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2009 Grants - Okereke
Planning Large-scale Alzheimer's Disease QUEstionnaire-aided Studies (PLAQUES)
Olivia Okereke, M.D.
Brigham and Women's Hospital, Inc.
2009 New Investigator Research Grant
Prior work in large cohorts (the Nurses', Physicians', and Women's Health Studies) established a valid telephone-based cognitive assessment. This method was used to identify relations between mid-life factors (e.g., alcohol, exercise, antioxidant trial agents) and late-life cognitive decline. However, it cannot yield clinical diagnoses, such as Alzheimer's, vascular dementia or mild cognitive impairment (MCI). In pilot work, diagnoses were obtained by supplementing telephone assessments with neurologic exams and other tests (e.g., imaging) performed at the Alzheimer's Disease Research Center (ADRC). However, this approach proved costly and inefficient.
Olivia Okereke, M.D., and colleagues aim to test a low-cost, efficient method for diagnosing MCI and dementias that will be directly applicable to large-scale trials and longitudinal studies. It will include a questionnaire for obtaining Clinical Dementia Rating (CDR) scores (developed in pilot work), telephone CDR symptom review and cognitive tests, medical record review of neurologic exams and supportive tests performed in the community, and consensus diagnoses based on the preceding information. Diagnoses by this method will be compared to those made in person at the ADRC. Although similar methods have been used successfully in the world of cardiovascular disease (CVD), they have been absent from Alzheimer research. Major CVD prevention trials typically involved tens of thousands of participants. These trials were possible because investigators used questionnaire-reported symptoms, covariates and outcomes—bolstered by medical record review of community-based physical exams and supportive tests. Thus, geographically-diverse participants could be recruited, and diagnoses did not depend on availability of tertiary care specialists.
Without similar means for conducting Alzheimer's research on a large scale, it may be impossible to achieve comparable gains in prevention and treatment of MCI and dementia. If successful, this method would be used to make diagnoses in large cohorts, and would open up a wide range of research on the role of mid- and late-life risk factors, and gene-environment interactions. Moreover, it could facilitate the kinds of large-scale trials in diverse populations .