HANDDS-ONT is designed with the following principal research question in mind:
Can the integration of biosamples, clinical data and remote wearable biosensor data across aging and neurodegenerative disease cohorts i) provide valuable diagnostic data, ii) demonstrate predictive utility for important clinical outcomes and iii) guide daily decisions and care for individuals living with neurodegenerative diseases? Ultimately we aim to improve the lived-experience of individuals affected by dementia. This protocol focuses on building the foundation for this long-term objective by adapting the NIA-AA framework to link genetic, proteomic, and free-living behavioural signatures across NDD cohorts.
Objectives:
Objective 1 will examine the expression of single proteins or sets of proteins (i.e., protein biomarkers), and different gene mutation inheritance patterns (e.g. mutation negative, monogenic mutation, polygenic mutations), to help identify unique cohorts with similar symptoms and free-living behavioural profiles.
Objective 2 will examine the relationship between multidimensional data (genomic-proteomic signatures, functional behaviours extracted from free-living data collected with wearable biosensors), and the risk for adverse health outcomes (e.g., ED visits, hospitalizations, long-term care admission, death, comorbid disease).
Objective 3 will examine the useability, acceptance and impact of feedback on self-management activities. Feedback around functional activities will be provided in the form of a participant report that conveys higher level metrics intended to inform and/or alter behavior relative to overall health, symptom management, and/or quality of life.
HANDDS-ONT is designed as a "Master Observational Trial" \[https://doi.org/10.1016/j.cell.2019.12.009\], connecting real-world clinical data with cellular, protein marker and genetic data, free-living behavioural data measured by wearable biosensors and longer-term health outcome data via linkage to administrative datasets at ICES.
Data collection will build on existing ONDRI research infrastructure and a central group of research cores that reflect the evolving state of research in neurodegenerative disorders. Specifically, there will be five complimentary research cores (Fluid biomarkers, Clinical, Wearable biosensors, Health Systems, and Neuroinformatics) overseen by a central research Administration Core.
To achieve Objective 1, fluid biomarkers from serum and plasma, genetic data, clinical information and free-living behaviours (e.g. sleep, physical activity and other markers collected using wearable biosensors) will be integrated to identify groups based on NIA-AA research framework. Participants will be asked to provide a blood sample, complete standardized questionnaires for data collection by telephone or online, and wear wearable biosensors for 7-10 days described in sections below.
To achieve Objective 2, the clinico-pathological cohorts identified in objective 1 (combining protein and genetic biomarker data with clinical and free-living behaviour data) will be linked to administrative datasets at ICES to identify risk factors for important clinical outcomes (e.g. death, long-term care need, comorbid diseases, falls) and patterns of health systems utilization. Participants will be asked for permission to securely store Health Card Numbers and link to ICES for outcomes (see Procedures and Assessments section, below).
To achieve Objective 3, surveys and interviews will be administered. As additional metrics are validated, they will be integrated into the feedback form for evaluation using the methods described in Objective 3, above. Participants may consent to being recontacted for ongoing feedback and new study options (see Procedures and Assessments section, below).
