CIMA-Q

Overview

Alzheimer's and related diseases (AD) affect 10% of individuals after the age of 65 and this percentage increases to 35% after the age of 85. Coordinated efforts are necessary to reduce the psychological, social and economic burden that AD place on patients, their families and society as a whole. Currently, AD is typically diagnosed when symptoms are already present, with cognition, quality of life, and autonomy affected significantly, however as evidence shows years after neurodegeneration has started in the brain. The Consortium for early identification of Alzheimer's disease - Québec (CIMA-Q) aims to (1) develop new methods enabling an earlier diagnosis and (2) acquire a better understanding of the initial pathophysiological stages of AD in order to develop more effective an earlier treatments, able to curb the trajectory of decline.

Participants

The CIMA-Q cohort participants are representative of different AD stages (pre-symptomatic and symptomatic) and clinical presentations (e.g., comorbidity). Moreover, we also recruited cognitively healthy elderly volunteers and healthy young volunteers to obtain comparison values on targeted cognitive and biological measures. Participants were recruited from different settings: the NuAge cohort, memory clinics, the community (advertisements and participant banks at participating sites) and the CCNA project.

As of March 2024, 412 participants aged 65 and over have been recruited (64 % women): 36 are individuals with Alzheimer’s type dementia (AD), 130 individuals with mild cognitive impairment (MCI), 178 individuals with subjective cognitive impairment (SCI), and 68 cognitively healthy elderly participants (C).

There were up to 9 evaluation time points over 8 years: 5 complete evaluations and 4 brief evaluations.

Recruitment started at the end of 2014 and 8-year follow-ups began recently. Our objective is to reach a total of 350 elderly participants with at least one completed follow-up (2 years from baseline) for all the SCI (150) and MCI (100) participants.

Methods and available data

All participants included in the study receive thorough neuropsychological and neuropsychiatric assessments, provide blood samples, and further undergo a clinical evaluation (clinical questionnaires, neurological and physical examination, blood tests). We also collect magnetic resonance neuroimaging data (MRI) and cerebrospinal fluid (CSF) from consenting participants. Finally, we collect additional information from a study partner (informant) (Belleville, et al. 2019).

Participants undergo mandatory in-person assessments at the initial visit and are invited back every 2 years (years 2, 4, 6, and 8). For year 1, 3, 5, and 7, they are contacted by phone for brief clinical assessments.

Participants can also consent to brain donation. Each collected brain undergoes neuropathological evaluation and is deposited at the Douglas-Bell Canada Brain Bank for research purposes.

FULL ASSESSMENT

Clinical, Neuropsychology & Blood samples

• post 2 years follow-up: 184 (+112 MRI)

• post 4 years follow-up: 134 (+53 MRI)

• post 6 years follow-up: 109 (+58 MRI)

• post 8 years follow-up: 23 (+11 MRI)

• TOTAL: 862

• Participants with at least 1 complete follow-up after initial evaluation: 222

• Participants with 1 follow-up evaluation: 86

• Participants with 2 follow-up evaluations: 62

• Participants with 3 follow-up evaluations: 54

• Participants with 4 follow-up evaluations: 20

NEUROIMAGING

• Participants with at least 1 MRI: 278
• Participants with 1 MRI: 153
• Participants with 2 MRIs: 78
• Participants with 3 MRIs: 27
• Participants with 4 MRIs: 15
• Participants with 5 MRIs: 5
• Total MRI: 475

BIOLOGICAL SAMPLES

Blood: 19,000+

CSF (60 participants): 6,000+ CSF from young healthy controls: to come

BRAIN BANK

4 Brains

CLINICAL ASSESSMENT

NURSE AND MEDICAL DOCTOR ASSESSMENT

SOCIO-DEMOGRAPHIC INFORMATION

Nationality, marital status, language, social support network, income, level of education, occupation, retirement, volunteering and activities, etc.

