Generalizability of findings from a clinical sample to a community‐based sample: A comparison of ADNI and ARIC

Gianattasio, Kan Z.; Bennett, Erin; Wei, Jingkai; Mehrotra, Megha; Mosley, Thomas H.; Gottesman, Rebecca F.; Wong, Dean F.; Stuart, Elizabeth A.; Griswold, Michael; Couper, David; Glymour, M. Maria; Power, Melinda C.

doi:10.1002/alz.12293

Cited by 24 publications

(27 citation statements)

References 49 publications

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“…Furthermore, we note that previous studies have shown that associations between ε4 and AD have been substantially larger when estimated in clinic‐based samples versus community‐based populations (odds ratio [OR] = 8.6 vs. 2.8, respectively) 41 . Our associations are smaller still.…”

Section: Discussioncontrasting

confidence: 72%

Apolipoprotein E (APOE) genotype, dementia, and memory performance among Caribbean Hispanic versus US populations

Llibre‐Guerra

Qian

et al. 2022

Alzheimer's & Dementia

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Introduction Apolipoprotein E (APOE) is considered the major susceptibility gene for developing Alzheimer's disease. However, the strength of this risk factor is not well established across diverse Hispanic populations. Methods We investigated the associations among APOE genotype, dementia prevalence, and memory performance (immediate and delayed recall scores) in Caribbean Hispanics (CH), African Americans (AA), Hispanic Americans (HA) and non‐Hispanic White Americans (NHW). Multivariable logistic regressions and negative binomial regressions were used to examine these associations by subsample. Results Our final dataset included 13,516 participants (5198 men, 8318 women) across all subsamples, with a mean age of 74.8 years. Prevalence of APOE ε4 allele was similar in CHs, HAs, and NHWs (21.8%–25.4%), but was substantially higher in AAs (33.6%; P < 0.001). APOE ε4 carriers had higher dementia prevalence across all groups. Discussion APOE ε4 was similarly associated with increased relative risk of dementia and lower memory performance in all subsamples.

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Section: Discussioncontrasting

confidence: 72%

Apolipoprotein E (APOE) genotype, dementia, and memory performance among Caribbean Hispanic versus US populations

Llibre‐Guerra

Qian

et al. 2022

Alzheimer's & Dementia

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“…One study showed that a significant proportion of the estimates of associations among predictors, cognitive performance, and neuroimaging studies differed between the ADNI cohort and a community-based sample. 42 In addition, the simulated trajectories for CDR-SB in the AD ACE model have not been validated against the community sample, but they do agree well with the mean trajectories from the NACC data set. 9 Another limitation is that our analyses are based on changes in a single measure of clinical outcome (ie, CDR-SB).…”

Section: Discussionmentioning

confidence: 90%

Evaluation of the Cost-effectiveness of Drug Treatment for Alzheimer Disease in a Simulation Model That Includes Caregiver and Societal Factors

et al. 2021

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IMPORTANCEThe possibility of widespread use of a novel effective therapy for Alzheimer disease (AD) will present important clinical, policy, and financial challenges. OBJECTIVE To describe how including different patient, caregiver, and societal treatment-related factors affects estimates of the cost-effectiveness of a hypothetical disease-modifying AD treatment. DESIGN, SETTING, AND PARTICIPANTS In this economic evaluation, the Alzheimer Disease Archimedes Condition Event Simulator was used to simulate the prognosis of a hypothetical cohort of patients selected from the Alzheimer Disease Neuroimaging Initiative database who received the diagnosis of mild cognitive impairment (MCI). Scenario analyses that varied costs and quality of life inputs relevant to patients and caregivers were conducted. The analysis was designed and conducted from June 15, 2019, to September 30, 2020. EXPOSURES A hypothetical drug that would delay progression to dementia in individuals with MCI compared with usual care. MAIN OUTCOMES AND MEASURES Incremental cost-effectiveness ratio (ICER), measured by cost per quality-adjusted life-year (QALY) gained. RESULTSThe model included a simulated cohort of patients who scored between 24 and 30 on the Mini-Mental State Examination and had a global Clinical Dementia Rating scale of 0.5, with a required memory box score of 0.5 or higher, at baseline. Using a health care sector perspective, which included only individual patient health care costs, the ICER for the hypothetical treatment was $192 000 per QALY gained. The result decreased to $183 000 per QALY gained in a traditional societal perspective analysis with the inclusion of patient non-health care costs. The inclusion of estimated caregiver health care costs produced almost no change in the ICER, but the inclusion of QALYs gained by caregivers led to a substantial reduction in the ICER for the hypothetical treatment, to $107 000 per QALY gained in the health sector perspective. In the societal perspective scenario, with the broadest inclusion of patient and caregiver factors, the ICER decreased to $74 000 per added QALY. CONCLUSIONS AND RELEVANCEThe findings of this economic evaluation suggest that policy makers should be aware that efforts to estimate and include the effects of AD treatments outside those on patients themselves can affect the results of the cost-effectiveness analyses that often underpin assessments of the value of new treatments. Further research and debate on including these factors in assessments that will inform discussions on fair pricing for new treatments are needed.

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“…31,32 This might be due to the fact that ADNI participants are on average more likely to be male, highly educated, apolipoprotein ε4 positive and less cognitively impaired. 32 Therefore, the results from our study should be confirmed in a community-based sample.…”

Section: Limitations and Future Studiesmentioning

confidence: 99%

Self‐reported word‐finding complaints are associated with cerebrospinal fluid amyloid beta and atrophy in cognitively normal older adults

Montembeault

Stijelja

Brambati

2022

Alz & Dem Diag Ass & Dis Mo

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Introduction Self‐reported word‐finding difficulties are among the most frequent complaints in cognitively normal (CN) older adults. However, the clinical significance is still debated. Methods We selected 239 CN from the Alzheimer's Disease Neuroimaging Initiative database who had completed the Everyday Cognition (ECog) questionnaire, as well as a lumbar puncture for amyloid beta (Aβ) and magnetic resonance imaging. Results Word‐finding complaints, with a few other memory items, were significantly more severe compared to all other cognitive complaints. Ecog‐Lang1 (Forgetting names of objects) severity significantly predicted Aβ levels in CN, even when controlling for general cognitive complaint, demographic, and psychological variables. Individuals with high Ecog‐Lang1 complaints showed atrophy in the left fusiform gyrus and the left rolandic operculum compared to CN with low complaints. Discussion Overall, our results support the fact that word‐finding complaints should be taken seriously. They have the potential to identify CN at risk of AD and support the need to include other cognitive domains in the investigation of subjective cognitive decline.

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Generalizability of findings from a clinical sample to a community‐based sample: A comparison of ADNI and ARIC

Cited by 24 publications

References 49 publications

Apolipoprotein E (APOE) genotype, dementia, and memory performance among Caribbean Hispanic versus US populations

Apolipoprotein E (APOE) genotype, dementia, and memory performance among Caribbean Hispanic versus US populations

Evaluation of the Cost-effectiveness of Drug Treatment for Alzheimer Disease in a Simulation Model That Includes Caregiver and Societal Factors

Self‐reported word‐finding complaints are associated with cerebrospinal fluid amyloid beta and atrophy in cognitively normal older adults

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