Study on Aging and Cognitive Impairment in China (HAPCAD)

A Longitudinal Study on the Aging of Health and Cognitive Impairment in China

Background: By the end of 2022, China had about 280 million people aged 60 and older, making up 19.8% of the population. This number is projected to exceed 300 million by the end of the 14th Five-Year Plan and 400 million by 2035, which would be over 30%. The 20th National Congress emphasized the need for a proactive strategy to tackle aging challenges. Approximately 6.04% of the elderly have dementia, with 3.94% having Alzheimer's disease. This totals around 15 million people with dementia. To address this, the China Cohort Consortium on Aging and Cognitive Impairment Development has been proposed to study health and cognitive changes in different age groups, aiming to support healthy aging policies. Methods: Participants from various age groups (children, youth, middle-aged, elderly) will be recruited from hospitals, schools, and communities using stratified sampling. They will undergo detailed medical examinations focusing on aging, cognitive impairments, and related diseases. A new database will track healthy aging and cognitive impairment development. Content: The study will involve comprehensive medical examinations, including physiological assessments, psychological evaluations, cognitive screenings, daily life assessments, imaging studies, and blood tests, to establish a detailed health and cognitive impairment database. The research will also investigate integrated intervention models in hospital, community, and home settings, develop remote medical management systems, and devise biomarker test kits for aging and cognitive impairments. Furthermore, it will concentrate on non-pharmacological interventions and artificial intelligence systems for the early detection, prevention, and treatment of aging-related conditions. Objectives: The China Cohort Consortium on Aging and Cognitive Impairment Development, commencing with the HAPCAD study, aims to monitor changes across various age groups, evaluate the impact of aging on health and cognitive function, and design targeted interventions. The objective is to enhance health management and services related to aging, establish effective strategies, develop therapeutic drugs, and promote healthy aging.

Study Overview

• Status: Recruiting
• Conditions: Cognitive Dysfunction; Aging

Detailed Description

Research Objectives:

Establish detailed medical examinations for population cohorts across different age groups, including physiological checks, psychological assessments, cognitive function screenings, evaluations of daily life abilities, imaging, and blood tests, to build a comprehensive health and mental impairments database. Develop artificial intelligence systems for early warnings related to aging-related diseases and create prevention and treatment strategies. Focus on advancing health management, interventions, research, and services related to healthy aging and aging-related diseases, and develop effective intervention strategies and therapeutic drugs to promote healthy aging.

Research Content:

1. Screening and Tracking: Implement a long-term cohort study on healthy aging and cognitive impairment to understand changes in physiological, psychological, mental, and daily life abilities across different age groups. Analyze the effects of genetic, environmental, and lifestyle factors on healthy aging and cognitive impairments. Based on identified risk factors, develop personalized lifestyle interventions and management plans. The study will include 20,000 participants.
2. Omics Approaches: Use genomics, transcriptomics, proteomics, and metabolomics to identify biomarkers associated with healthy aging, cognitive impairments, and other aging-related diseases. This will support further primary research in these areas.

Research Methods and Technical Roadmap:

1. Questionnaire Survey: Collect demographic information (age, gender, height, weight, education, occupation, smoking, alcohol consumption, dietary habits, medical history, family history, medication history, etc.) and conduct various scale assessments. Specific scales will include Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA) Background Version, memory and digit span tests, Hamilton Depression Rating Scale (HAMD), Hamilton Anxiety Rating Scale (HAMA), PHQ-9 Depression Screening Scale, HIS Ischemia Scale, Neuropsychiatric Inventory (NPI), Pittsburgh Sleep Quality Index (PSQI), International Physical Activity Questionnaire (IPAQ), Activities of Daily Living (ADL), Clinician's Interview-Based Impression of Change Plus Caregiver Input (CIBIC-PLUS), Clinical Dementia Rating (CDR) scale, and Epidemic Protective Behavior Scale.
2. Clinical Laboratory Index Collection: Perform blood tests (complete blood count, biochemical tests, glucose, glycated hemoglobin, lipid profile, folic acid, vitamin B, homocysteine, thyroid function, C-reactive protein), urinalysis, stool tests, and measure biomarkers (ApoE, T-tau, NFL, GFAP, UCHL1, pTau-181, pTau-217, Aβ40, Aβ42, etc.).
3. Clinical Examination Index Collection: Conduct brain MRI, Transcranial Doppler (TCD), carotid artery and vertebral artery ultrasound, echocardiogram, lower limb vascular ultrasound, ambulatory blood pressure monitoring, fundus photography, CT scans, and review pathological reports.
4. Sample Collection: Collect blood, cerebrospinal fluid, brain tissue, stool, urine, and saliva as needed for clinical diagnostics. Additional samples (20 ml blood, 10 ml urine, 30 ml stool, 20 ml saliva) will be collected, processed, and analyzed for genomics, transcriptomics, proteomics, and metabolomics to identify specific biomarkers.

