Prescreening for European Prevention of Alzheimer Dementia (EPAD) trial-ready cohort: impact of AD risk factors and recruitment settings
Prescreening for European Prevention of Alzheimer Dementia (EPAD) trial-ready cohort: impact of AD risk factors and recruitment settings
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DOI：
10.1186/s13195-019-0576-y
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发表时间：
2020-01-06
影响因子：
9
通讯作者：
Visser, Pieter Jelle
中科院分区：
文献类型：
--
作者：
Vermunt, Lisa;Muniz-Terrera, Graciela;Visser, Pieter Jelle
背景招募常常是阿尔茨海默病（AD）二级预防试验的瓶颈。此外，这些试验中的筛查失败率通常很高，因为在没有痴呆的个体中，特别是在认知未受损的个体中，AD病理学的患病率相对较低。对AD风险因素的预筛选可能有助于招募，但效率将取决于这些因素如何与参与率和AD病理学联系起来。我们研究了在不同的预筛选设置中，常见的AD相关因素是否可预测试验就绪队列参与和淀粉样蛋白状态。方法我们监测了与欧洲预防阿尔茨海默病（EPAD）登记处（n = 16，877;平均+/- SD年龄= 64 +/- 8岁）相关的四个队列的预筛选。这些包括临床队列、研究面对面队列、研究在线队列和基于人群的队列。个体被要求参加EPAD纵向队列研究（EPAD-LCS），该研究作为二级预防试验的试验就绪队列。作为EPAD-LCS评估的一部分，在脑脊液中测量淀粉样蛋白阳性。我们计算了参与率和每个淀粉样蛋白阳性参与者需要预筛选（NNPS）的人数。我们测试了年龄，性别，教育水平，APOE状态，痴呆症家族史，记忆投诉或记忆评分，先前在这些队列中收集的，是否可以预测参与和淀粉样蛋白状态。结果共联系了2595名参与者参与EPAD-LCS。参与率因设置而异，在3%至59%之间。NNPS为6.9（临床队列）、7.5（研究面对面队列）、8.4（研究在线队列）和88.5（基于人群的队列）。参加EPAD-LCS（n = 413（16%））与较低的年龄相关（比值比（OR）年龄= 0.97 [0.95-0.99]），高学历男性（OR = 1.56 [1.19 -2.04]）和痴呆家族史（OR = 1.66 [1.19-2.31]）。在EPAD-LCS的参与者中，淀粉样蛋白阳性（33%）与较高的年龄（OR = 1.06 [1.02-1.10]）和APOE e4等位基因携带（OR = 2.99 [1.81-4.94]）相关。这些结果在预筛选设置中相似。结论：不同设置之间需要预筛选的人数差异很大。了解常见的AD风险因素如何与研究参与和淀粉样蛋白阳性联系起来，对于AD二级预防研究的招募策略具有重要意义。
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 e4 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.