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Attitudes toward clinical trials across the Alzheimer’s disease spectrum

Authors: Nuño, Michelle M; Gillen, Daniel L; Dosanjh, Kulwant K; Brook, Jenny; Elashoff, David; Ringman, John M; Grill, Joshua D;

Attitudes toward clinical trials across the Alzheimer’s disease spectrum

Abstract

Research has revealed that manifest Alzheimer's disease (AD) dementia is preceded by preclinical and prodromal phases during which pathology is accumulating but function remains intact. This understanding and concern that disease-modifying interventions initiated at the dementia stage may come too late in the neurodegenerative process to be successful has led to a paradigm shift in AD clinical trials. AD trials now enroll patients with mild cognitive impairment (MCI) and persons with no cognitive symptoms. Trial designs are similar to those enrolling dementia participants. We set out to test the hypothesis that attitudes towards trial design features differ among different potential AD trial populations.We sent a survey composed of 37 items assessing specific trial elements to 246 cognitively normal, MCI, and AD dementia participants at the University of California Los Angeles (UCLA) Alzheimer's Disease Research Center (ADRC), from whom we received 91 responses (37 cognitively normal, 32 MCI, and 22 dementia). To quantify willingness to enroll, we created three composite scenarios by summing responses and fitting proportional odds models with a binary outcome variable for whether patients were highly willing to participate in low-, moderate-, or high-risk and burden trials.MCI participants less frequently correctly self-identified their diagnoses than those with dementia or normal cognition. Compared to dementia patients, the odds of participating in a low-risk, low-burden trial were 12% lower for MCI patients (odds ratio (OR) = 0.88, 95% confidence interval (CI) 0.23-3.29) and 70% lower (OR = 0.30, 95% CI 0.08-1.09) for cognitively normal participants. With increasing risk and burden, willingness to enroll decreased and the gap in relative willingness between diagnostic groups increased. In the medium-risk, medium-burden scenario, the estimated OR was 0.64 (95% CI 0.17-2.40) for MCI and 0.21 for the cognitively normal (95% CI 0.06-0.77). In the high-risk, high-burden scenario, the estimated OR indicated reduced willingness for MCI (OR = 0.27, 95% CI 0.06-1.15) and cognitively normal respondents (OR = 0.12, 95% CI 0.03-0.54).These results suggest that AD trials enrolling predementia populations, especially those requiring frequent visits and implementing biomarker testing procedures, may encounter challenges to enrollment.

Country
United States
Keywords

Male, Aging, Biomedical and clinical sciences, Neurodegenerative, Acquired Cognitive Impairment (rcdc), Alzheimer's Disease, 11 Medical and Health Sciences (for), Medical and Health Sciences, Aging (rcdc), Clinical Research (rcdc), Clinical trials, Brain Disorders (rcdc), Cognitive Dysfunction (mesh), Surveys and Questionnaires, Dementia (rcdc), Odds Ratio, Longitudinal Studies, Male (mesh), Neurosciences (rcdc), Neurodegenerative (rcdc), 42 Health Sciences (for-2020), Alzheimer Disease (mesh), Humans (mesh), Clinical Trials as Topic, Alzheimer's Disease (rcdc), Alzheimer's disease, Regression Analysis (mesh), Preclinical, 4203 Health Services and Systems (for-2020), Research Design, Neurological, Regression Analysis, Female, Recruitment, Behavioral and Social Science (rcdc), Alzheimer’s disease, RC321-571, Clinical Trials and Supportive Activities, Clinical Trials and Supportive Activities (rcdc), 610, Clinical Trials as Topic (mesh), Neurosciences. Biological psychiatry. Neuropsychiatry, Patient Acceptance of Health Care (mesh), Surveys and Questionnaires (mesh), Clinical Research, 42 Health sciences (for-2020), Alzheimer Disease, Health Services and Systems, Health Sciences, Behavioral and Social Science, 616, Acquired Cognitive Impairment, Humans, Cognitive Dysfunction, RC346-429, Aged, Neurological (hrcs-hc), Aged (mesh), Research, 4.1 Discovery and preclinical testing of markers and technologies (hrcs-rac), Neurosciences, Alzheimer's Disease including Alzheimer's Disease Related Dementias (AD/ADRD), Mild cognitive impairment, Patient Acceptance of Health Care, Odds Ratio (mesh), Longitudinal Studies (mesh), Brain Disorders, 4.1 Discovery and preclinical testing of markers and technologies, 32 Biomedical and clinical sciences (for-2020), Attitude, Female (mesh), Dementia, Alzheimer's Disease including Alzheimer's Disease Related Dementias (AD/ADRD) (rcdc), Research Design (mesh), Neurology. Diseases of the nervous system, Attitude (mesh)

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    influence
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selected citations
These citations are derived from selected sources.
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
41
Top 10%
Top 10%
Top 10%
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