollment recovery. RESULTS Participants enrolled during the pandemic (vs pre-pandemic) were more likely to have dementia and be referred by health professionals. The pandemic was associated with a 77% drop in enrollment, with projected trend recovery in March 2024 and 100% recovery in September 2024. COVID was associated with a 91% drop in Black/African American participants, compared to 71% in White participants. Enrollment of both Hispanic and female participants was declining 1.4% and 0.3%/month pre-pandemic. DISCUSSION Funders and researchers should account for ongoing COVID-19 impact on ADRD research enrollment. Strategies to speed enrollment recovery are needed, especially for Black/African American and Hispanic groups. HIGHLIGHTS Tested COVID pandemic association with enrollment at Alzheimer's Disease Research Centers. During versus pre-pandemic enrollees differed on demographic and clinical variables. Interrupted time series analyses: immediate 77% drop in enrollment related to COVID. Recovery projections: trend recovery in March 2024, 100% recovery in September 2024. Enrollment of African American and Hispanic participants should be prioritized.
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Affiliation(s)
- C. Elizabeth Shaaban
- Department of EpidemiologySchool of Public HealthUniversity of PittsburghPittsburghPennsylvaniaUSA
- Alzheimer's Disease Research CenterUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Hsing‐Hua Sylvia Lin
- Department of EpidemiologySchool of Public HealthUniversity of PittsburghPittsburghPennsylvaniaUSA
- Department of Anesthesiology & Perioperative MedicineUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
| | - Melita Terry
- Alzheimer's Disease Research CenterUniversity of PittsburghPittsburghPennsylvaniaUSA
- Department of Neurology, School of MedicineUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Dianxu Ren
- Department of Health & Community Systems, School of NursingUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Jennifer H. Lingler
- Alzheimer's Disease Research CenterUniversity of PittsburghPittsburghPennsylvaniaUSA
- Department of Health & Community Systems, School of NursingUniversity of PittsburghPittsburghPennsylvaniaUSA
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Tian G, Hanfelt J, Lah J, Risk BB. Mixture of regressions with multivariate responses for discovering subtypes in Alzheimer's biomarkers with detection limits. DATA SCIENCE IN SCIENCE 2024; 3:2309403. [PMID: 38680829 PMCID: PMC11044119 DOI: 10.1080/26941899.2024.2309403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 01/16/2024] [Indexed: 05/01/2024]
Abstract
There is no gold standard for the diagnosis of Alzheimer's disease (AD), except from autopsies, which motivates the use of unsupervised learning. A mixture of regressions is an unsupervised method that can simultaneously identify clusters from multiple biomarkers while learning within-cluster demographic effects. Cerebrospinal fluid (CSF) biomarkers for AD have detection limits, which create additional challenges. We apply a mixture of regressions with a multivariate truncated Gaussian distribution (also called a censored multivariate Gaussian mixture of regressions or a mixture of multivariate tobit regressions) to over 3,000 participants from the Emory Goizueta Alzheimer's Disease Research Center and Emory Healthy Brain Study to examine amyloid-beta peptide 1-42 (Abeta42), total tau protein and phosphorylated tau protein in CSF with known detection limits. We address three gaps in the literature on mixture of regressions with a truncated multivariate Gaussian distribution: software availability; inference; and clustering accuracy. We discovered three clusters that tend to align with an AD group, a normal control profile and non-AD pathology. The CSF profiles differed by race, gender and the genetic marker ApoE4, highlighting the importance of considering demographic factors in unsupervised learning with detection limits. Notably, African American participants in the AD-like group had significantly lower tau burden.
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Affiliation(s)
- Ganzhong Tian
- Department of Biostatistics and Bioinformatics, Emory University
| | - John Hanfelt
- Department of Biostatistics and Bioinformatics, Emory University
| | - James Lah
- Department of Neurology, Emory University School of Medicine
| | - Benjamin B Risk
- Department of Biostatistics and Bioinformatics, Emory University
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Xu J, Chen Y, Shi Y, Sun A, Yang Y, Boustani M, Su J, Zhang P. Associations Between Neuroinflammation-Related Conditions and Alzheimer's Disease: A Study of US Insurance Claims Data. J Alzheimers Dis 2024; 99:739-752. [PMID: 38701142 PMCID: PMC11228456 DOI: 10.3233/jad-231286] [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] [Indexed: 05/05/2024]
Abstract
Background Early detection of Alzheimer's disease (AD) is a key component for the success of the recently approved lecanemab and aducanumab. Patients with neuroinflammation-related conditions are associated with a higher risk for developing AD. Objective Investigate the incidence of AD among patients with neuroinflammation-related conditions including epilepsy, hemorrhage stroke, multiple sclerosis (MS), and traumatic brain injury (TBI). Methods We used Optum's de-identified Clinformatics Data Mart Database (CDM). We derived covariate-matched cohorts including patients with neuroinflammation-related conditions and controls without the corresponding condition. The matched cohorts were: 1) patients with epilepsy and controls (N = 67,825 matched pairs); 2) patients with hemorrhage stroke and controls (N = 81,510 matched pairs); 3) patients with MS and controls (N = 9,853 matched pairs); and 4) patients TBI and controls (N = 104,637 matched pairs). We used the Cox model to investigate the associations between neuroinflammation-related conditions and AD. Results We identified that epilepsy, hemorrhage stroke, and TBI were associated with increased risks of AD in both males and females (hazard ratios [HRs]≥1.74, p < 0.001), as well as in gender- and race-conscious subpopulations (HRs≥1.64, p < 0.001). We identified that MS was associated with increased risks of AD in both males and females (HRs≥1.47, p≤0.004), while gender- and race-conscious subgroup analysis shown mixed associations. Conclusions Patients with epilepsy, hemorrhage stroke, MS, and/or TBI are associated with a higher risk of developing AD. More attention on cognitive status should be given to older patients with these conditions.
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Affiliation(s)
- Jing Xu
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Yao Chen
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Yi Shi
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Anna Sun
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Yuedi Yang
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Malaz Boustani
- Indiana University Center for Health Innovation and Implementation Science, School of Medicine, Indianapolis, IN, USA
| | - Jing Su
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Pengyue Zhang
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, USA
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Byfield G, Starks TD, Luther R, Edwards CL, Lloyd SL, Caban-Holt A, Deon Adams L, Vance JM, Cuccaro M, Haines JL, Reitz C, Pericak-Vance MA, Byrd GS. Leveraging African American family connectors for Alzheimer's disease genomic studies. Alzheimers Dement 2023; 19:5437-5446. [PMID: 37212603 PMCID: PMC10663385 DOI: 10.1002/alz.13106] [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: 01/23/2023] [Revised: 03/22/2023] [Accepted: 03/23/2023] [Indexed: 05/23/2023]
Abstract
INTRODUCTION The underrepresentation of African Americans (AAs) in Alzheimer's disease (AD) research may limit potential benefits from translational applications. This article describes an approach to recruit AA families into an AD genomic study and characteristics of seeds (family connectors) used to overcome recruitment barriers of AA families into AD research. METHODS A four-step outreach and snowball sampling approach relying on family connectors was used to recruit AA families. Descriptive statistics of a profile survey were gathered to understand the demographic and health characteristics of family connectors. RESULTS Twenty-five AA families (117 participants) were enrolled in the study via family connectors. Most family connectors self-identified as female (88%), were 60 years of age or older (76%), and attained post-secondary education (77%). DISCUSSION Community-engaged strategies were essential to recruit AA families. Relationships between study coordinators and family connectors build trust early in the research process among AA families. HIGHLIGHTS Community events were most effective for recruiting African American families. Family connectors were primarily female, in good health, and highly educated. Systematic efforts by researchers are necessary to "sell" a study to participants.
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Affiliation(s)
- Grace Byfield
- Department of Genetics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, 27514, USA
| | - Takiyah D. Starks
- Maya Angelou Center for Health Equity, Wake Forest School of Medicine, Winston Salem, North Carolina, 27101, USA
| | | | - Christopher L. Edwards
- College of Arts, Social Sciences and Humanities, North Carolina Central University, Durham, North Carolina, 27707, USA
| | - Shawnta L. Lloyd
- Maya Angelou Center for Health Equity, Wake Forest School of Medicine, Winston Salem, North Carolina, 27101, USA
| | - Allison Caban-Holt
- Maya Angelou Center for Health Equity, Wake Forest School of Medicine, Winston Salem, North Carolina, 27101, USA
| | - Larry Deon Adams
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, Florida, 33136, USA
| | - Jeffery M. Vance
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, Florida, 33136, USA
- Dr. John T. Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
| | - Michael Cuccaro
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, Florida, 33136, USA
- Dr. John T. Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
- Department of Psychology & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida, 33136, USA
| | - Jonathan L. Haines
- Cleveland Institute for Computational Biology and Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio, 44106, USA
| | - Christiane Reitz
- Gertrude H. Sergievsky Center and the Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University, New York, New York, 10032, USA
| | - Margaret A. Pericak-Vance
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, Florida, 33136, USA
- Dr. John T. Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
| | - Goldie S. Byrd
- Maya Angelou Center for Health Equity, Wake Forest School of Medicine, Winston Salem, North Carolina, 27101, USA
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Weiner MW, Aaronson A, Eichenbaum J, Kwang W, Ashford MT, Gummadi S, Santhakumar J, Camacho MR, Flenniken D, Fockler J, Truran-Sacrey D, Ulbricht A, Mackin RS, Nosheny RL. Brain health registry updates: An online longitudinal neuroscience platform. Alzheimers Dement 2023; 19:4935-4951. [PMID: 36965096 PMCID: PMC10518371 DOI: 10.1002/alz.13077] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 02/28/2023] [Accepted: 03/08/2023] [Indexed: 03/27/2023]
Abstract
INTRODUCTION Remote, internet-based methods for recruitment, screening, and longitudinally assessing older adults have the potential to facilitate Alzheimer's disease (AD) clinical trials and observational studies. METHODS The Brain Health Registry (BHR) is an online registry that includes longitudinal assessments including self- and study partner-report questionnaires and neuropsychological tests. New initiatives aim to increase inclusion and engagement of commonly underincluded communities using digital, community-engaged research strategies. New features include multilingual support and biofluid collection capabilities. RESULTS BHR includes > 100,000 participants. BHR has made over 259,000 referrals resulting in 25,997 participants enrolled in 30 aging and AD studies. In addition, 28,278 participants are coenrolled in BHR and other studies with data linkage among studies. Data have been shared with 28 investigators. Recent efforts have facilitated the enrollment and engagement of underincluded ethnocultural communities. DISCUSSION The major advantages of the BHR approach are scalability and accessibility. Challenges include compliance, retention, cohort diversity, and generalizability. HIGHLIGHTS Brain Health Registry (BHR) is an online, longitudinal platform of > 100,000 members. BHR made > 259,000 referrals, which enrolled 25,997 participants in 32 studies. New efforts increased enrollment and engagement of underincluded communities in BHR. The major advantages of the BHR approach are scalability and accessibility. BHR provides a unique adjunct for clinical neuroscience research.
