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Vermunt L, Muniz-Terrera G, ter Meulen L, Veal C, Blennow K, Campbell A, Carrié I, Delrieu J, Fauria K, Huesa Rodríguez G, Ingala S, Jenkins N, Molinuevo JL, Ousset PJ, Porteous D, Prins ND, Solomon A, Tom BD, Zetterberg H, Zwan M, Ritchie CW, Scheltens P, Luscan G, Brookes AJ, Visser PJ. Prescreening for European Prevention of Alzheimer Dementia (EPAD) trial-ready cohort: impact of AD risk factors and recruitment settings. Alzheimers Res Ther 2020; 12:8. [PMID: 31907067 PMCID: PMC6945608 DOI: 10.1186/s13195-019-0576-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Accepted: 12/23/2019] [Indexed: 12/02/2022]
Abstract
BACKGROUND Recruitment is often a bottleneck in secondary prevention trials in Alzheimer disease (AD). Furthermore, screen-failure rates in these trials are typically high due to relatively low prevalence of AD pathology in individuals without dementia, especially among cognitively unimpaired. Prescreening on AD risk factors may facilitate recruitment, but the efficiency will depend on how these factors link to participation rates and AD pathology. We investigated whether common AD-related factors predict trial-ready cohort participation and amyloid status across different prescreen settings. METHODS We monitored the prescreening in four cohorts linked to the European Prevention of Alzheimer Dementia (EPAD) Registry (n = 16,877; mean ± SD age = 64 ± 8 years). These included a clinical cohort, a research in-person cohort, a research online cohort, and a population-based cohort. Individuals were asked to participate in the EPAD longitudinal cohort study (EPAD-LCS), which serves as a trial-ready cohort for secondary prevention trials. Amyloid positivity was measured in cerebrospinal fluid as part of the EPAD-LCS assessment. We calculated participation rates and numbers needed to prescreen (NNPS) per participant that was amyloid-positive. We tested if age, sex, education level, APOE status, family history for dementia, memory complaints or memory scores, previously collected in these cohorts, could predict participation and amyloid status. RESULTS A total of 2595 participants were contacted for participation in the EPAD-LCS. Participation rates varied by setting between 3 and 59%. The NNPS were 6.9 (clinical cohort), 7.5 (research in-person cohort), 8.4 (research online cohort), and 88.5 (population-based cohort). Participation in the EPAD-LCS (n = 413 (16%)) was associated with lower age (odds ratio (OR) age = 0.97 [0.95-0.99]), high education (OR = 1.64 [1.23-2.17]), male sex (OR = 1.56 [1.19-2.04]), and positive family history of dementia (OR = 1.66 [1.19-2.31]). Among participants in the EPAD-LCS, amyloid positivity (33%) was associated with higher age (OR = 1.06 [1.02-1.10]) and APOE ɛ4 allele carriership (OR = 2.99 [1.81-4.94]). These results were similar across prescreen settings. CONCLUSIONS Numbers needed to prescreen varied greatly between settings. Understanding how common AD risk factors link to study participation and amyloid positivity is informative for recruitment strategy of studies on secondary prevention of AD.
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Affiliation(s)
- Lisa Vermunt
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit, PO Box 7057, 1007 MB Amsterdam, The Netherlands
| | | | - Lea ter Meulen
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit, PO Box 7057, 1007 MB Amsterdam, The Netherlands
| | - Colin Veal
- Department of Genetics, University of Leicester, Leicester, UK
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Archie Campbell
- Molecular Medicine Centre, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Isabelle Carrié
- Centre de Recherche Clinique du Gérontopôle, Toulouse University Hospital, Toulouse, France
| | - Julien Delrieu
- Gérontopôle de Toulouse, UMR INSERM 1027, Toulouse University Hospital, Toulouse, France
| | - Karine Fauria
- BarcelonaBeta Brain Research Center, Fundacio Pasqual Maragall, Barcelona, Spain
| | - Gema Huesa Rodríguez
- BarcelonaBeta Brain Research Center, Fundacio Pasqual Maragall, Barcelona, Spain
| | - Silvia Ingala
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Natalie Jenkins
- Centre for Dementia Prevention, University of Edinburgh, Edinburgh, Scotland
| | - José Luis Molinuevo
- BarcelonaBeta Brain Research Center, Fundacio Pasqual Maragall, Barcelona, Spain
| | - Pierre-Jean Ousset
- Centre de Recherche Clinique du Gérontopôle, Toulouse University Hospital, Toulouse, France
| | - David Porteous
- Molecular Medicine Centre, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Niels D. Prins
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit, PO Box 7057, 1007 MB Amsterdam, The Netherlands
- Brain Research Center, Amsterdam, The Netherlands
| | - Alina Solomon
- Institute of Clinical Medicine, Neurology, University of Eastern Finland, P.O. Box 1627, 70211 Kuopio, Finland
- Division of Clinical Geriatrics, NVS, Karolinska Institutet, Stockholm, Sweden
| | - Brian D. Tom
- MRC Biostatistics Unit, University of Cambridge, Cambridge, UK
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Department of Neurodegenerative Disease, UCL Institute of Neurology, London, UK
- UK Dementia Research Institute at UCL, London, UK
| | - Marissa Zwan
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit, PO Box 7057, 1007 MB Amsterdam, The Netherlands
| | - Craig W. Ritchie
- Centre for Dementia Prevention, University of Edinburgh, Edinburgh, Scotland
| | - Philip Scheltens
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit, PO Box 7057, 1007 MB Amsterdam, The Netherlands
| | - Gerald Luscan
- Global Innovative Pharma Business – Clinical Sciences, Pfizer, Paris, France
| | | | - Pieter Jelle Visser
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit, PO Box 7057, 1007 MB Amsterdam, The Netherlands
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Alzheimer Centrum Limburg, Maastricht University, Maastricht, The Netherlands
| | - for the IMI-EPAD collaborators
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit, PO Box 7057, 1007 MB Amsterdam, The Netherlands
- Centre for Dementia Prevention, University of Edinburgh, Edinburgh, Scotland
- Department of Genetics, University of Leicester, Leicester, UK
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Molecular Medicine Centre, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
- Centre de Recherche Clinique du Gérontopôle, Toulouse University Hospital, Toulouse, France
- Gérontopôle de Toulouse, UMR INSERM 1027, Toulouse University Hospital, Toulouse, France
- BarcelonaBeta Brain Research Center, Fundacio Pasqual Maragall, Barcelona, Spain
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
- Brain Research Center, Amsterdam, The Netherlands
- Institute of Clinical Medicine, Neurology, University of Eastern Finland, P.O. Box 1627, 70211 Kuopio, Finland
- Division of Clinical Geriatrics, NVS, Karolinska Institutet, Stockholm, Sweden
- MRC Biostatistics Unit, University of Cambridge, Cambridge, UK
- Department of Neurodegenerative Disease, UCL Institute of Neurology, London, UK
- UK Dementia Research Institute at UCL, London, UK
- Global Innovative Pharma Business – Clinical Sciences, Pfizer, Paris, France
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Alzheimer Centrum Limburg, Maastricht University, Maastricht, The Netherlands
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