Characteristics of the Ontario Neurodegenerative Disease Research Initiative cohort.

INTRODUCTION: Understanding synergies between neurodegenerative and cerebrovascular pathologies that modify dementia presentation represents an important knowledge gap. METHODS: This multi-site, longitudinal, observational cohort study recruited participants across prevalent neurodegenerative diseases and cerebrovascular disease and assessed participants comprehensively across modalities. We describe univariate and multivariate baseline features of the cohort and summarize recruitment, data collection, and curation processes. RESULTS: We enrolled 520 participants across five neurodegenerative and cerebrovascular diseases. Median age was 69 years, median Montreal Cognitive Assessment score was 25, median independence in activities of daily living was 100% for basic and 93% for instrumental activities. Spousal study partners predominated; participants were often male, White, and more educated. Milder disease stages predominated, yet cohorts reflect clinical presentation. DISCUSSION: Data will be shared with the global scientific community. Within-disease and disease-agnostic approaches are expected to identify markers of severity, progression, and therapy targets. Sampling characteristics also provide guidance for future study design.

The Ontario Neurodegenerative Disease Research Initiative (ONDRI).

Because individuals develop dementia as a manifestation of neurodegenerative or neurovascular disorder, there is a need to develop reliable approaches to their identification. We are undertaking an observational study (Ontario Neurodegenerative Disease Research Initiative [ONDRI]) that includes genomics, neuroimaging, and assessments of cognition as well as language, speech, gait, retinal imaging, and eye tracking. Disorders studied include Alzheimer's disease, amyotrophic lateral sclerosis, frontotemporal dementia, Parkinson's disease, and vascular cognitive impairment. Data from ONDRI will be collected into the Brain-CODE database to facilitate correlative analysis. ONDRI will provide a repertoire of endophenotyped individuals that will be a unique, publicly available resource.

Motor Phenotype in Neurodegenerative Disorders: Gait and Balance Platform Study Design Protocol for the Ontario Neurodegenerative Research Initiative (ONDRI).

BACKGROUND: The association of cognitive and motor impairments in Alzheimer's disease and other neurodegenerative diseases is thought to be related to damage in the common brain networks shared by cognitive and cortical motor control processes. These common brain networks play a pivotal role in selecting movements and postural synergies that meet an individual's needs. Pathology in this "highest level" of motor control produces abnormalities of gait and posture referred to as highest-level gait disorders. Impairments in cognition and mobility, including falls, are present in almost all neurodegenerative diseases, suggesting common mechanisms that still need to be unraveled. OBJECTIVE: To identify motor-cognitive profiles across neurodegenerative diseases in a large cohort of patients. METHODS: Cohort study that includes up to 500 participants, followed every year for three years, across five neurodegenerative disease groups: Alzheimer's disease/mild cognitive impairment, frontotemporal degeneration, vascular cognitive impairment, amyotrophic lateral sclerosis, and Parkinson's disease. Gait and balance will be assessed using accelerometers and electronic walkways, evaluated at different levels of cognitive and sensory complexity, using the dual-task paradigm. RESULTS: Comparison of cognitive and motor performances across neurodegenerative groups will allow the identification of motor-cognitive phenotypes through the standardized evaluation of gait and balance characteristics. CONCLUSIONS: As part of the Ontario Neurodegenerative Research Initiative (ONDRI), the gait and balance platform aims to identify motor-cognitive profiles across neurodegenerative diseases. Gait assessment, particularly while dual-tasking, will help dissect the cognitive and motor contribution in mobility and cognitive decline, progression to dementia syndromes, and future adverse outcomes including falls and mortality.

Impact of a social marketing media campaign on public awareness of hypertension.