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Affiliation(s)
- Michael W. Weiner
- Northern California Institute for Research and Education (NCIRE), Department of Veterans Affairs Medical Center, San Francisco, California, USA
- VA Advanced Research Center, San Francisco, California, USA
- University of California, San Francisco Department of Radiology and Biomedical Imaging, San Francisco, California, USA
- University of California, San Francisco Department of Psychiatry and Behavioral Sciences, San Francisco, California, USA
- University of California, San Francisco Department of Medicine, San Francisco, California, USA
- University of California, San Francisco Department of Neurology, San Francisco, California, USA
| | - Anna Aaronson
- VA Advanced Research Center, San Francisco, California, USA
- University of California, San Francisco Department of Radiology and Biomedical Imaging, San Francisco, California, USA
| | - Joseph Eichenbaum
- VA Advanced Research Center, San Francisco, California, USA
- University of California, San Francisco Department of Radiology and Biomedical Imaging, San Francisco, California, USA
| | - Winnie Kwang
- VA Advanced Research Center, San Francisco, California, USA
- University of California, San Francisco Department of Radiology and Biomedical Imaging, San Francisco, California, USA
| | - Miriam T. Ashford
- Northern California Institute for Research and Education (NCIRE), Department of Veterans Affairs Medical Center, San Francisco, California, USA
- VA Advanced Research Center, San Francisco, California, USA
- University of California, San Francisco Department of Radiology and Biomedical Imaging, San Francisco, California, USA
| | - Shilpa Gummadi
- VA Advanced Research Center, San Francisco, California, USA
- University of California, San Francisco Department of Radiology and Biomedical Imaging, San Francisco, California, USA
| | - Jessica Santhakumar
- VA Advanced Research Center, San Francisco, California, USA
- University of California, San Francisco Department of Radiology and Biomedical Imaging, San Francisco, California, USA
| | - Monica R. Camacho
- Northern California Institute for Research and Education (NCIRE), Department of Veterans Affairs Medical Center, San Francisco, California, USA
- VA Advanced Research Center, San Francisco, California, USA
- University of California, San Francisco Department of Radiology and Biomedical Imaging, San Francisco, California, USA
| | - Derek Flenniken
- Northern California Institute for Research and Education (NCIRE), Department of Veterans Affairs Medical Center, San Francisco, California, USA
- VA Advanced Research Center, San Francisco, California, USA
- University of California, San Francisco Department of Radiology and Biomedical Imaging, San Francisco, California, USA
| | - Juliet Fockler
- VA Advanced Research Center, San Francisco, California, USA
- University of California, San Francisco Department of Radiology and Biomedical Imaging, San Francisco, California, USA
| | - Diana Truran-Sacrey
- Northern California Institute for Research and Education (NCIRE), Department of Veterans Affairs Medical Center, San Francisco, California, USA
- VA Advanced Research Center, San Francisco, California, USA
- University of California, San Francisco Department of Radiology and Biomedical Imaging, San Francisco, California, USA
| | - Aaron Ulbricht
- VA Advanced Research Center, San Francisco, California, USA
- University of California, San Francisco Department of Radiology and Biomedical Imaging, San Francisco, California, USA
| | - R. Scott Mackin
- VA Advanced Research Center, San Francisco, California, USA
- University of California, San Francisco Department of Psychiatry and Behavioral Sciences, San Francisco, California, USA
| | - Rachel L. Nosheny
- VA Advanced Research Center, San Francisco, California, USA
- University of California, San Francisco Department of Psychiatry and Behavioral Sciences, San Francisco, California, USA
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Lim AC, Barnes LL, Weissberger GH, Lamar M, Nguyen AL, Fenton L, Herrera J, Han SD. Quantification of race/ethnicity representation in Alzheimer's disease neuroimaging research in the USA: a systematic review. COMMUNICATIONS MEDICINE 2023; 3:101. [PMID: 37491471 PMCID: PMC10368705 DOI: 10.1038/s43856-023-00333-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 07/05/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND Racial and ethnic minoritized groups are disproportionately at risk for Alzheimer's Disease (AD), but are not sufficiently recruited in AD neuroimaging research in the United States. This is important as sample composition impacts generalizability of findings, biomarker cutoffs, and treatment effects. No studies have quantified the breadth of race/ethnicity representation in the AD literature. METHODS This review identified median race/ethnicity composition of AD neuroimaging US-based research samples available as free full-text articles on PubMed. Two types of published studies were analyzed: studies that directly report race/ethnicity data (i.e., direct studies), and studies that do not report race/ethnicity but used data from a cohort study/database that does report this information (i.e., indirect studies). RESULTS Direct studies (n = 719) have median representation of 88.9% white or 87.4% Non-Hispanic white, 7.3% Black/African American, and 3.4% Hispanic/Latino ethnicity, with 0% Asian American, Native Hawaiian/Pacific Islander, and American Indian/Alaska Native, Multiracial, and Other Race participants. Cohort studies/databases (n = 44) from which indirect studies (n = 1745) derived are more diverse, with median representation of 84.2% white, 83.7% Non-Hispanic white, 11.6% Black/African American, 4.7% Hispanic/Latino, and 1.75% Asian American participants. Notably, 94% of indirect studies derive from just 10 cohort studies/databases. Comparisons of two time periods using a median split for publication year, 1994-2017 and 2018-2022, indicate that sample diversity has improved recently, particularly for Black/African American participants (3.39% from 1994-2017 and 8.29% from 2018-2022). CONCLUSIONS There is still underrepresentation of all minoritized groups relative to Census data, especially for Hispanic/Latino and Asian American individuals. The AD neuroimaging literature will benefit from increased representative recruitment of ethnic/racial minorities. More transparent reporting of race/ethnicity data is needed.
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Affiliation(s)
- Aaron C Lim
- Department of Family Medicine, Keck School of Medicine of USC, Alhambra, CA, USA
| | - Lisa L Barnes
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Gali H Weissberger
- The Interdisciplinary Department of Social Sciences, Bar-Ilan University, Raman Gat, Israel
| | - Melissa Lamar
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Annie L Nguyen
- Department of Family Medicine, Keck School of Medicine of USC, Alhambra, CA, USA
| | - Laura Fenton
- Department of Psychology, USC Dornsife College of Letters, Arts, and Sciences, Los Angeles, CA, USA
| | - Jennifer Herrera
- Department of Family Medicine, Keck School of Medicine of USC, Alhambra, CA, USA
| | - S Duke Han
- Department of Family Medicine, Keck School of Medicine of USC, Alhambra, CA, USA.
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA.
- Department of Psychology, USC Dornsife College of Letters, Arts, and Sciences, Los Angeles, CA, USA.
- USC School of Gerontology, Los Angeles, CA, USA.
- Department of Neurology, Keck School of Medicine of USC, Los Angeles, CA, USA.
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Chen A, Li Q, Shenkman E, Wu Y, Guo Y, Bian J. Exploring the Effect of Eligibility Criteria on AD Severity and Severe Adverse Event in Eligible Patients. IEEE INTERNATIONAL CONFERENCE ON HEALTHCARE INFORMATICS. IEEE INTERNATIONAL CONFERENCE ON HEALTHCARE INFORMATICS 2023; 2023:756-759. [PMID: 39070248 PMCID: PMC11273173 DOI: 10.1109/ichi57859.2023.00139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
Clinical trials were vital tools to prove the effectiveness and safety of medications. To maximize generalizability, the study sample should represent the sample population and the target population. However, the clinical trial design tends to favor the evaluation of drug safety and procedure (i.e., internal validity) without clear knowledge of its penalty on trial generalizability (i.e., external validity). Alzheimer's Disease (AD) trials are known to have generalizability issues. Thus, in this study, we explore the effect of eligibility criteria on the AD severity patients and the severe adverse event (SAE) among the eligible patients.
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Affiliation(s)
- Aokun Chen
- Department of Health Outcome and Biomedical Informatics, College of Medicine University of Florida Gainesville, FL,USA
| | - Qian Li
- Department of Health Outcome and Biomedical Informatics, College of Medicine University of Florida Gainesville, FL,USA
| | - Elizabeth Shenkman
- Department of Health Outcome and Biomedical Informatics, College of Medicine University of Florida Gainesville, FL,USA
| | - Yonghui Wu
- Department of Health Outcome and Biomedical Informatics, College of Medicine University of Florida Gainesville, FL,USA
| | - Yi Guo
- Department of Health Outcome and Biomedical Informatics, College of Medicine University of Florida Gainesville, FL,USA
| | - Jiang Bian
- Department of Health Outcome and Biomedical Informatics, College of Medicine University of Florida Gainesville, FL,USA
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Ashford MT, Zhu D, Bride J, McLean E, Aaronson A, Conti C, Cypress C, Griffin P, Ross R, Duncan T, Deng X, Ulbricht A, Fockler J, Camacho MR, Flenniken D, Truran D, Mackin SR, Hill C, Weiner MW, Byrd D, Turner Ii RW, Cham H, Rivera Mindt M, Nosheny RL. Understanding Online Registry Facilitators and Barriers Experienced by Black Brain Health Registry Participants: The Community Engaged Digital Alzheimer's Research (CEDAR) Study. J Prev Alzheimers Dis 2023; 10:551-561. [PMID: 37357297 PMCID: PMC10395260 DOI: 10.14283/jpad.2023.25] [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] [Indexed: 08/04/2023]
Abstract
BACKGROUND Failure of Alzheimer's disease and related diseases (ADRD) research studies to include and engage Black participants is a major issue, which limits the impact and generalizability of research findings. Little is known about participation of Black adults in online ADRD-related research registries. OBJECTIVES As part of the Community Engaged Digital Alzheimer's Research (CEDAR) Study, this study aims to increase our understanding of facilitators and barriers of Black adults to participating in ADRD-related online registries, as well as to understand their preferences for communication channels. DESIGN, SETTING, PARTICIPANTS, MEASUREMENTS We invited all Black participants enrolled in the Brain Health Registry (BHR) to complete a cross-sectional online survey. The survey consisted of rating scales and open-text questions asking about their attitudes towards brain health research, reasons for joining and continuing to participate in BHR, difficulties with participating, and preferences for modes of contact and website usage. RESULTS Of all invited Black BHR participants (N=3,636), 198 (5.5%) completed the survey. The mean age was 58.4 (SD=11.3), mean years of education were 16.3 (SD=2.4), and 85.5% identified as female. Reported facilitators for joining and continuing to participate in BHR were personal interest (e.g., learning more about own brain health) and altruism (e.g., helping research). Among additional registry features which could encourage return, receiving feedback or scores about BHR tasks was rated the highest. Of those who found BHR participation difficult (21%), the most frequent reason was time burden. The most preferred way of receiving study information was via email. Participants reported that the websites that they used the most were YouTube and Facebook. DISCUSSION The results of our study can inform the development of culturally-responsive registry features and engagement efforts to improve inclusion and participation of Black adults in online ADRD research. Providing participants with feedback about their registry performance and reducing the number of registry tasks are among the recommended strategies.
