Alzheimer's disease progression by geographical region in a clinical trial setting.
David B. Henley,Sherie A. Dowsett,Yun-Fei Chen,Hong Liu-Seifert,Joshua D. Grill,Rachelle S. Doody,Paul S. Aisen,Rema Raman,David S. Miller,Ann Marie Hake,Ann Marie Hake,Jeffrey L. Cummings +11 more
TLDR
Assessment of disease progression across geographic regions using placebo data from four large, multi-national clinical trials of investigational compounds developed to target AD pathophysiology suggests that in multi- national clinical trials, AD progression or its measurement may differ across geographical regions.Abstract:
To facilitate enrollment and meet local registration requirements, sponsors have increasingly implemented multi-national Alzheimer’s disease (AD) studies. Geographic regions vary on many dimensions that may affect disease progression or its measurement. To aid researchers designing and implementing Phase 3 AD trials, we assessed disease progression across geographic regions using placebo data from four large, multi-national clinical trials of investigational compounds developed to target AD pathophysiology. Four similarly-designed 76 to 80 week, randomized, double-blind placebo-controlled trials with nearly identical entry criteria enrolled patients aged ≥55 years with mild or moderate NINCDS/ADRDA probable AD. Descriptive analyses were performed for observed mean score and observed mean change in score from baseline at each scheduled visit. Data included in the analyses were pooled from the intent-to-treat placebo-assigned overall (mild and moderate) AD dementia populations from all four studies. Disease progression was assessed as change from baseline for each of 5 scales - the AD Assessment Scale-cognitive subscale (ADAS-cog11), the AD Cooperative Study- Activities of Daily Living Scale (ADCS-ADL), Mini-Mental State Examination (MMSE), the Clinical Dementia Rating scored by the sum of boxes method (CDR-SB), and the Neuropsychiatric Inventory (NPI). Regions were heterogeneous at baseline. At baseline, disease severity as measured by ADAS-cog11, ADCS-ADL, and CDR-SB was numerically worse for Eastern Europe/Russia compared with other regions. Of all regional populations, Eastern Europe/Russia showed the greatest cognitive and functional decline from baseline; Japan, Asia and/or S. America/Mexico showed the least cognitive and functional decline. These data suggest that in multi-national clinical trials, AD progression or its measurement may differ across geographic regions; this may be in part due to heterogeneity across populations at baseline. The observed differences in AD progression between outcome measures across geographic regions may generalize to 'real-world' clinic populations, where heterogeneity is the norm. ClinicalTrials.gov NCT00594568
– IDENTITY. Registered 11 January 2008. ClinicalTrials.gov NCT00762411
– IDENTITY2. Registered 26 September 2008 ClinicalTrials.gov NCT00905372
– EXPEDITION. Registered 18 May 2009 ClinicalTrials.gov NCT00904683
– EXPEDITION2. Registered 18 May 2009read more
Citations
More filters
Book ChapterDOI
Alzheimer’s Disease Drug Development: A Research and Development Ecosystem
TL;DR: Alzheimer's disease (AD) drug development is a complex process that proceeds from identification of a biological target; to testing of candidate therapies in in vitro assays; assessment of efficacy in animal models and assessment of safety in several animal species; clinical testing in humans in Phase1, Phase 2, and Phase 3 clinical trials; regulatory review by agencies in all countries in which the drug might be marketed; and eventual commercialization as discussed by the authors .
Journal ArticleDOI
Current Landscape of Late-Phase Clinical Trials for Alzheimer’s Disease: Comparing Regional Variation Between Subjects in Japan and North America
TL;DR: The results suggest that regional variation could have an impact on functional measurements due to cultural differences in pivotal clinical trials, and caution should be exercised according to the characteristics of the endpoint used.
Journal ArticleDOI
Differences in Gut Microbiota as a Potential Factor in Alzheimer’s Disease Development
Briya Patel,Leya Joykutty +1 more
TL;DR: Gut bacteria can produce neurotransmitters such as melatonin, gamma-aminobutyric acid, histamine, and acetylcholine, which can contribute or antagonize neuroinflammation and neurofibrillary tangles as mentioned in this paper.
