新想法:淀粉样蛋白扫描研究的痴呆症成像证据
新想法:淀粉样蛋白扫描研究的痴呆症成像证据 - 一项提高淀粉样蛋白 PET 覆盖和患者护理精度的研究
研究概览
详细说明
共有 7,000 名符合该研究资格标准的医疗保险受益人将获得同意,并在 30 个月的时间里在美国各地的地点进行登记。 为了确保多样性,该研究将招募至少 2,000 名黑人/非裔美国人、至少 2,000 名拉丁裔/西班牙裔以及最多 3,000 名来自其他种族和民族背景的参与者。 根据 PET 之前的疾病阶段,所有参与者将被分类为患有 MCI 或痴呆症作为其疾病阶段。 根据 PET 前的临床表现,所有参与者将被归类为“典型”(即, 进行性遗忘)或 AD 的“非典型”临床表现是痴呆或 MCI 的潜在原因。
痴呆症专家将与 PET 机构合作,这些机构拥有经过培训的放射科医生/核医学医师,并且可以进行淀粉样蛋白 PET。 所有参与的医生和研究人员将完成全面的培训,以确保遵守数据要求和研究时间表。 淀粉样蛋白 PET 将在每个机构进行并解释,并将结果提供给订购痴呆症专家,以支持进一步决策。 痴呆症专家将根据当前的临床和诊断信息记录他们的诊断和预期的管理计划,并假设未来在“PET 前就诊”时无法进行淀粉样蛋白 PET。 这代表了一项“思想实验”,记录了如果参与者没有注册 New IDEAS 并因此无法获得淀粉样蛋白 PET,专家将推荐的管理计划。 PET 结果将向患者披露,任何后续的管理变更(如果有)将在“PET 披露访视”时建议。 患者将在 PET 后 90 ± 30 天返回进行亲自“PET 后访视”。 在最后一次就诊时,痴呆症专家将记录诊断并实施管理计划,将淀粉样蛋白 PET 纳入临床决策。 将直接从 CMS 收集每位参与者在 PET 成像前 12 个月和 PET 成像后 12 个月的医疗保险索赔数据。
目标 1 利用医疗保险索赔数据比较整个队列中患有 MCI 和痴呆症的淀粉样蛋白 PET 阳性与淀粉样蛋白 PET 阴性个体的 12 个月索赔结果。 目标 2 和 3 根据自我认定的种族和民族(目标 2)以及临床表现(目标 3),在研究参与者亚组中调查这些关联。 目标 2 和 3 另外评估相关亚组 PET 就诊前和 PET 后就诊之间的管理变化,以测试临床管理的变化是否可以调节健康结果的益处。 研究者的总体假设是,淀粉样蛋白 PET 结果将与临床管理的变化相关,并得到第一项 IDEAS 研究初步数据的支持,而这反过来又会转化为相比之下淀粉样蛋白 PET 扫描呈阳性的患者健康结果的改善淀粉样蛋白 PET 扫描阴性的患者。 我们进一步假设这些影响将出现在不同种族背景、临床表现和疾病阶段(MCI 和痴呆)的患者中。
该研究的可选部分包括收集和存档参与者的淀粉样蛋白 PET 图像和血浆。 这些存储库将作为该领域的资源,从而能够测试和验证新兴的遗传和血液生物标志物。 参与这些组成部分将获得单独的同意。
研究类型
注册 (估计的)
联系人和位置
学习联系方式
- 姓名:New IDEAS Study Team
- 电话号码:215-574-3229
- 邮箱:ideas-study@acr.org
学习地点
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Pennsylvania
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Philadelphia、Pennsylvania、美国、19103
- 招聘中
- Full list of Active Sites and Imaging Facilities
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接触:
- Go to Site Finder Website at https://www.ideas-study.org/Find-a-Site
- 电话号码:866-507-7254
- 邮箱:newideas-participant@alz.org
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参与标准
资格标准
适合学习的年龄
接受健康志愿者
取样方法
研究人群
描述
纳入标准:
- 以 Medicare 作为主要保险的 Medicare 受益人;
- 符合 2018 年国家老龄化研究所 - 阿尔茨海默病协会研究框架定义的轻度认知障碍 (MCI) 或痴呆症的临床标准
- 入组前24个月内进行脑MRI和/或CT检查;
- 入组前 12 个月内进行临床实验室评估(全血细胞计数 [CBC]、标准血液化学分析、促甲状腺激素 [TSH]、维生素 B12);
- 能够耐受方案要求的淀粉样蛋白 PET,并在参与的 PET 设施中进行;
- 会说英语或西班牙语(出于知情同意的目的);
- 愿意并且能够表示同意。 可以通过代理人同意;
- 神经精神综合征可分为“临床典型”或“临床非典型”类别
排除标准:
- 未经认知测试或关键信息提供者验证的正常认知或主观抱怨。
- 痴呆症专家认为,了解淀粉样蛋白状态可能会造成严重的心理伤害或对患者或家人产生其他负面影响。
- 根据先前的淀粉样蛋白成像或脑脊液分析,患者或转诊临床医生已知淀粉样蛋白状态。
- 当前或之前参加抗淀粉样蛋白治疗试验。
- 仅根据痴呆症家族史、载脂蛋白 E (ApoE) 4 的存在来订购扫描,或代替对可疑常染色体突变携带者进行基因分型。
- 出于非医疗目的(例如法律、保险或就业筛选)而订购的扫描。
- 需要积极治疗的癌症(不包括非黑色素瘤皮肤癌)。
- 入组前 12 个月内发生髋部/骨盆骨折。
- 体重超过 PET 扫描仪重量限制。
- 目前已怀孕或计划在注册后 90 天内怀孕。
- 根据合并症,预期寿命少于 24 个月。
- 居住在熟练的护理机构(辅助生活机构不是排除标准)。
学习计划
研究是如何设计的?
设计细节
- 观测模型:队列
- 时间观点:预期
队列和干预
团体/队列 |
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淀粉样蛋白 PET 阳性
Β 淀粉样蛋白 PET 扫描结果与潜在 AD 一致,可导致或促成认知障碍
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淀粉样蛋白 PET-阴性
Β 淀粉样蛋白 PET 扫描已排除 AD 的患者(即
与导致或促成认知障碍的潜在 AD 不一致)
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研究衡量的是什么?
主要结果指标
结果测量 |
措施说明 |
大体时间 |
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目标 1:淀粉样蛋白 PET 阳性与淀粉样蛋白 PET 阴性的健康结果
大体时间:12个月
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比较不同医疗保险受益人的整个研究队列中出现 MCI 和痴呆的淀粉样蛋白 PET 阳性与淀粉样蛋白 PET 阴性个体的 12 个月索赔衍生的健康结果。
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12个月
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次要结果测量
结果测量 |
措施说明 |
大体时间 |
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目标 2:改变不同种族群体的患者管理和健康结果
大体时间:12个月
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描述患有 MCI 和痴呆的黑人/非裔美国人、拉丁裔/西班牙裔和白人/白种人中淀粉样蛋白 PET 结果与患者管理变化以及 12 个月索赔衍生的健康结果之间的关系。
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12个月
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其他结果措施
结果测量 |
措施说明 |
大体时间 |
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目标 3:不同临床表现的患者管理和健康结果的变化
大体时间:12个月
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描述淀粉样蛋白 PET 结果与典型(进行性遗忘)与非典型 MCI 和 AD 痴呆临床表现的个体的治疗变化和 12 个月索赔衍生的健康结果之间的关系。
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12个月
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合作者和调查者
调查人员
- 学习椅:Gil Rabinovici, MD、University of California, San Francisco
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