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Affiliation(s)
- M T Ashford
- Miriam Ashford, 4150 Clement St, San Francisco, CA 94121, , Phone: (415) 750-6954, Fax number: (415) 750-9358
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Mindt MR, Ashford MT, Zhu D, Cham H, Aaronson A, Conti C, Deng X, Alaniz R, Sorce J, Cypress C, Griffin P, Flenniken D, Camacho M, Fockler J, Truran D, Mackin RS, Hill C, Weiner MW, Byrd D, Turner Ii RW, Nosheny RL. The Community Engaged Digital Alzheimer's Research (CEDAR) Study: A Digital Intervention to Increase Research Participation of Black American Participants in the Brain Health Registry. J Prev Alzheimers Dis 2023; 10:847-856. [PMID: 37874107 PMCID: PMC10598330 DOI: 10.14283/jpad.2023.32] [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] [Indexed: 10/25/2023]
Abstract
BACKGROUND Although Black/African American older adults bear significant inequities in prevalence, incidence, and outcomes of Alzheimer's disease and related dementias, they are profoundly under-included in Alzheimer's Disease research. Community-Engaged Research (e.g., equitable community/science partnerships) is an evidence-based approach for improving engagement of underrepresented populations into Alzheimer's Disease research, but has lacked scalability to the national level. As internet use among older adults from underrepresented populations continues to grow, internet-based research shows promise as a feasible, valid approach to engagement and longitudinal assessment. The Community Engaged Digital Alzheimer's Research (CEDAR) study utilizes a community-engaged research approach to increase the engagement and research participation of Black/African American adults in the Brain Health Registry (BHR) and Alzheimer Disease clinical research. OBJECTIVES To describe the methods and evaluate the feasibility of the CEDAR culturally-informed digital platform within BHR. DESIGN All Black/African American participants in BHR were invited to enroll in CEDAR and to consider serving on a newly convened Community-Scientific Partnership Board to guide the study. The community board guided the development a culturally-informed cadre of engagement materials and strategies to increase research participation. Engagement strategies included incentives for study task completion, culturally-informed communications (e.g., landing page, emails and social media), resources about brain health, and video and written testimonials by CEDAR participants. SETTING BHR, an Internet-based registry and cohort. PARTICIPANTS BHR participants self-identifying as Black/African American were invited to enroll. All participants who signed an online informed consent document were enrolled. MEASUREMENTS We report the number of participants invited, enrolled, completed tasks, and volunteered to join the community board. We compared the demographics, cognitive profile, and baseline BHR task completion rates between CEDAR participants and all those invited to join the study. RESULTS Of 3738 invited, 349 (9.34%) enrolled in CEDAR. 134 (37% of CEDAR participants) volunteered to join the community board, of which 19 were selected for the community board. Compared to those invited, the CEDAR cohort had a higher percentage of female participants (84.5%) and a lower percentage of participants who identify as belonging to more than one ethnocultural group (21.8%). Compared to those did not enroll in CEDAR, those enrolled in CEDAR had a higher percentage of participants completing all BHR tasks (22%) and a higher percentage of participants completing at least one cognitive test (76%). Those enrolled in CEDAR also had a higher percentage of participants having an enrolled study partner (18%). CONCLUSIONS A culturally-informed Community-Engaged Research approach, including a remotely-convened community board, to engagement of Black/African American participants in an online research registry is feasible. This approach can be adapted for use in various clinical studies and other settings. Future studies will evaluate the effectiveness of the engagement strategies.
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Affiliation(s)
- M R Mindt
- Rachel Nosheny, 4150 Clement Street, 114M, San Francisco, CA. 94121, USA, Telephone: 415-221-4810, Email address: Fax number: 415-221-4810
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16
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Power MC, Engelman BC, Wei J, Glymour MM. Closing the Gap Between Observational Research and Randomized Controlled Trials for Prevention of Alzheimer Disease and Dementia. Epidemiol Rev 2022; 44:17-28. [PMID: 35442427 PMCID: PMC10362937 DOI: 10.1093/epirev/mxac002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2022] [Indexed: 12/29/2022] Open
Abstract
Although observational studies have identified modifiable risk factors for Alzheimer disease and related dementias (ADRD), randomized controlled trials (RCTs) of risk factor modification for ADRD prevention have been inconsistent or inconclusive. This finding suggests a need to improve translation between observational studies and RCTs. However, many common features of observational studies reduce their relevance to designing related RCTs. Observational studies routinely differ from RCTs with respect to eligibility criteria, study population, length of follow-up, treatment conditions, outcomes, and effect estimates. Using the motivating example of blood pressure reduction for ADRD prevention, we illustrate the need for a tighter connection between observational studies and RCTs, discuss barriers to using typically reported observational evidence in developing RCTs, and highlight methods that may be used to make observational research more relevant to clinical trial design. We conclude that the questions asked and answered by observational research can be made more relevant to clinical trial design and that better use of observational data may increase the likelihood of successful, or at least definitive, trials. Although we focus on improving translation of observational studies on risk factors for ADRD to RCTs in ADRD prevention, the overarching themes are broadly applicable to many areas of biomedical research.
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Affiliation(s)
- Melinda C Power
- Correspondence to Melinda C. Power, Milken Institute School of Public Health, George Washington University, 950 New Hampshire Avenue, NW, Washington, DC 20052 (e-mail: )
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Ashford MT, Raman R, Miller G, Donohue MC, Okonkwo OC, Mindt MR, Nosheny RL, Coker GA, Petersen RC, Aisen PS, Weiner MW. Screening and enrollment of underrepresented ethnocultural and educational populations in the Alzheimer's Disease Neuroimaging Initiative (ADNI). Alzheimers Dement 2022; 18:2603-2613. [PMID: 35213778 PMCID: PMC9402812 DOI: 10.1002/alz.12640] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 02/02/2022] [Accepted: 02/04/2022] [Indexed: 01/31/2023]
Abstract
INTRODUCTION An analysis of the ethnocultural and socioeconomic composition of Alzheimer's Disease Neuroimaging Initiative (ADNI) participants is needed to assess the generalizability of ADNI data to diverse populations. METHODS ADNI data collected between October 2004 and November 2020 were used to determine ethnocultural and educational composition of the sample and differences in the following metrics: screening, screen fails, enrollment, biomarkers. RESULTS Of 3739 screened individuals, 11% identified as being from ethnoculturally underrepresented populations (e.g., Black, Latinx) and 16% had <12 years of education. Of 2286 enrolled participants, 11% identified as ethnoculturally underrepresented individuals and 15% had <12 years of education. This participation is considerably lower than US Census data for adults 60+ (ethnoculturally underrepresented populations: 25%; <12 years of education: 4%). Individuals with <12 years of education failed screening at a higher rate. DISCUSSION Our findings suggest that ADNI results may not be entirely generalizable to ethnoculturally diverse and low education populations.
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Affiliation(s)
- Miriam T. Ashford
- Northern California Institute for Research and Education (NCIRE), Department of Veterans Affairs Medical Center - San Francisco (United States)
| | - Rema Raman
- Alzheimer's Therapeutic Research Institute, University of Southern California - San Diego (United States)
| | - Garrett Miller
- Alzheimer's Therapeutic Research Institute, University of Southern California - San Diego (United States)
| | - Michael C. Donohue
- Alzheimer's Therapeutic Research Institute, University of Southern California - San Diego (United States)
| | - Ozioma C. Okonkwo
- Wisconsin Alzheimer's Disease Research Center and The Department of Medicine, University of Wisconsin School Of Medicine And Public Health - Madison (United States)
| | - Monica Rivera Mindt
- Psychology & Latin American Latino Studies Institute, Fordham University, Joint Appointment in Neurology, Icahn School of Medicine at Mount Sinai - New York (United States)
| | - Rachel L. Nosheny
- Department Of Psychiatry, University of California San Francisco - San Francisco (United States)
| | - Godfrey A. Coker
- Alzheimer's Therapeutic Research Institute, University of Southern California - San Diego (United States)
| | | | - Paul S. Aisen
- Alzheimer's Therapeutic Research Institute, University of Southern California - San Diego (United States)
| | - Michael W. Weiner
- Department Of Radiology and Biomedical Imaging, University of California San Francisco - San Francisco (United States)
| | - Alzheimer’s Disease Neuroimaging Initiative
- Data used in preparation of this article were obtained from the Alzheimer’s Disease Neuroimaging Initiative (ADNI) database (adni.loni.usc.edu). A complete listing of ADNI investigators can be found at:http://adni.loni.usc.edu/wp-content/uploads/how_to_apply/ADNI_Acknowledgement_List.pdf
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18
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John SE, Evans SA, Kim B, Ozgul P, Loring DW, Parker M, Lah JJ, Levey AI, Goldstein FC. Examination of the reliability and feasibility of two smartphone applications to assess executive functioning in racially diverse older adults. NEUROPSYCHOLOGY, DEVELOPMENT, AND COGNITION. SECTION B, AGING, NEUROPSYCHOLOGY AND COGNITION 2022; 29:1068-1086. [PMID: 34382482 PMCID: PMC8837703 DOI: 10.1080/13825585.2021.1962790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 07/27/2021] [Indexed: 10/20/2022]
Abstract
Inclusion of Black participants in clinical research is a national priority. Mobile applications and remote data collection may increase study access for diverse populations. This study examined the reliability and feasibility of two mobile smartphone application-based cognitive measures in a diverse middle aged and older adult sample. Black (n = 44; Mage = 59.93) and non-Hispanic white (NHW; n = 50; Mage = 61.06) participants completed traditional paper-based neuropsychological testing and two app-based measures, Arrows and Number Match. Intraclass correlations demonstrated poor to moderate reliability (range: .417-.569) between performance on the app-based versions and performance on the traditional versions. Performance score differences by racial group were not statistically significant. Both Black and NHW participants rated the app-based measures as feasible and acceptable, though Black participants endorsed a stronger likelihood of future use. These findings add to the growing literature on remote cognitive testing .