4.1. Genomics: Use the Illumina platform for whole-genome sequencing (WGS) to identify genetic variations and conduct genotype diversity, evolution analysis, and disease screening. Perform whole-genome bisulfite sequencing (WGBS) to study DNA methylation, which supports research on genome-wide methylation modifications relevant to aging and diseases.

4.2. Transcriptomics: Utilize the Illumina platform for next-generation sequencing to analyze coding and non-coding RNAs. Employ the 10x Chromium Single Cell Gene Expression Solution platform for single-cell gene expression profiling, enabling detailed analysis of cell populations and creating single-cell expression atlases.

4.3. Proteomics and Metabolomics: Study protein composition and activity patterns using proteomics and explore small molecule metabolites using metabolomics. Integrate data from both approaches to identify differential proteins and metabolites and describe molecular regulatory mechanisms.

Follow-Up and Tracking:

Track and follow up with enrolled participants.

Experimental Methods:

Employ traditional and advanced statistical methods, including t-tests, non-parametric tests, chi-square tests, logistic regression, Cox proportional hazards models, artificial neural networks, and Bayesian models. Analyze data to identify biomarkers for disease prediction, explore disease mechanisms, and guide treatment strategies. Utilize samples for scientific analysis, molecular experiments, and drug development.

Key Technologies and Descriptions:

Sample Processing: Use centrifuges, slicers, pipettes, and DNA/RNA extraction instruments. Following standardized procedures, store samples in low-temperature equipment, including refrigerators, freezers, and liquid nitrogen tanks.

Simoa Detection Technology:

Utilize Simoa for single-molecule detection with high sensitivity, using capture antibody binding sites on magnetic beads and detecting signals using CCD cameras. This technology allows for precise measurement of protein concentrations.

Annual Research Plan:

Recruit volunteers from hospitals of all age groups for comprehensive physical examinations, aiming to establish a detailed human growth and aging map.

• Study Type: Observational
• Enrollment (Estimated): 20000

Contacts and Locations

• Study Contact: Name: Sipei Pan Dr.; Phone Number: 86+13758710622; Email: pansipei@wmu.edu.cn
• Study Contact Backup: Name: Qin-Fen Chen Dr.; Phone Number: 86+15167735852; Email: chenqinfen@wmu.edu.cn

Study Locations

• China
  • Zhejiang
    • Wenzhou, Zhejiang, China, 32500
      • Recruiting
      • The First Affiliated Hospital of Wenzhou Medical University
      • Contact: Sipei Pan Dr.; Phone Number: +8613758710622; Email: pansipei@wmu.edu.cn

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: Yes

• Sampling Method: Non-Probability Sample

Study Population

The study population is sourced from communities, hospitals, and healthy volunteers. There is no requirement for randomization of study subjects at enrollment. However, during further testing and analysis, one or more researchers select appropriate case samples for grouping and blinding assessors, and analysts is implemented to prevent bias.

Description

Inclusion Criteria:

1. Ability to sign an informed consent form: Participants and/or their legally authorized representatives, in case of diminished decision-making capacity, are capable of reading, understanding, and providing written informed consent as per national legal requirements.
2. Capability to complete assessments independently or with assistance.
3. Willingness and ability to fulfill all study requirements, including peripheral organ function assessments, EEG, lumbar puncture, MRI, and PET imaging examinations.
4. Agreement to participate in follow-up visits.

Exclusion Criteria:

1. Terminal stage of significant diseases such as malignant tumors or autoimmune diseases at enrollment;
2. Substance abusers.