BACKGROUND: Barriers to high blood pressure (BP) awareness and control are exacerbated by poor knowledge of the consequences and uncertainty regarding how to and who should direct care. We developed a social marketing hypertension awareness program to determine baseline awareness, knowledge, and treatment behavior, and then studied the impact of a targeted, media intervention among randomly surveyed adults at risk in a representative urban community compared to a control community immediately and 6 months after the intervention. METHODS: The program consisted of three random-digit telephone surveys conducted in two mid-sized Ontario cities to determine high BP awareness, knowledge, and treatment behavior. Using baseline knowledge and attitudes toward high BP in both communities, a social marketing awareness strategy and mass media intervention campaign incorporating television, radio, print, direct to patient, and interactive techniques was developed and implemented in the test city only. Both test and control cities were resurveyed immediately after and at 6 months post-media intervention to detect change and decay. RESULTS: A sample of 6873 men and women more than 35 years old who were aware of their high BP demonstrated a high prevalence of high BP in the general population ( approximately 34% in both communities). At baseline this population had poor knowledge of their own BP numbers and poor understanding of the diseases related to high BP. Although few considered high BP a health concern, they had good understanding of lifestyle interventions for high BP prevention and control. The number of the respondents who claimed to have high BP increased immediately after intervention in the test city (38%; P < .02), whereas the number of respondents who were treated and uncontrolled decreased (P < .05) compared to control. There was a significant increase in patients' knowledge of consequences and in their perception that they were most responsible for high BP control in the test city (P < .005) compared to control. At 6 months, no further changes were observed in those claiming to have high BP in either city, whereas decay to baseline in those treated but not controlled and those claiming responsibility for their BP control was observed in the test city. No changes were observed in the control city accept for an increase from baseline to 6 months in the percentage claiming to be treated but uncontrolled. We were unable to determine whether the increase in number treated but uncontrolled was due to a higher treatment rate, similar treatment rate but more patients being uncontrolled, or a combination of these scenarios. CONCLUSIONS: High BP is very prevalent in adults and knowledge of lifestyle options for management is encouraging. In the short-term, although our media awareness program increased the number of respondents claiming to have high BP and patient self-efficacy for BP control, this was not maintained. We did not change knowledge of consequences or importantly, the health importance of BP control among those at risk. Hence, in addition to a mass media campaign, attention should be focused on dissemination of awareness knowledge information through medical professionals at the point of care.

Diabetes and Technology for Increased Activity (DaTA) study: results of a remote monitoring intervention for prevention of metabolic syndrome.

OBJECTIVE: An increasingly aged, overweight, and sedentary population has resulted in elevated risk of cardiovascular disease (CVD). The escalating incidence of diabetes and other chronic illnesses, deficits in health care budgets, and physician shortages, especially in rural communities, have prompted investigations of feasible solutions. The Diabetes and Technology for Increased Activity (DaTA) study was designed to test the effectiveness of a lifestyle intervention driven by self-monitoring of blood glucose (BG), blood pressure (BP), physical activity (PA), and weight to positively impact CVD risk factors in a medically underserviced rural population with a high incidence of metabolic syndrome (MS). RESEARCH DESIGN AND METHODS: Conducted in a community-based research setting, this single-center open feasibility study used smart phones to transmit BP, BG, pedometer, weight, heart rate, and activity measurements to a database. Technology allowed participants to interface with the clinical team and self-monitor their personal health indicators. RESULTS: Twenty-four participants aged 30 to 71 years completed the 8-week intervention. Participants had significant improvement in clinic (p = .046) and self-monitored diastolic BP (p = .001), body mass index (p = .002), and total cholesterol (p = .009), and steps per day. Daily PA increased as well as participants' interest in and willingness to make lifestyle changes that impact health outcomes. CONCLUSIONS: The DaTA study demonstrated that self-monitoring of the risk factors for MS and increased PA improved the participant's CVD risk profile. Considering the 8-week time period of this intervention, results are encouraging. This lifestyle intervention, which uses education and technology as tools, confirms the utility of remote health monitoring.

Remote monitoring technologies for the prevention of metabolic syndrome: the Diabetes and Technology for Increased Activity (DaTA) study.

OBJECTIVES: Remote monitoring technologies are ideally suited for rural communities with limited access to health care. In an 8-week pilot study, we examined the feasibility of implementing and conducting a technology-intensive intervention in an underserviced rural setting. Our goal was to test the utility of self-monitoring technologies, physical activity, and education as tools to manage health indicators for the development of the cardiovascular complications (CVCs) of type 2 diabetes. RESEARCH DESIGN AND METHODS: The Diabetes and Technology for Increased Activity study was an open single-center study conducted in a community-based research setting. All 24 participants were provided with a Blackberry™ Smartphone, blood pressure monitor, glucometer, and pedometer. Smartphones transmitted measurements and survey results to the database, interfaced participants with the clinical team, and allowed for self-monitoring. RESULTS: Outcomes were improved body composition, improved markers of CVC risk factors, increased daily exercise, and interest in or awareness of lifestyle changes that impact health outcomes. Participants had excellent compliance for measurements, as self-monitoring provided a sense of security that improved from week 4 to week 8. CONCLUSIONS: Our team gained substantial insight into the operational requirements of technology-facilitated health care, including redefined hours of service; data reporting, management, and access protocols; and the utility of real-time clinical measures by remote monitoring. We developed an understanding of knowledge translation strategies as well as successful motivational and educational tools. Importantly, remote monitoring technology was found to be feasible and accepted in a rural setting.