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Affiliation(s)
- Samantha E. John
- Department of Brain Health, School of Integrated Health Sciences, UNLV, Las Vegas, NV, USA
| | - Sarah A. Evans
- Department of Psychology, Marquette University, Milwaukee, WI, USA
| | - Bona Kim
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Petek Ozgul
- Emory Goizueta Alzheimer’s Disease Research Center, Atlanta, GA, USA
| | - David W. Loring
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Monica Parker
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - James J. Lah
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
- Emory Goizueta Alzheimer’s Disease Research Center, Atlanta, GA, USA
| | - Allan I. Levey
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
- Emory Goizueta Alzheimer’s Disease Research Center, Atlanta, GA, USA
| | - Felicia C. Goldstein
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
- Emory Goizueta Alzheimer’s Disease Research Center, Atlanta, GA, USA
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Traylor MK, Bauman AJ, Saiyasit N, Frizell CA, Hill BD, Nelson AR, Keller JL. An examination of the relationship among plasma brain derived neurotropic factor, peripheral vascular function, and body composition with cognition in midlife African Americans/Black individuals. Front Aging Neurosci 2022; 14:980561. [PMID: 36092801 PMCID: PMC9453229 DOI: 10.3389/fnagi.2022.980561] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 08/08/2022] [Indexed: 11/22/2022] Open
Abstract
African American/Black individuals have been excluded from several lines of prominent neuroscience research, despite exhibiting disproportionately higher risk factors associated with the onset and magnitude of neurodegeneration. Therefore, the objective of the current investigation was to examine potential relationships among brain derived neurotropic factor (BDNF), peripheral vascular function, and body composition with cognition in a sample of midlife, African American/Black individuals. Midlife adults (men: n = 3, 60 ± 4 years; women: n = 9, 58 ± 5 years) were invited to complete two baseline visits separated by 4 weeks. Peripheral vascular function was determined by venous occlusion plethysmography, a dual-energy X-ray absorptiometry was used to determine body composition, and plasma was collected to quantify BDNF levels. The CNS Vital Signs computer-based test was used to provide scores on numerous cognitive domains. The principal results included that complex attention (r = 0.629) and processing speed (r = 0.734) were significantly (p < 0.05) related to the plasma BDNF values. However, there was no significant (p > 0.05) relationship between any vascular measure and any cognitive domain or BDNF value. Secondary findings included the relationship between lean mass and peak hyperemia (r = 0.758) as well as total hyperemia (r = 0.855). The major conclusion derived from these results was that there is rationale for future clinical trials to use interventions targeting increasing BDNF to potentially improve cognition. Additionally, these results strongly suggest that clinicians aiming to improve cognitive health via improvements in the known risk factor of vascular function should consider interventions capable of promoting the size and function of skeletal muscle, especially in the African American/Black population.
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Affiliation(s)
- Miranda K. Traylor
- Integrative Laboratory of Exercise and Applied Physiology (iLEAP), Department of Health, Kinesiology, and Sport, College of Education and Professional Studies, University of South Alabama, Mobile, AL, United States
| | - Allison J. Bauman
- Department of Physiology and Cell Biology, College of Medicine, University of South Alabama, Mobile, AL, United States
| | - Napatsorn Saiyasit
- Department of Physiology and Cell Biology, College of Medicine, University of South Alabama, Mobile, AL, United States
| | - Carl A. Frizell
- Physician Assistant Sciences Program, School of Graduate Studies and Research, Meharry Medical College, Nashville, TN, United States
| | - Benjamin D. Hill
- Department of Psychology, College of Arts and Sciences, University of South Alabama, Mobile, AL, United States
| | - Amy R. Nelson
- Department of Physiology and Cell Biology, College of Medicine, University of South Alabama, Mobile, AL, United States
| | - Joshua L. Keller
- Integrative Laboratory of Exercise and Applied Physiology (iLEAP), Department of Health, Kinesiology, and Sport, College of Education and Professional Studies, University of South Alabama, Mobile, AL, United States
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Saiyasit N, Butlig EAR, Chaney SD, Traylor MK, Hawley NA, Randall RB, Bobinger HV, Frizell CA, Trimm F, Crook ED, Lin M, Hill BD, Keller JL, Nelson AR. Neurovascular Dysfunction in Diverse Communities With Health Disparities-Contributions to Dementia and Alzheimer's Disease. Front Neurosci 2022; 16:915405. [PMID: 35844216 PMCID: PMC9279126 DOI: 10.3389/fnins.2022.915405] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 05/31/2022] [Indexed: 12/13/2022] Open
Abstract
Alzheimer's disease and related dementias (ADRD) are an expanding worldwide crisis. In the absence of scientific breakthroughs, the global prevalence of ADRD will continue to increase as more people are living longer. Racial or ethnic minority groups have an increased risk and incidence of ADRD and have often been neglected by the scientific research community. There is mounting evidence that vascular insults in the brain can initiate a series of biological events leading to neurodegeneration, cognitive impairment, and ADRD. We are a group of researchers interested in developing and expanding ADRD research, with an emphasis on vascular contributions to dementia, to serve our local diverse community. Toward this goal, the primary objective of this review was to investigate and better understand health disparities in Alabama and the contributions of the social determinants of health to those disparities, particularly in the context of vascular dysfunction in ADRD. Here, we explain the neurovascular dysfunction associated with Alzheimer's disease (AD) as well as the intrinsic and extrinsic risk factors contributing to dysfunction of the neurovascular unit (NVU). Next, we ascertain ethnoregional health disparities of individuals living in Alabama, as well as relevant vascular risk factors linked to AD. We also discuss current pharmaceutical and non-pharmaceutical treatment options for neurovascular dysfunction, mild cognitive impairment (MCI) and AD, including relevant studies and ongoing clinical trials. Overall, individuals in Alabama are adversely affected by social and structural determinants of health leading to health disparities, driven by rurality, ethnic minority status, and lower socioeconomic status (SES). In general, these communities have limited access to healthcare and healthy food and other amenities resulting in decreased opportunities for early diagnosis of and pharmaceutical treatments for ADRD. Although this review is focused on the current state of health disparities of ADRD patients in Alabama, future studies must include diversity of race, ethnicity, and region to best be able to treat all individuals affected by ADRD.
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Affiliation(s)
- Napatsorn Saiyasit
- Department of Physiology and Cell Biology, College of Medicine, University of South Alabama, Mobile, AL, United States
| | - Evan-Angelo R. Butlig
- Department of Neurology, Eli and Edythe Broad Center of Regenerative Medicine and Stem Cell Research, Intellectual and Developmental Disabilities Research Center, University of California, Los Angeles, Los Angeles, CA, United States
| | - Samantha D. Chaney
- Department of Physiology and Cell Biology, College of Medicine, University of South Alabama, Mobile, AL, United States
| | - Miranda K. Traylor
- Department of Health, Kinesiology, and Sport, University of South Alabama, Mobile, AL, United States
| | - Nanako A. Hawley
- Department of Psychology, University of South Alabama, Mobile, AL, United States
| | - Ryleigh B. Randall
- Department of Physiology and Cell Biology, College of Medicine, University of South Alabama, Mobile, AL, United States
| | - Hanna V. Bobinger
- Department of Physiology and Cell Biology, College of Medicine, University of South Alabama, Mobile, AL, United States
| | - Carl A. Frizell
- Department of Physician Assistant Studies, University of South Alabama, Mobile, AL, United States
| | - Franklin Trimm
- College of Medicine, University of South Alabama, Mobile, AL, United States
| | - Errol D. Crook
- Department of Internal Medicine, College of Medicine, University of South Alabama, Mobile, AL, United States
| | - Mike Lin
- Department of Physiology and Cell Biology, College of Medicine, University of South Alabama, Mobile, AL, United States
| | - Benjamin D. Hill
- Department of Psychology, University of South Alabama, Mobile, AL, United States
| | - Joshua L. Keller
- Department of Health, Kinesiology, and Sport, University of South Alabama, Mobile, AL, United States
| | - Amy R. Nelson
- Department of Physiology and Cell Biology, College of Medicine, University of South Alabama, Mobile, AL, United States
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Gilmore-Bykovskyi A, Croff R, Glover CM, Jackson JD, Resendez J, Perez A, Zuelsdorff M, Green-Harris G, Manly JJ. Traversing the Aging Research and Health Equity Divide: Toward Intersectional Frameworks of Research Justice and Participation. THE GERONTOLOGIST 2022; 62:711-720. [PMID: 34324633 PMCID: PMC9154232 DOI: 10.1093/geront/gnab107] [Citation(s) in RCA: 50] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Indexed: 11/14/2022] Open
Abstract
Meaningful reductions in racial and ethnic inequities in chronic diseases of aging remain unlikely without major advancements in the inclusion of minoritized populations in aging research. While sparse, studies investigating research participation disparities have predominantly focused on individual-level factors and behavioral change, overlooking the influence of study design, structural factors, and social determinants of health on participation. This is also reflected in conventional practices that consistently fail to address established participation barriers, such as study requirements that impose financial, transportation, linguistic, and/or logistical barriers that disproportionately burden participants belonging to minoritized populations. These shortcomings not only risk exacerbating distrust toward research and researchers, but also introduce significant selection biases, diminishing our ability to detect differential mechanisms of risk, resilience, and response to interventions across subpopulations. This forum article examines the intersecting factors that drive both health inequities in aging and disparate participation in aging research among minoritized populations. Using an intersectional, social justice, and emancipatory lens, we characterize the role of social determinants, historical contexts, and contemporaneous structures in shaping research accessibility and inclusion. We also introduce frameworks to accelerate transformative theoretical approaches to fostering equitable inclusion of minoritized populations in aging research.
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Affiliation(s)
- Andrea Gilmore-Bykovskyi
- University of Wisconsin-Madison Center for Health Disparities Research, Madison, WI, USA
- University of Wisconsin–Madison School of Nursing, Madison, WI, USA
| | - Raina Croff
- NIA Layton Aging and Alzheimer’s Disease Center, Oregon Health & Science University, Portland, Oregon, USA
| | - Crystal M Glover
- Division of Behavioral Sciences, Rush Medical College, Chicago, Illinois, USA
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Jonathan D Jackson
- Community Access, Recruitment, & Engagement (CARE) Research Center, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Jason Resendez
- UsAgainstAlzheimer’s, Washington, District of Columbia, USA
| | - Adriana Perez
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | - Megan Zuelsdorff
- University of Wisconsin-Madison Center for Health Disparities Research, Madison, WI, USA
| | | | - Jennifer J Manly
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York City, New York, USA
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University, New York City, New York, USA
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22
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Franzen S, Smith JE, van den Berg E, Rivera Mindt M, van Bruchem‐Visser RL, Abner EL, Schneider LS, Prins ND, Babulal GM, Papma JM. Diversity in Alzheimer's disease drug trials: The importance of eligibility criteria. Alzheimers Dement 2022; 18:810-823. [PMID: 34590409 PMCID: PMC8964823 DOI: 10.1002/alz.12433] [Citation(s) in RCA: 47] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 06/14/2021] [Accepted: 06/24/2021] [Indexed: 01/01/2023]
Abstract
INTRODUCTION To generalize safety and efficacy findings, it is essential that diverse populations are well represented in Alzheimer's disease (AD) drug trials. In this review, we aimed to investigate participant diversity in disease-modifying AD trials over time, and the frequencies of participant eligibility criteria. METHODS A systematic review was performed using Medline, Embase, the Cochrane Library, and Clinicaltrials.gov, identifying 2247 records. RESULTS In the 101 included AD trials, participants were predominantly White (median percentage: 94.7%, interquartile range: 81.0-96.7%); and this percentage showed no significant increase or decrease over time (2001-2019). Eligibility criteria such as exclusion of persons with psychiatric illness (78.2%), cardiovascular disease (71.3%) and cerebrovascular disease (68.3%), obligated caregiver attendance (80.2%), and specific Mini-Mental State Examination scores (90.1%; no significant increase/decrease over time) may have led to a disproportionate exclusion of ethnoracially diverse individuals. DISCUSSION Ethnoracially diverse participants continue to be underrepresented in AD clinical trials. Several recommendations are provided to broaden eligibility criteria.