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort

Observation group; Establish a screening and long-term tracking cohort study related to healthy aging and the development of cognitive impairments to understand changes in physiological, psychological, mental, and daily living abilities across different age groups in humans. Analyze genetic factors, environmental influences, lifestyle, and their impacts on the occurrence and development of healthy aging, cognitive impairments, and other age-related diseases.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Assessing the prevalence of cognitive impairment in China based on MMSE, MoCA and CDR.	The statement involves evaluating the prevalence of cognitive impairment in China using three assessment tools: the Mini-Mental State Examination (MMSE), the Montreal Cognitive Assessment (MoCA), and the Clinical Dementia Rating (CDR). MMSE: This test has a maximum score of 30 points, with scores below 24 typically indicating cognitive impairment. MoCA: The MoCA also has a maximum score of 30 points, where a score of 26 or lower indicates cognitive impairment. CDR: The CDR uses a scale from 0 to 3, where 0 indicates no cognitive impairment, 0.5 suggests mild cognitive impairment, 1 denotes mild dementia, 2 indicates moderate dementia, and 3 reflects severe dementia.	through study completion, an average of 5 year.
Change in Alzheimer disease biomarkers over time	Aβ, t-tau and p-tau levels in pg/ml	through study completion, an average of 3 year.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Changes of brain structure at different stage of cognitive impairment in Alzheimer disease in China.	Changes of structure of the whole brain, hippocampus other brain structures measured by MRI.	through study completion, an average of 5 year.
Changes of brain glucose metabolism at different stage of cognitive impairment in Alzheimer disease in China.	Changes of glucose metabolism of the whole brain, hippocampus and other brain structures as measured by 18F-fluorodeoxyglucose (FDG)-positron emission tomography (PET).	through study completion, an average of 3 year.
Changes of brain amyloid deposition at different stage of cognitive impairment in Alzheimer disease in China.	Changes of amyloid deposition of the whole brain, hippocampus and other brain structures as measured by amyloid PET.	through study completion, an average of 3 year.
Changes of brain tau deposition at different stage of cognitive impairment in Alzheimer disease in China.	Changes of tau deposition of the whole brain, hippocampus and other brain structures as measured by tau PET.	through study completion, an average of 3 year.

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Other clinical measure: Body Height	Body Height: without shoes, measured to the nearest cm	Measured at Baseline
Changes in Lifestyle factors over time: Smoking	Smoking: never/past/current	Measured at Baseline, year 1, year3, year 5, year 10
Changes in Lifestyle factors over time: Alcohol Consumption	Alcohol: units/week	Measured at Baseline, year 1, year3, year 5, year 10
Changes in Lifestyle factors over time: drug abuse/misuse	Drug abuse/misuse: never/past/current	Measured at Baseline, year 1, year3, year 5, year 10
Changes in Lifestyle factors over time: physical activity frequency	Physical activity: daily, 2-3 times/week, 2-3 times/month, a few times a year, not at all	Measured at Baseline, year 1, year3, year 5, year 10
Changes in Lifestyle factors over time: Sleep, total over time, units on a scale	Sleep: Pittsburgh Sleep Quality Index	Measured at Baseline, year 1, year3, year 5, year 10
Other neuro-imaging measure: Vascular Burden, over time, units on a scale	Vascular Burden: Counts of White Matter Lesions, infarcts, laciness, micro bleeds and superficial siderosis.	Measured at Baseline, year 1, year3, year 5, year 10
Sociodemographic Factors	Date of Birth, Age, Ethnicity, Education, Marital Status, Handedness	Measured at Baseline
Family History of Alzheimer disease	Family history of Alzheimer disease in number of family members of first degree with history compatible with Alzheimer disease	Measured at Baseline
Medical History	Medical History: Yes/No for: Stroke, Diabetes (type 1 or 2), Hypertension, Hypercholesterolemia, Myocardial Infarction, Chronic Ischemic Heart Disease, Chronic Obstructive Pulmonary Disease, Asthma, Depression, Rheumatoid Arthritis, Any Cancer, Head Injury assessed with the Brain Injury Screening Questionnaire (BISQ), Mild Cognitive Impairment.	Measured at Baseline, year 1, year3, year 5, year 10
Current Medication	Drug, treatment duration (<1year / 1-5years / >5years)	Measured at Baseline, year 1, year3, year 5, year 10
Other clinical measure: Body Weight	Body Weight: measured to the nearest 0.1kg	Measured at Baseline, year 1, year3, year 5, year 10
Other clinical measure: Hip-waist Circumference	Hip-waist Circumference: measured to nearest 0.1cm	Measured at Baseline, year 1, year3, year 5, year 10

Collaborators and Investigators

• Sponsor: First Affiliated Hospital of Wenzhou Medical University
• Collaborators: Wenzhou Medical University
• Investigators: Study Chair: Weihong Song Prof., First Affiliated Hospital of Wenzhou Medical University

Study record dates

Study Major Dates

• Study Start (Estimated): November 20, 2024
• Primary Completion (Estimated): December 31, 2033
• Study Completion (Estimated): December 31, 2033

Study Registration Dates

• First Submitted: September 11, 2024
• First Submitted That Met QC Criteria: November 6, 2024
• First Posted (Estimated): November 7, 2024

Study Record Updates

• Last Update Posted (Estimated): November 7, 2024
• Last Update Submitted That Met QC Criteria: November 6, 2024
• Last Verified: October 1, 2024

More Information

Terms related to this study

• Keywords: aging; Alzheimer disease; Cognitive dysfunction
• Additional Relevant MeSH Terms: Mental Disorders; Neurocognitive Disorders; Cognition Disorders; Cognitive Dysfunction
• Other Study ID Numbers: weihongsong2024

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No