CONSENSUS: a Shiny application of dementia evaluation and reporting for the KU ADC longitudinal Clinical Cohort database.

BACKGROUND: The University of Kansas Alzheimer's Disease Center (KU ADC) maintains several large databases to track participant recruitment, enrollment, and capture various research-related activities. It is challenging to manage and coordinate all the research-related activities. One of the crucial activities involves generating a consensus diagnosis and communicating with participants and their primary care providers. PROCESS: To effectively manage the cohort, the KU ADC utilizes a combination of open-source electronic data capture (EDC) (i.e. REDCap), along with other homegrown data management and analytic systems developed using R-studio and Shiny. PROCESS EVALUATION: In this article, we describe the method and utility of the user-friendly dashboard that was developed for the rapid reporting of dementia evaluations which allows clinical researchers to summarize recruitment metrics, automatically generate letters to both participants and healthcare providers, which ultimately help optimize workflows. CONCLUSIONS: We believe this general framework would be beneficial to any institution that build reports and summarizing key metrics of their research from longitudinal databases.

Impaired fasting glucose is associated with increased regional cerebral amyloid.

The Alzheimer's disease risk gene apolipoprotein E epsilon 4 (APOE ε4) is associated with increased cerebral amyloid. Although impaired glucose metabolism is linked to Alzheimer's disease risk, the relationship between impaired glycemia and cerebral amyloid is unclear. To investigate the independent effects of APOE ε4 and impaired glycemia on cerebral amyloid, we stratified nondemented subjects (n = 73) into 4 groups: normal glucose, APOE ε4 noncarrier (control [CNT]; n = 31), normal glucose, APOE ε4 carrier (E4 only; n = 14) impaired glycemia, APOE ε4 noncarrier (IG only; n = 18), and impaired glycemia, APOE ε4 carrier (IG+E4; n = 10). Cerebral amyloid differed both globally (p = 0.023) and regionally; precuneus (p = 0.007), posterior cingulate (PCC; p = 0.020), superior parietal cortex (SPC; p = 0.029), anterior cingulate (p = 0.027), and frontal cortex (p = 0.018). Post hoc analyses revealed that E4 only subjects had increased cerebral amyloid versus CNT globally and regionally in the precuneus, PCC, SPC, anterior cingulate, and frontal cortex. In IG only subjects, increased cerebral amyloid compared with CNT was restricted to precuneus, PCC, and SPC. IG+E4 subjects exhibited higher cerebral amyloid only in the precuneus relative to CNT. These results indicate that impaired glycemia and APOE ε4 genotype are independent risk factors for regional cerebral amyloid deposition. However, APOE ε4 and impaired glycemia did not have an additive effect on cerebral amyloid.

Feasibility of a Memory Clinic-Based Physical Activity Prescription Program.

BACKGROUND: Effective programs for promoting physical activity are needed for those with cognitive impairment. OBJECTIVE: To test the feasibility of mobile Health (mHealth) technology-supported physical activity prescription from a tertiary care memory clinic. METHODS: This feasibility study was designed as a 16-week randomized, crossover trial of a physical activity prescription: 8 weeks of intervention, 8 weeks of baseline or maintenance phase data collection. We recruited 2 cohorts: 21 individuals with Alzheimer-related cognitive impairment (mean age 72.3 (5.2), 9 females), and 9 individuals with normal cognition (mean age 69.6 (5.8), 8 females). We gave each cohort an mHealth accelerometer-based physical activity prescription to double number of steps taken. Our primary outcomes were feasibility and safety. Our secondary outcomes were change in weekly steps taken, Dementia Quality of Life Scale, Self-efficacy Scale, 6-minute Walk, and mini-Physical Performance Test. RESULTS: Set-up and use of the device was not a barrier to participation. However, only 62% of participants with cognitive impairment completed the intervention. The cohort with cognitive impairment did not change their weekly step count above Week 1. All participants in the cohort with normal cognition were able to set up and use their device and increased their weekly step count above Week 1. There were no differences between Week 1 and Week 8 for any secondary measures in either cohort. CONCLUSIONS: Setup and daily use of mHealth technology appears to be feasible for a person with cognitive impairment with the help of a partner, but increasing daily step counts over 8 weeks was not achieved. Future work needs to assess alternative activity prescription goals or additional support for patients and their partners.

Open-source, Rapid Reporting of Dementia Evaluations.

The National Institutes of Health Alzheimer's Disease Center consortium requires member institutions to build and maintain a longitudinally characterized cohort with a uniform standard data set. Increasingly, centers are employing electronic data capture to acquire data at annual evaluations. In this paper, the University of Kansas Alzheimer's Disease Center reports on an open-source system of electronic data collection and reporting to improve efficiency. This Center capitalizes on the speed, flexibility and accessibility of the system to enhance the evaluation process while rapidly transferring data to the National Alzheimer's Coordinating Center. This framework holds promise for other consortia that regularly use and manage large, standardized datasets.

Modeling Percentile Rank of Cardiorespiratory Fitness Across the Lifespan.

PURPOSE: The purpose of this investigation was to create an equation for continuous percentile rank of maximal oxygen consumption (VO2 max) from ages 20 to 99. METHODS: We used a two-staged modeling approach with existing normative data from the American College of Sports Medicine for VO2 max. First, we estimated intercept and slope parameters for each decade of life as a logistic function. We then modeled change in intercept and slope as functions of age (stage two) using weighted least squares regression. The resulting equations were used to predict fitness percentile rank based on age, sex, and VO2 max, and included estimates for individuals beyond 79 years old. RESULTS: We created a continuous, sex specific model of VO2 max percentile rank across the lifespan. CONCLUSIONS: Percentile ranking of VO2 max can be made continuous and account for adults aged 20 to 99 with reasonable accuracy, improving the utility of this normalization procedure in practical and research settings, particularly in aging populations.

Cardiopulmonary exercise testing is well tolerated in people with Alzheimer-related cognitive impairment.

OBJECTIVE: To retrospectively assess whether cardiopulmonary exercise testing would be well tolerated in individuals with Alzheimer disease (AD) compared with a nondemented peer group. DESIGN: We retrospectively reviewed 575 cardiopulmonary exercise tests (CPETs) in individuals with and without cognitive impairment caused by AD. SETTING: University medical center. PARTICIPANTS: Exercise tests (N=575) were reviewed for nondemented individuals (n=340) and those with AD-related cognitive impairment (n=235). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The main outcome measure for this study was reporting the reason for CPET termination. The hypothesis reported was formulated after data collection. RESULTS: We found that in cognitively impaired individuals, CPETs were terminated because of fall risk more often, but that overall test termination was infrequent-5.5% versus 2.1% (P=.04) in peers without cognitive impairment. We recorded 6 cardiovascular and 7 fall risk events in those with AD, compared with 7 cardiovascular and 0 fall risk events in those without cognitive impairment. CONCLUSIONS: Our findings support using CPETs to assess peak oxygen consumption in older adults with cognitive impairment caused by AD.