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Affiliation(s)
- Sanne Franzen
- Department of NeurologyErasmus MC University Medical CenterRotterdamthe Netherlands
| | - Jade Emily Smith
- Department of NeurologyErasmus MC University Medical CenterRotterdamthe Netherlands
| | - Esther van den Berg
- Department of NeurologyErasmus MC University Medical CenterRotterdamthe Netherlands
| | - Monica Rivera Mindt
- Department of Psychology and Latin American Latino Studies InstituteFordham UniversityThe BronxNew YorkUSA
- Department of NeurologyThe Icahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | | | - Erin L. Abner
- Sanders‐Brown Center on Aging and Alzheimer's Disease CenterUniversity of KentuckyLexingtonKentuckyUSA
- College of Public HealthDepartment of EpidemiologyUniversity of KentuckyLexingtonKentuckyUSA
- College of Public HealthDepartment of BiostatisticsUniversity of KentuckyLexingtonKentuckyUSA
| | - Lon S. Schneider
- Keck School of Medicine of the University of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Niels D. Prins
- Alzheimer CenterDepartment of NeurologyVU University Medical CenterAmsterdamthe Netherlands
- Brain Research CenterAmsterdamthe Netherlands
| | - Ganesh M. Babulal
- Department of Neurology and Knight Alzheimer's Disease Research CenterWashington University School of MedicineSt. LouisMissouriUSA
- Department of PsychologyUniversity of JohannesburgJohannesburgSouth Africa
| | - Janne M. Papma
- Department of NeurologyErasmus MC University Medical CenterRotterdamthe Netherlands
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Laptop-Administered NIH Toolbox and Cogstate Brief Battery in Community-Dwelling Black Adults: Unexpected Pattern of Cognitive Performance between MCI and Healthy Controls. J Int Neuropsychol Soc 2022; 28:239-248. [PMID: 33752763 PMCID: PMC10112283 DOI: 10.1017/s135561772100028x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Black adults are approximately twice as likely to develop Alzheimer's disease (AD) than non-Hispanic Whites and access diagnostic services later in their illness. This dictates the need to develop assessments that are cost-effective, easily administered, and sensitive to preclinical stages of AD, such as mild cognitive impairment (MCI). Two computerized cognitive batteries, NIH Toolbox-Cognition and Cogstate Brief Battery, have been developed. However, utility of these measures for clinical characterization remains only partially determined. We sought to determine the convergent validity of these computerized measures in relation to consensus diagnosis in a sample of MCI and healthy controls (HC). METHOD Participants were community-dwelling Black adults who completed the neuropsychological battery and other Uniform Data Set (UDS) forms from the AD centers program for consensus diagnosis (HC = 61; MCI = 43) and the NIH Toolbox-Cognition and Cogstate batteries. Discriminant function analysis was used to determine which cognitive tests best differentiated the groups. RESULTS NIH Toolbox crystallized measures, Oral Reading and Picture Vocabulary, were the most sensitive in identifying MCI apart from HC. Secondarily, deficits in memory and executive subtests were also predictive. UDS neuropsychological test analyses showed the expected pattern of memory and executive functioning tests differentiating MCI from HC. CONCLUSIONS Contrary to expectation, NIH Toolbox crystallized abilities appeared preferentially sensitive to diagnostic group differences. This study highlights the importance of further research into the validity and clinical utility of computerized neuropsychological tests within ethnic minority populations.
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Schaefer SY, Malek-Ahmadi M, Hooyman A, King JB, Duff K. Association Between Motor Task Performance and Hippocampal Atrophy Across Cognitively Unimpaired, Amnestic Mild Cognitive Impairment, and Alzheimer's Disease Individuals. J Alzheimers Dis 2022; 85:1411-1417. [PMID: 34958015 DOI: 10.3233/jad-210665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Hippocampal atrophy is a widely used biomarker for Alzheimer's disease (AD), but the cost, time, and contraindications associated with magnetic resonance imaging (MRI) limit its use. Recent work has shown that a low-cost upper extremity motor task has potential in identifying AD risk. Fifty-four older adults (15 cognitively unimpaired, 24 amnestic mild cognitive impairment, and 15 AD) completed six motor task trials and a structural MRI. Several measures of motor task performance significantly predicted bilateral hippocampal volume, controlling for age, sex, education, and memory. Thus, this motor task may be an affordable, non-invasive screen for AD risk and progression.
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Affiliation(s)
- Sydney Y Schaefer
- School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ, USA
| | | | - Andrew Hooyman
- School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ, USA
| | - Jace B King
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, USA
| | - Kevin Duff
- Center for Alzheimer's Care, Imaging, & Research, University of Utah, Salt Lake City, UT, USA
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25
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Grill JD, Kind A, Hoang D, Gillen DL. Diversifying Recruitment Registries: Considering Neighborhood Health Metrics. J Prev Alzheimers Dis 2022; 9:119-125. [PMID: 35098982 PMCID: PMC8903055 DOI: 10.14283/jpad.2021.50] [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] [Indexed: 06/14/2023]
Abstract
BACKGROUND Disparities in clinical research participation perpetuate broader health disparities. Recruitment registries are novel tools to address known challenges in accrual to clinical research. Registries may accelerate accrual, but the utility of these tools to improve generalizability is unclear. OBJECTIVE To examine the diversity of a local on-line recruitment registry using the Area Deprivation Index (ADI), a publicly available metric of neighborhood disadvantage. DESIGN Retrospective analysis. SETTING Data were collected in the University of California Irvine Consent-to-Contact Registry. PARTICIPANTS We categorized N=2,837 registry participants based on the ADI decile (collapsed into quintiles) using a state-based rankings. MEASUREMENTS We examined the proportion of enrollees per ADI quintile and quantified the demographics of these groups. We assessed willingness to participate in studies involving unique research procedures among the ADI groups. RESULTS Although registry enrollees represented the full spectrum of the ADI, they disproportionately represented less disadvantaged neighborhoods (lowest to highest quintiles: 42%, 30%, 15%, 6%, 7%). Compared to participants from less disadvantaged neighborhoods, participants from more disadvantaged neighborhoods were more often female, of non-white race, and Hispanic ethnicity. Despite demographic differences, ADI groups were observed to have similar willingness to participate in research studies. CONCLUSIONS People from more disadvantaged neighborhoods may be underrepresented in recruitment registries, increasing the risk that they will be underrepresented when using these tools to facilitate prospective recruitment to clinical research. Once enrolled in registries, participants from more disadvantaged neighborhoods may be equally willing to participate in research. Efforts to increase representation of participants from disadvantaged neighborhoods in registries could be an important first step toward increasing the generalizability of clinical research.
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Affiliation(s)
- J D Grill
- Joshua Grill, PhD, 3204 Biological Sciences III, University of California Irvine, Irvine, CA 92697,USA, , t: (949) 824-5905, f: (949) 824-0885
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Rubin L, Ingram LA, Resciniti NV, Ashford-Carroll B, Leith KH, Rose A, Ureña S, McCollum Q, Friedman DB. Genetic Risk Factors for Alzheimer's Disease in Racial/Ethnic Minority Populations in the U.S.: A Scoping Review. Front Public Health 2021; 9:784958. [PMID: 35004586 PMCID: PMC8739784 DOI: 10.3389/fpubh.2021.784958] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 11/23/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: As the United States (U.S.) population rapidly ages, the incidence of Alzheimer's Disease and Related Dementias (ADRDs) is rising, with racial/ethnic minorities affected at disproportionate rates. Much research has been undertaken to test, sequence, and analyze genetic risk factors for ADRDs in Caucasian populations, but comparatively little has been done with racial/ethnic minority populations. We conducted a scoping review to examine the nature and extent of the research that has been published about the genetic factors of ADRDs among racial/ethnic minorities in the U.S. Design: Using an established scoping review methodological framework, we searched electronic databases for articles describing peer-reviewed empirical studies or Genome-Wide Association Studies that had been published 2005-2018 and focused on ADRD-related genes or genetic factors among underrepresented racial/ethnic minority population in the U.S. Results: Sixty-six articles met the inclusion criteria for full text review. Well-established ADRD genetic risk factors for Caucasian populations including APOE, APP, PSEN1, and PSEN2 have not been studied to the same degree in minority U.S. populations. Compared to the amount of research that has been conducted with Caucasian populations in the U.S., racial/ethnic minority communities are underrepresented. Conclusion: Given the projected growth of the aging population and incidence of ADRDs, particularly among racial/ethnic minorities, increased focus on this important segment of the population is warranted. Our review can aid researchers in developing fundamental research questions to determine the role that ADRD risk genes play in the heavier burden of ADRDs in racial/ethnic minority populations.