Journal ArticleDOI
Cross‐sectional and longitudinal assessments of function in prodromal‐to‐mild Alzheimer's disease: A comparison of the ADCS‐ADL and A‐IADL‐Q scales
Edmond Teng,Yi-hua Li,Paul T. Manser,Karen Pickthorn,Brandon Butcher,Mira Blendstrup,Sietske A.M. Sikkes +6 more
TL;DR: In this paper , the Amsterdam Instrumental Activities of Daily Living Questionnaire (AADL•Q) was compared to the ADCS•ADL for clinical trials in early Alzheimer's disease.
Book ChapterDOI
Globalization of Alzheimer’s Disease Clinical Trials
TL;DR: In this article , the authors overview the significant drives of globalization in Alzheimer's disease drug development: the growth of the world's AD population, the need for a larger sample in trials to secure enrollment in the required timeframe, and the ethnographic and ethnobiological contributors.
References
More filters
Journal ArticleDOI
“Mini-mental state”: A practical method for grading the cognitive state of patients for the clinician
Marshal F. Folstein,Marshal F. Folstein,Susan E B Folstein,Susan E B Folstein,Paul R. McHugh,Paul R. McHugh +5 more
TL;DR: A simplified, scored form of the cognitive mental status examination, the “Mini-Mental State” (MMS) which includes eleven questions, requires only 5-10 min to administer, and is therefore practical to use serially and routinely.
A practical method for grading the cognitive state of patients for the clinician
TL;DR: The Mini-Mental State (MMS) as mentioned in this paper is a simplified version of the standard WAIS with eleven questions and requires only 5-10 min to administer, and is therefore practical to use serially and routinely.
Journal ArticleDOI
The Neuropsychiatric Inventory: Comprehensive assessment of psychopathology in dementia
Jeffrey L. Cummings,Michael S. Mega,Kevin F. Gray,S. Rosenberg-Thompson,Daniela Carusi,Jeffrey Gornbein +5 more
TL;DR: The NPI has the advantages of evaluating a wider range of psychopathology than existing instruments, soliciting information that may distinguish among different etiologies of dementia, differentiating between severity and frequency of behavioral changes, and minimizing administration time.
Journal ArticleDOI
Meta-analysis of 74,046 individuals identifies 11 new susceptibility loci for Alzheimer's disease
Jean-Charles Lambert,Jean-Charles Lambert,Jean-Charles Lambert,Carla A. Ibrahim-Verbaas,Denise Harold,Adam C. Naj,Rebecca Sims,Céline Bellenguez,Céline Bellenguez,Céline Bellenguez,Gyungah Jun,Anita L. DeStefano,Joshua C. Bis,Gary W. Beecham,Benjamin Grenier-Boley,Benjamin Grenier-Boley,Benjamin Grenier-Boley,Giancarlo Russo,Tricia A. Thornton-Wells,Nicola Jones,Albert V. Smith,Vincent Chouraki,Vincent Chouraki,Vincent Chouraki,Charlene Thomas,M. Arfan Ikram,Diana Zelenika,Badri N. Vardarajan,Yoichiro Kamatani,Chiao-Feng Lin,Amy Gerrish,Helena Schmidt,Brian W. Kunkle,Melanie L. Dunstan,Agustín Ruiz,Marie-Thérèse Bihoreau,Seung Hoan Choi,Christiane Reitz,Florence Pasquier,Paul Hollingworth,Alfredo Ramirez,Olivier Hanon,Annette L. Fitzpatrick,Joseph D. Buxbaum,Dominique Campion,Paul K. Crane,Clinton T. Baldwin,Tim Becker,Tim Becker,Vilmundur Gudnason,Carlos Cruchaga,David Craig,Najaf Amin,Claudine Berr,Oscar L. Lopez,Philip L. De Jager,Philip L. De Jager,Vincent Deramecourt,Janet A. Johnston,Denis