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Affiliation(s)
- Lindsey Rubin
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, United States
| | - Lucy A. Ingram
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, United States
| | - Nicholas V. Resciniti
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC, United States
| | - Brianna Ashford-Carroll
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, United States
| | - Katherine Henrietta Leith
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, United States
| | - Aubrey Rose
- School of Medicine, University of South Carolina, Columbia, SC, United States
| | - Stephanie Ureña
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, United States
| | - Quentin McCollum
- College of Social Work, University of South Carolina, Columbia, SC, United States
| | - Daniela B. Friedman
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, United States
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Raman R, Quiroz YT, Langford O, Choi J, Ritchie M, Baumgartner M, Rentz D, Aggarwal NT, Aisen P, Sperling R, Grill JD. Disparities by Race and Ethnicity Among Adults Recruited for a Preclinical Alzheimer Disease Trial. JAMA Netw Open 2021; 4:e2114364. [PMID: 34228129 PMCID: PMC8261604 DOI: 10.1001/jamanetworkopen.2021.14364] [Citation(s) in RCA: 82] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Underrepresentation of many racial/ethnic groups in Alzheimer disease (AD) clinical trials limits generalizability of results and hinders opportunities to examine potential effect modification of candidate treatments. OBJECTIVE To examine racial and ethnic differences in recruitment methods and trial eligibility in a multisite preclinical AD trial. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study analyzed screening data from the Anti-Amyloid in Asymptomatic AD study, collected from April 2014 to December 2017. Participants were categorized into 5 mutually exclusive ethnic/racial groups (ie, Hispanic, Black, White, Asian, and other) using participant self-report. Data were analyzed from May through December 2020 and included 5945 cognitively unimpaired older adults between the ages of 65 and 85 years screened at North American study sites. MAIN OUTCOMES AND MEASURES Primary outcomes included recruitment sources, study eligibility, and ineligibility reasons. To assess the probability of trial eligibility, regression analyses were performed for the likelihood of being eligible after the first screening visit involving clinical and cognitive assessments. RESULTS Screening data were included for 5945 participants at North American sites (mean [SD] age, 71.7 [4.9] years; 3524 women [59.3%]; 5107 White [85.9%], 323 Black [5.4%], 261 Hispanic [4.4%], 112 Asian [1.9%], and 142 [2.4%] who reported race or ethnicity as other). Recruitment sources differed by race and ethnicity. While White participants were recruited through a variety of sources, site local recruitment efforts resulted in the majority of Black (218 [69.2%]), Hispanic (154 [59.7%]), and Asian (61 [55.5%]) participants. Participants from underrepresented groups had lower mean years of education (eg, mean [SD] years: Hispanic participants, 15.5 [3.2] years vs White participants, 16.7 [2.8] years) and more frequently were women (226 [70.0%] Black participants vs 1364 [58.5%] White participants), were unmarried (184 [56.9%] Black participants vs 1364 [26.7%] White participants), and had nonspousal study partners (237 [73.4%] Black participants vs 2147 [42.0%] White participants). They were more frequently excluded for failure to meet cognitive inclusion criteria (eg, screen failures by specific inclusion criteria: 147 [45.5%] Black participants vs 1338 [26.2%] White participants). Compared with White participants, Black (odds ratio [OR], 0.43; 95% CI, 0.34-0.54; P < .001), Hispanic (OR, 0.53; 95% CI, 0.41-0.69; P < .001), and Asian participants (OR, 0.56; 95% CI, 0.38-0.82; P = .003) were less likely to be eligible after screening visit 1. CONCLUSIONS AND RELEVANCE Racial/ethnic groups differed in sources of recruitment, reasons for screen failure, and overall probability of eligibility in a preclinical AD trial. These results highlight the need for improved recruitment strategies and careful consideration of eligibility criteria when planning preclinical AD clinical trials.
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Affiliation(s)
- Rema Raman
- Alzheimer Therapeutic Research Institute, Keck School of Medicine, University of Southern California, San Diego
| | - Yakeel T. Quiroz
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Oliver Langford
- Alzheimer Therapeutic Research Institute, Keck School of Medicine, University of Southern California, San Diego
| | - Jiyoon Choi
- Alzheimer Therapeutic Research Institute, Keck School of Medicine, University of Southern California, San Diego
| | - Marina Ritchie
- Institute for Memory Impairments and Neurological Disorders, University of California Irvine
| | - Morgan Baumgartner
- Institute for Memory Impairments and Neurological Disorders, University of California Irvine
| | - Dorene Rentz
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- Department of Neurology, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Neelum T. Aggarwal
- Department of Neurological Sciences, Rush Alzheimer’s Disease Center, Rush University, Chicago, Illinois
| | - Paul Aisen
- Alzheimer Therapeutic Research Institute, Keck School of Medicine, University of Southern California, San Diego
| | - Reisa Sperling
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- Department of Neurology, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Joshua D. Grill
- Institute for Memory Impairments and Neurological Disorders, University of California Irvine
- Department of Psychiatry and Human Behavior, University of California Irvine
- Department of Neurobiology and Behavior, University of California Irvine
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Bernstein OM, Grill JD, Gillen DL. Recruitment and retention of participant and study partner dyads in two multinational Alzheimer's disease registration trials. Alzheimers Res Ther 2021; 13:16. [PMID: 33419457 PMCID: PMC7791680 DOI: 10.1186/s13195-020-00762-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 12/23/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Early study exit is detrimental to statistical power and increases the risk for bias in Alzheimer's disease clinical trials. Previous analyses in early phase academic trials demonstrated associations between rates of trial incompletion and participants' study partner type, with participants enrolling with non-spouse study partners being at greater risk. METHODS We conducted secondary analyses of two multinational phase III trials of semagacestat, an oral gamma secretase inhibitor, for mild-to-moderate AD dementia. Cox's proportional hazards regression model was used to estimate the relationship between study partner type and the risk of early exit from the trial after adjustment for a priori identified potential confounding factors. Additionally, we used a random forest model to identify top predictors of dropout. RESULTS Among participants with spousal, adult child, and other study partners, respectively, 35%, 38%, and 36% dropped out or died prior to protocol-defined study completion, respectively. In unadjusted models, the risk of trial incompletion differed by study partner type (unadjusted p value = 0.027 for test of differences by partner type), but in models adjusting for potential confounding factors, the differences were not statistically significant (p value = 0.928). In exploratory modeling, participant age was identified as the primary characteristic to explain the relationship between study partner type and the risk of failing to complete the trial. Participant age was also the strongest predictor of trial incompletion in the random forest model. CONCLUSIONS After adjustment for age, no differences in the risk of incompletion were observed when comparing participants with different study partner types in these trials. Differences between our findings and the findings of previous studies may be explained by differences in trial phase, size, geographic regions, or the composition of academic and non-academic sites.
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Affiliation(s)
- Olivia M Bernstein
- Department of Statistics, University of California, Irvine, Bren Hall 2019, Irvine, CA, 92697-1250, USA.
| | - Joshua D Grill
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, Irvine, CA, USA
- Alzheimer's Disease Research Center, University of California, Irvine, Irvine, CA, USA
- Department of Psychiatry and Human Behavior, University of California, Irvine, Irvine, CA, USA
- Department of Neurobiology and Behavior, University of California, Irvine, Irvine, CA, USA
| | - Daniel L Gillen
- Department of Statistics, University of California, Irvine, Bren Hall 2019, Irvine, CA, 92697-1250, USA
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, Irvine, CA, USA
- Alzheimer's Disease Research Center, University of California, Irvine, Irvine, CA, USA
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Deniz K, Ho CCG, Malphrus KG, Reddy JS, Nguyen T, Carnwath TP, Crook JE, Lucas JA, Graff-Radford NR, Carrasquillo MM, Ertekin-Taner N. Plasma Biomarkers of Alzheimer's Disease in African Americans. J Alzheimers Dis 2021; 79:323-334. [PMID: 33252078 PMCID: PMC7902984 DOI: 10.3233/jad-200828] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background/Objective: The aim of this study was to determine if plasma concentrations of 5 surrogate markers of Alzheimer’s disease (AD) pathology and neuroinflammation are associated with disease status in African Americans. Methods: We evaluated 321 African Americans (159 AD, 162 controls) from the Florida Consortium for African-American Alzheimer’s Disease Studies (FCA3DS). Five plasma proteins reflecting AD neuropathology or inflammation (Aβ42, tau, IL6, IL10, TNFα) were tested for associations with AD, age, sex, APOE and MAPT genotypes, and for pairwise correlations. Results: Plasma tau levels were higher in AD when adjusted for biological and technical covariates. APOEɛ4 was associated with lower plasma Aβ42 and tau levels. Older age was associated with higher plasma Aβ42, tau, and TNFα. Females had lower IL10 levels. Inflammatory proteins had strong pairwise correlations amongst themselves and with Aβ42. Conclusion: We identified effects of demographic and genetic variants on five potential plasma biomarkers in African Americans. Plasma inflammatory biomarkers and Aβ42 may reflect correlated pathologies and elevated plasma tau may be a biomarker of AD in this population.
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Affiliation(s)
- Kaancan Deniz
- Mayo Clinic, Department of Neuroscience, Jacksonville, FL, USA
| | | | | | - Joseph S Reddy
- Mayo Clinic, Department of Health Science Research, Jacksonville, FL, USA
| | - Thuy Nguyen
- Mayo Clinic, Department of Neuroscience, Jacksonville, FL, USA
| | - Troy P Carnwath
- Mayo Clinic, Department of Neuroscience, Jacksonville, FL, USA
| | - Julia E Crook
- Mayo Clinic, Department of Health Science Research, Jacksonville, FL, USA
| | - John A Lucas
- Mayo Clinic, Department of Psychiatry and Psychology, Jacksonville, FL, USA
| | | | | | - Nilüfer Ertekin-Taner
- Mayo Clinic, Department of Neuroscience, Jacksonville, FL, USA.,Mayo Clinic, Department of Neurology, Jacksonville, FL, USA
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Comparing fluid biomarkers of Alzheimer's disease between African American or Black African and white groups: A systematic review and meta-analysis. J Neurol Sci 2020; 421:117270. [PMID: 33349466 DOI: 10.1016/j.jns.2020.117270] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 11/19/2020] [Accepted: 12/10/2020] [Indexed: 12/29/2022]
Abstract
RATIONALE Biomarker research for Alzheimer's disease (AD) has grown rapidly in recent years, ensuing the integration of the AD fluid biomarker profile: Aβ1-42, t-tau, and p-tau181, into clinical and research criteria. However, current insights of AD arise almost exclusively from studies on white individuals. Some studies have revealed that epidemiology, clinical features, and genetics of AD show variations between individuals from black and white backgrounds, conveying the importance of ethnoracial differences, and the possibility of such differences also influencing AD biomarker levels. This systematic review explored whether AD fluid biomarker levels differ between African American (AA) or Black African and white groups. AIM To compare AD fluid biomarkers (Aβ1-42, p-tau181, and t-tau) levels between AA or Black Africans and white individuals. METHOD PubMed, Scopus, and other sources were explored for studies that quantified AD biomarkers in biological fluid from whites and AA or Black African groups. Meta-analyses were performed to find the standardized mean difference for biomarkers that were quantified in ≥3 studies. RESULTS Five studies were included; studies on Black Africans were not found. The meta-analyses found CSF t-tau and p-tau181 were consistently lower in AA than white individuals, in samples with normal cognition or with mild cognitive impairment/dementia. CONCLUSIONS The meta-analyses found significant differences for CSF tau between AA and white individuals with normal cognition and within the dementia spectrum, expressing the importance of taking into account ethnoracial factors when interpreting CSF AD biomarkers levels. However, the generalisability of these differences is restricted by small samples' size, lack of unified methodologies and recruitment's biases within studies; further large multicentre studies with harmonized protocols and sufficient power are imperative to investigate the extent of ethnoracial differences across the spectrum of cognitive decline, with vaster efforts necessary to diversify recruitment.
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Portacolone E, Palmer NR, Lichtenberg P, Waters CM, Hill CV, Keiser S, Vest L, Maloof M, Tran T, Martinez P, Guerrero J, Johnson JK. Earning the Trust of African American Communities to Increase Representation in Dementia Research. Ethn Dis 2020; 30:719-734. [PMID: 33250619 DOI: 10.18865/ed.30.s2.719] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Black/African American populations are underrepresented as participants in dementia research. A major barrier to participation of African American older adults in dementia research is a tendency to distrust research institutions owing to both historical and contemporary racism. Building on the Ford framework, the objective of our study was to examine factors that influence participation in dementia research among African American older adults and caregivers, with an emphasis on understanding factors related to trust. Data were collected during January 2019 and March 2020 from 10 focus groups with African American older adults (n=91), 5 focus groups with caregivers (n=44), and interviews with administrators of community-based organizations (n=11), and meetings with our Community Advisory Board. Inductive/deductive content analysis was used to identify themes. The results identified an overall tension between distrust of researchers and a compelling desire to engage in dementia research. This overarching theme was supported by six themes that provided insights about the multiple layers of distrust, as well as expectations about the appropriate conduct of researchers and academic institutions. Strong commitment to the community was identified as a priority. The findings suggest that a paradigm shift is needed to increase the representation of African Americans in dementia research. In this new paradigm, earning the trust of African American communities becomes a systemic endeavor, with academic, state, and national institutions deeply committed to earning the trust of African American communities and guiding researchers in this endeavor. The findings also generated actionable recommendations to help improve representation of African American older adults in dementia research.
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Affiliation(s)
- Elena Portacolone
- Institute for Health & Aging; University of California San Francisco, CA
| | - Nynikka R Palmer
- Division of General Internal Medicine at Zuckerberg San Francisco General Hospital,University of California San Francisco, San Francisco, CA
| | - Peter Lichtenberg
- Department of Psychology, Institute of Gerontology, Michigan Center for Urban African American Research, Wayne State University, Detroit, MI
| | - Catherine M Waters
- School of Nursing, University of California San Francisco, San Francisco, CA
| | | | - Sahru Keiser
- Institute for Health & Aging; University of California San Francisco, CA
| | - Leah Vest
- Institute for Health & Aging; University of California San Francisco, CA
| | | | - Thi Tran
- Institute for Health & Aging; University of California San Francisco, CA
| | - Paula Martinez
- Institute for Health & Aging; University of California San Francisco, CA
| | - Javier Guerrero
- Institute for Health & Aging; University of California San Francisco, CA
| | - Julene K Johnson
- Institute for Health & Aging; University of California San Francisco, CA
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Training needs of investigators and research team members to improve inclusivity in clinical and translational research participation. J Clin Transl Sci 2020; 5:e57. [PMID: 33948278 PMCID: PMC8057444 DOI: 10.1017/cts.2020.554] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Despite increasing attention to the importance of diverse research participants, success across the translational research spectrum remains limited. To assess investigator and research team training needs, we conducted a web-based survey exploring barriers in knowledge and practice. Respondents (n = 279) included those affiliated with the University of Wisconsin Institute for Clinical and Translational Research (ICTR). Although all respondents reported an abstract belief in the importance of diversity, factors associated with higher levels of best practices knowledge and implementation included: (1) use of federal funding; (2) having fewer years of experience; (3) recruiting healthy participants; and (4) having recruitment training.
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Proactive Recruitment of Older African-Americans for Alzheimer's Research with Brain Donation: a Cohort Case Study of Success. J Racial Ethn Health Disparities 2020; 8:463-474. [PMID: 32588397 DOI: 10.1007/s40615-020-00803-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 06/09/2020] [Accepted: 06/11/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Older African-American adults are under-recruited for Alzheimer's-related research that includes brain donation. OBJECTIVE This article describes the Minority Aging Research Study's brain donation challenges, processes, and successful procurement with older African-American adults (65 years and older). DESIGN AND METHODS The recruitment and retention strategy of the Minority Aging Research Study Brain Gifting Program was developed in accordance with Peplau's theory of interpersonal relationship and Swanson's middle-range theory of caring. RESULTS At the time of this submission, approximately 345 of 755 older African-American adults in the Minority Aging Research Study consented to brain donation to be completed at the time of death. Furthermore, the Minority Aging Research Study has had 33 successful brain donations with family amenability. DISCUSSION Tailored caring behaviors are effective to achieve high donation rates with older African-American adults who have consented to brain donation within an Alzheimer Research Study. IMPLICATIONS Changes in funding policy are needed to meet tailored active recruitment that is required to close the gaps in older African-American adults' participation in Alzheimer's-related research studies.
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Kaplow J, Vandijck M, Gray J, Kanekiyo M, Huyck E, Traynham CJ, Esquivel R, Fagan AM, Luthman J. Concordance of Lumipulse cerebrospinal fluid t-tau/Aβ42 ratio with amyloid PET status. Alzheimers Dement 2020; 16:144-152. [PMID: 31914216 PMCID: PMC7061432 DOI: 10.1002/alz.12000] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 10/08/2019] [Accepted: 10/20/2019] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Cerebrospinal fluid (CSF) biomarkers can identify individuals with Alzheimer's disease (AD) pathology (eg, amyloid plaques, neurofibrillary tangles), but defined analyte cut-points using high-throughput automated assays are necessary for general clinical use. METHODS CSF amyloid β42 peptide (Aβ42), t-tau, and t-tau/Aβ42 were quantified by the Lumipulse platform in two test cohorts (A/B: Eisai BAN2401-201/MISSION AD E2609-301/302, n = 138; C: Knight Alzheimer's Disease Research Center (ADRC), n = 198), and receiver operating characteristic (ROC) curve analyses defined cut-points corresponding best to amyloid determinations using positron emission tomography (PET) imaging. The best-performing cut-point was then validated as a predictor of amyloid status in an independent cohort (D: MISSION AD E2609-301/302, n = 240). RESULTS Virtually identical t-tau/Aβ42 cut-points (∼0.54) performed best in both test cohorts and with similar accuracy (areas under ROC curve [AUCs] [A/B: 0.95; C: 0.94]). The cut-point yielded an overall percent agreement with amyloid PET of 85.0% in validation cohort D. DISCUSSION Lumipulse CSF biomarker measures with validated cut-points have clinical utility in identifying AD pathology.
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Affiliation(s)
| | | | - Julia Gray
- Department of Neurology, Knight Alzheimer’s Disease Research Center, Washington University, St. Louis, MO, 63110, USA
| | | | - Els Huyck
- Fujirebio Europe, Ghent, 9052 Belgium
| | - CJ Traynham
- Fujirebio Diagnostics Inc., Malvern, PA, 19355, USA
| | | | - Anne M. Fagan
- Department of Neurology, Knight Alzheimer’s Disease Research Center, Washington University, St. Louis, MO, 63110, USA
- Corresponding author: Anne M. Fagan, PhD, Dept. of Neurology, Washington University in St. Louis, 660 S. Euclid Ave., Campus Box 8111, St. Louis, MO 63110, Tel: (314) 362-3453, Fax: (314) 362-2244,
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Amariglio RE, Buckley RF, Rabin JS, Papp KV, Quiroz YT, Mormino EC, Sparks KP, Johnson KA, Rentz DM, Sperling RA. Examining Cognitive Decline Across Black and White Participants in the Harvard Aging Brain Study. J Alzheimers Dis 2020; 75:1437-1446. [PMID: 32417775 PMCID: PMC7397774 DOI: 10.3233/jad-191291] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Black Americans are approximately twice as likely to develop dementia as compared to White Americans and the magnitude of this disparity is often attributed to a variety of factors that include psychosocial and vascular risk factors. However, less is known about the potential contribution of Alzheimer's disease pathological differences. OBJECTIVE To examine potential differences incross-sectional and longitudinal cognitive performance in black and white participants who were clinically normal at baseline. METHODS 296 participants (48 African-American/black participants) underwent MRI and amyloid PET at baseline. Linear mixed models were used to examine the main effects of race, years of education, reading ability, Framingham Heart Study cardiovascular risk score (FHS-CVD), white matter hyperintensities (WMH), and amyloid (Aβ) burden on the Preclinical Alzheimer Cognitive Composite-5 (PACC5). RESULTS Lower levels of educationalattainment and reading ability were found for blacks compared to whites. By contrast, no differences in FHS-CVD, WMH, or Aβ were found by racial group. Baseline differences in PACC5 score were attenuated after adjusting for educationalfactors, vascular factors, and Aβ, but remained lower for blacks compared to whites (β= -0.24, p = 0.014). Further, blacks demonstrated a faster rate of PACC5 decline longitudinally compared to whites (β = -0.055, p = 0.025) after adjusting for covariates. CONCLUSION Accounting for educationalfactors, vascular factors, and Aβ burden diminished, but did not eliminate, racial differences in PACC5 performance longitudinally. Understanding potential differences in longitudinal cognitive outcomes by race may be important for upcoming secondary prevention trials.