A. Evans,Simon Lovestone,Luc Letenneur,Francisco J. Morón,David C. Rubinsztein,Gudny Eiriksdottir,Kristel Sleegers,Kristel Sleegers,Alison Goate,Nathalie Fievet,Nathalie Fievet,Matthew J. Huentelman,Michael Gill,Kristelle Brown,M. Ilyas Kamboh,Lina Keller,Pascale Barberger-Gateau,Bernadette McGuinness,Eric B. Larson,Eric B. Larson,Robert C. Green,Amanda J. Myers,Carole Dufouil,Stephen Todd,David Wallon,Seth Love,Ekaterina Rogaeva,John Gallacher,Peter St George-Hyslop,Peter St George-Hyslop,Jordi Clarimón,Alberto Lleó,Anthony Bayer,Debby W. Tsuang,Lei Yu,Magda Tsolaki,Paola Bossù,Gianfranco Spalletta,Petroula Proitsi,John Collinge,Sandro Sorbi,Florentino Sanchez-Garcia,Nick C. Fox,John Hardy,Maria Candida Deniz Naranjo,Paolo Bosco,Robert Clarke,Carol Brayne,Daniela Galimberti,Michelangelo Mancuso,Fiona E. Matthews,Genetic,Environmental Risk in Alzheimer's Disease,Environmental Risk in Alzheimer's Disease,Cohorts for Heart,Cohorts for Heart,Susanne Moebus,Patrizia Mecocci,Maria Del Zompo,Wolfgang Maier,Wolfgang Maier,Harald Hampel,Harald Hampel,Alberto Pilotto,María J. Bullido,María J. Bullido,Francesco Panza,Paolo Caffarra,Paolo Caffarra,Benedetta Nacmias,John R. Gilbert,Manuel Mayhaus,Lars Lannfelt,Hakon Hakonarson,Sabrina Pichler,Minerva M. Carrasquillo,Martin Ingelsson,Duane Beekly,Victoria Alvarez,Fanggeng Zou,Otto Valladares,Steven G. Younkin,Eliecer Coto,Kara L. Hamilton-Nelson,Wei Gu,Cristina Razquin,Pau Pastor,Ignacio Mateo,Michael John Owen,Kelley Faber,Palmi V. Jonsson,Onofre Combarros,Michael Conlon O'Donovan,Laura B. Cantwell,Hilkka Soininen,Deborah Blacker,Simon Mead,Thomas H. Mosley,David A. Bennett,Tamara B. Harris,Laura Fratiglioni,Laura Fratiglioni,Clive Holmes,Renée F.A.G. de Bruijn,Peter Passmore,Thomas J. Montine,Karolien Bettens,Karolien Bettens,Jerome I. Rotter,Alexis Brice,Alexis Brice,Kevin Morgan,Tatiana Foroud,Walter A. Kukull,Didier Hannequin,John Powell,Mike A. Nalls,Karen Ritchie,Kathryn L. Lunetta,John S. K. Kauwe,Eric Boerwinkle,Eric Boerwinkle,Matthias Riemenschneider,Mercè Boada,Mikko Hiltunen,Eden R. Martin,Reinhold Schmidt,Dan Rujescu,Li-San Wang,Jean-François Dartigues,Jean-François Dartigues,Richard Mayeux,Christophe Tzourio,Albert Hofman,Markus M. Nöthen,Caroline Graff,Caroline Graff,Bruce M. Psaty,Bruce M. Psaty,Lesley Jones,Jonathan L. Haines,Peter Holmans,Mark Lathrop,Mark Lathrop,Margaret A. Pericak-Vance,Lenore J. Launer,Lindsay A. Farrer,Cornelia M. van Duijn,Christine Van Broeckhoven,Christine Van Broeckhoven,Valentina Moskvina,Sudha Seshadri,Julie Williams,Gerard D. Schellenberg,Philippe Amouyel,Philippe Amouyel,Philippe Amouyel +215 more
TL;DR: In addition to the APOE locus (encoding apolipoprotein E), 19 loci reached genome-wide significance (P < 5 × 10−8) in the combined stage 1 and stage 2 analysis, of which 11 are newly associated with Alzheimer's disease.
Journal ArticleDOI
Alzheimer's Disease International.
Nori Graham,Henry Brodaty +1 more
TL;DR: The output of the 1994 Xth Alzheimer's Disease International meeting in Edinburgh in 1994 reflects the international experience of the disorder in self‐help groups in Eastern Europe, difficulties of epidemiological studies in India and the complex interplay between staff attitude and residents' sexuality in nursing homes in the USA.