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Affiliation(s)
- Rebecca E. Amariglio
- Center for Alzheimer Research and Treatment, Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts 02115
- Department of Neurology, Massachusetts General Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114
| | - Rachel F. Buckley
- Department of Neurology, Massachusetts General Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114
- Florey Institute, University of Melbourne, Parkville, Victoria, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Jennifer S. Rabin
- Department of Psychiatry, Massachusetts General Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114
| | - Kathryn V. Papp
- Center for Alzheimer Research and Treatment, Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts 02115
- Department of Neurology, Massachusetts General Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114
| | - Yakeel T. Quiroz
- Department of Neurology, Massachusetts General Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114
- Department of Psychiatry, Massachusetts General Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114
| | - Elizabeth C. Mormino
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Kathryn P. Sparks
- Department of Neurology, Massachusetts General Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114
| | - Keith A. Johnson
- Center for Alzheimer Research and Treatment, Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts 02115
- Department of Neurology, Massachusetts General Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114
| | - Dorene M. Rentz
- Center for Alzheimer Research and Treatment, Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts 02115
- Department of Neurology, Massachusetts General Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114
| | - Reisa A. Sperling
- Center for Alzheimer Research and Treatment, Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts 02115
- Department of Neurology, Massachusetts General Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114
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Green-Harris G, Coley SL, Koscik RL, Norris NC, Houston SL, Sager MA, Johnson SC, Edwards DF. Addressing Disparities in Alzheimer's Disease and African-American Participation in Research: An Asset-Based Community Development Approach. Front Aging Neurosci 2019; 11:125. [PMID: 31214014 PMCID: PMC6554429 DOI: 10.3389/fnagi.2019.00125] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 05/13/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- Gina Green-Harris
- Wisconsin Alzheimer's Institute Regional Milwaukee Office, University of Wisconsin School of Medicine and Public Health, Milwaukee, WI, United States.,Center for Community Engagement and Health Partnerships, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Sheryl L Coley
- Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Rebecca L Koscik
- Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Nia C Norris
- Wisconsin Alzheimer's Institute Regional Milwaukee Office, University of Wisconsin School of Medicine and Public Health, Milwaukee, WI, United States
| | - Stephanie L Houston
- Wisconsin Alzheimer's Institute Regional Milwaukee Office, University of Wisconsin School of Medicine and Public Health, Milwaukee, WI, United States
| | - Mark A Sager
- Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Sterling C Johnson
- Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States.,Geriatric Research Education and Clinical Center, Wm. S. Middleton Veterans Hospital, Madison, WI, United States.,Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Dorothy Farrar Edwards
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States.,Department of Kinesiology, School of Education, University of Wisconsin, Madison, WI, United States.,Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
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Canevelli M, Bruno G, Grande G, Quarata F, Raganato R, Remiddi F, Valletta M, Zaccaria V, Vanacore N, Cesari M. Race reporting and disparities in clinical trials on Alzheimer's disease: A systematic review. Neurosci Biobehav Rev 2019; 101:122-128. [PMID: 30946856 DOI: 10.1016/j.neubiorev.2019.03.020] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 02/24/2019] [Accepted: 03/24/2019] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Race is an important health determinant and should adequately be considered in research and drug development protocols targeting Alzheimer's disease (AD). METHODS A systematic review of available randomized controlled trials (RCTs) on the currently marketed treatments for AD was conducted with the aim of 1) documenting the reporting of race, and 2) exploring the impact of race on the efficacy and safety/tolerability of the considered medications. RESULTS Overall, 59.2% of the 49 retained RCTs reported information concerning the race of participants. Only a striking minority of enrolled patients was constituted of blacks and Hispanics. None on the retained studies reported results on the efficacy and safety/tolerability of the tested treatment separately for racial groups nor performed sensitivity analyses accounting for the race of participants. DISCUSSION Race has insufficiently been reported in previous interventional studies on AD. Its potential association with the effectiveness and safety/tolerability of the tested medications has completely been neglected.
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Affiliation(s)
- Marco Canevelli
- Department of Human Neuroscience, "Sapienza" University, Rome, Italy; National Center for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy.
| | - Giuseppe Bruno
- Department of Human Neuroscience, "Sapienza" University, Rome, Italy
| | - Giulia Grande
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Federica Quarata
- Department of Human Neuroscience, "Sapienza" University, Rome, Italy
| | - Riccardo Raganato
- Department of Human Neuroscience, "Sapienza" University, Rome, Italy
| | - Francesca Remiddi
- Department of Human Neuroscience, "Sapienza" University, Rome, Italy
| | - Martina Valletta
- Department of Human Neuroscience, "Sapienza" University, Rome, Italy
| | - Valerio Zaccaria
- Department of Human Neuroscience, "Sapienza" University, Rome, Italy
| | - Nicola Vanacore
- National Center for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy
| | - Matteo Cesari
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy; Geriatric Unit, Department of Clinical Sciences and Community Health, University of Milan, Milano, Italy
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Largent EA, Karlawish J, Grill JD. Study partners: essential collaborators in discovering treatments for Alzheimer's disease. Alzheimers Res Ther 2018; 10:101. [PMID: 30261910 PMCID: PMC6161465 DOI: 10.1186/s13195-018-0425-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Global leaders have set an ambitious goal of developing interventions to effectively treat or prevent Alzheimer's disease by 2025. CASE PRESENTATION Achieving this goal will require clinical trials to test promising interventions, yet Alzheimer's researchers are confronting a clinical trial recruitment crisis. One reason for this is that Alzheimer's disease trials must enroll "dyads" composed of both a participant and his or her study partner. CONCLUSIONS In this article, we argue that it is essential to identify ways to facilitate study partner participation, such as removing logistical barriers, offering payment, and providing paid, protected time off for study visits. Facilitating participation, particularly among non-spousal study partners, should offer a twofold benefit: faster accrual and greater generalizability of results.
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Affiliation(s)
- Emily A. Largent
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Blockley Hall, Room 1403, 423 Guardian Drive, Philadelphia, PA 19104 USA
- Leonard Davis Institute of Health Economics, 3641 Locust Walk # 210, Philadelphia, PA 19104 USA
| | - Jason Karlawish
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, 3400 Civic Center Boulevard, Building 421, Philadelphia, PA USA
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Dulles 3rd Floor, 3400 Spruce Street, Philadelphia, PA 19104 USA
| | - Joshua D. Grill
- Department of Psychiatry and Human Behavior, University of California Irvine, Neuropsychiatric Center, 101 The City Drive South,Third Floor Orange, Irvine, 92868 USA
- Department of Neurobiology and Behavior, University of California Irvine, 2205 McGaugh Hall, Irvine, CA 92697 USA
- Institute for Memory Impairments and Neurological Disorders, Institute for Clinical and Translational Science, 2642 Biological Sciences III, Irvine, CA 92697-4545 USA
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Ferguson SA, Panos JJ, Sloper D, Varma V. Neurodegenerative Markers are Increased in Postmortem BA21 Tissue from African Americans with Alzheimer's Disease. J Alzheimers Dis 2018; 59:57-66. [PMID: 28582866 DOI: 10.3233/jad-170204] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Alzheimer's disease (AD) presents with an earlier onset age and increased symptom severity in African Americans and Hispanics. OBJECTIVE Although the prevalence of plaques and tangles may not exhibit ethnicity-related differences, levels of neurodegenerative proteins have not been described. METHODS Here, levels of five proteins (i.e., S100B, sRAGE, GDNF, Aβ40, and Aβ42) and the Aβ42/Aβ40 ratio were measured in postmortem samples of the middle temporal gyrus (BA21) from age-matched African Americans and Caucasians with AD (n = 6/gender/ethnicity). RESULTS S100B levels were increased 17% in African Americans (p < 0.003) while sRAGE was mildly decreased (p < 0.09). Aβ42 levels were increased 121% in African Americans (p < 0.02), leading to a 493% increase in the Aβ42/Aβ40 ratio (p < 0.002). Analysis of GDNF levels did not indicate any significant effects. There were no significant effects of gender and no significant ethnicity with gender interactions on any analyte. Effect size calculations indicated "medium" to "very large" effects. CONCLUSION S100B is typically elevated in AD cases; however, the increased levels in African Americans here may be indicative of increased severity in specific populations. Increased Aβ42/Aβ40 ratios in the current study are compatible with increased disease severity and might indicate increased AD pathogenesis in African Americans. Overall, these results are compatible with a hypothesis of increased neuroinflammation in African Americans with AD.
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Affiliation(s)
- Sherry A Ferguson
- Division of Neurotoxicology, National Center for Toxicological Research/Food and Drug Administration, Jefferson, AR, USA
| | - John J Panos
- Division of Neurotoxicology, National Center for Toxicological Research/Food and Drug Administration, Jefferson, AR, USA
| | - Daniel Sloper
- Division of Systems Biology, National Center for Toxicological Research/Food and Drug Administration, Jefferson, AR, USA
| | - Vijayalakshmi Varma
- Division of Systems Biology, National Center for Toxicological Research/Food and Drug Administration, Jefferson, AR, USA
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40
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Howell JC, Parker MW, Watts KD, Kollhoff A, Tsvetkova DZ, Hu WT. Research Lumbar Punctures among African Americans and Caucasians: Perception Predicts Experience. Front Aging Neurosci 2016; 8:296. [PMID: 27994549 PMCID: PMC5133251 DOI: 10.3389/fnagi.2016.00296] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 11/21/2016] [Indexed: 12/21/2022] Open
Abstract
African Americans are under-represented in Alzheimer's disease (AD)-related biomarker studies, and it has been speculated that mistrust plays a major factor in the recruitment of African Americans for studies involving invasive procedures such as the lumbar puncture (LP). We set out to determine factors associated with non-participation in a biomarker study aiming to explore cerebrospinal fluid (CSF) AD biomarker differences between older African Americans and Caucasians. We also surveyed participants' procedure-related perception (a standard medical procedure vs. a frightening invasive procedure) and reluctance, as well as the rate and type of post-procedure discomfort and complications. Among 288 subjects approached for study participation, 145 (50.3%) refused participation with concerns over LP being the most commonly reported reason. Relatively more African Americans than Caucasians reported concerns over LP as the main reason for non-participation (46% vs. 25%, p = 0.03), but more African Americans also did not provide a specific reason for non-participation. Among those who completed study participation (including the LP), African Americans and Caucasians were similar in pre-LP perceptions and reluctance, as well as post-LP rates of discomfort or complication. Perceiving LP as a frightening invasive procedure, not race, is associated with increased likelihood of post-LP discomfort or complication (RR 6.2, 95% confidence interval 1.1-37.0). Our results indicate that LP is a well perceived procedure in a cohort of African American and Caucasian research participants, and is associated with few serious complications. The pre-procedure perception that the LP is a frightening invasive procedure significantly increases the risk of self-reported discomfort of complications, and African Americans may be more likely to turn down study participation because of the LP. Future studies will need to address factors associated with negative LP perceptions to further assure participants and reduce complication rates.
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Affiliation(s)
- Jennifer C Howell
- Department of Neurology, Emory University School of MedicineAtlanta, GA, USA; Center for Neurodegenerative Diseases Research, Emory University School of MedicineAtlanta, GA, USA; Alzheimer's Disease Research Center, Emory University School of MedicineAtlanta, GA, USA
| | - Monica W Parker
- Department of Neurology, Emory University School of MedicineAtlanta, GA, USA; Alzheimer's Disease Research Center, Emory University School of MedicineAtlanta, GA, USA
| | - Kelly D Watts
- Department of Neurology, Emory University School of MedicineAtlanta, GA, USA; Center for Neurodegenerative Diseases Research, Emory University School of MedicineAtlanta, GA, USA; Alzheimer's Disease Research Center, Emory University School of MedicineAtlanta, GA, USA
| | - Alexander Kollhoff
- Department of Neurology, Emory University School of MedicineAtlanta, GA, USA; Center for Neurodegenerative Diseases Research, Emory University School of MedicineAtlanta, GA, USA; Alzheimer's Disease Research Center, Emory University School of MedicineAtlanta, GA, USA
| | - Dobromira Z Tsvetkova
- Department of Neurology, Emory University School of MedicineAtlanta, GA, USA; Center for Neurodegenerative Diseases Research, Emory University School of MedicineAtlanta, GA, USA
| | - William T Hu
- Department of Neurology, Emory University School of MedicineAtlanta, GA, USA; Center for Neurodegenerative Diseases Research, Emory University School of MedicineAtlanta, GA, USA; Alzheimer's Disease Research Center, Emory University School of MedicineAtlanta, GA, USA
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