COGNITION

1. MoCA (Montreal Cognitive Assessment)
2. Telephone-Mini Mental State Examination (T-MMSE)
3. Logical Memory test from the Wechsler Memory Scale (short story, immediate and delayed recall)
4. Cognitive complaint question (Jessen)
5. Clinical diagnosis

COGNITIVE RESERVE

1. Cognitive reserve questionnaire (Bartrés score)
2. Questions on bilingualism

FUNCTIONAL HABILITIES

1. Alzheimer’s disease cooperative study (ADCS) – Activities of Daily Living questionnaire
2. Physical self-maintenance scale (PSMS)
3. Score – Clinical Dementia Rating (CDR)

NUTRITION

1. Mini Nutritional Assessment® SF

GENDER IDENTITY

1. Question on gender identity

PSYCHIATRIC SYMPTOMS

1. Apathy Inventory (AI)
2. Neuropsychiatric Inventory (NPI-Q)
3. PHQ-9 (Patient Health Questionnaire)
4. Mild Behavioral Impairment Checklist (MBI-C)

CHRONIC PAIN

1. Chronic pain Self-Assessment

HEALTH SELF-ASSESSMENT

1. Health and well-being survey (SF-36)
2. Health status and auto perception of health status

SLEEP

1. Chronic insomnia
2. Sleep apnea (+ Stop Bang)
3. REM sleep disorders

SMELL

1. Olfactive capacity test (UPSIT)

VITALS SIGNS AND PHYSICAL MEASUREMENTS

1. Resting state blood pressure
2. Orthostatic change
3. Anthropometric measures
4. Grip strength
5. Walking speed

MEDICAL HISTORY

1. Medical history
2. Family history of dementia
3. Alcohol and other drug use
4. History and evolution: cognitive complaint
5. Surgical history
6. Personal psychiatric history
7. Psychiatric history of the family
8. Allergies

NEUROLOGICAL EXAMINATION

1. Level of consciousness
2. Cranial nerves
3. Nervous system
4. Cerebellar functions
5. Gait

EVALUATION SCALES

1. Charlson Score
2. Hachinski Ischemic Scale
3. Fried frailty index

COMPLETE PHYSICAL EXAM

Including a blood test and a haematological profile

MEDICATION

1. List of current medication

COVID-19

1. History of infection and vaccination

STUDY PARTNER QUESTIONNAIRES

1. Cognitive complaint question (Jessen)
2. Neuropsychiatric Inventory (NPI-Q),
3. Apathy Inventory (AI)
4. Questionnaire relating to activities of daily living (ADCS-PI)
5. Mild Behavioral Impairment Checklist (MBI-C) ?

NEUROPSYCHOLOGICAL, NEUROPSYCHIATRIC AND PSYCHOSOCIAL ASSESSMENT

EPISODIC MEMORY

1. Rey Auditory Verbal Learning Task (RAVLT)
2. Face-Name memory test (associative episodic memory)
3. Cued recall from Memoria

PROSPECTIVE MEMORY

1. Envelope Task

SEMANTIC PERCEPTION

1. Object Decision test (BORB)

VISUAL DISCRIMINATION

1. Visual Perception line orientation test (BORB)

EXECUTIVE FUNCTIONS

1. Stroop-D-KEFS (4 conditions)
2. Trail making test A and B
3. Computerized Hayling task
4. Digit Symbol test (WAIS-III)
5. Alpha-span (short form)

LANGUAGE

1. Verbal fluency (category – animals)
2. Boston Naming Test
3. Vocabulary test (WAIS-III)

PSYCHIATRIC SYMPTOMS

1. Geriatric Depression Scale (GDS-30)
2. Geriatric Anxiety Inventory (GAI)
3. Apathy inventory (participant)

COGNITIVE COMPLAINT

1. Cognitive Change Index (CCI)
2. Memory auto-administered questionnaire (QAM, short form)

PSYCHOSOCIAL

1. Siegrist’s Questionnaire (effort-reward imbalance at work)
2. Karasek’s Questionnaire (Work related stress)

SLEEP

1. Insomnia Severity Index (ISI)
2. Epworth Sleepiness Scale
3. Sleep quality questionnaire

DEMENTIA LITERACY

1. Knowledge about Alzheimer’s disease
2. Dementia Attitude Scale (DAS)
3. Perception Regarding Investigational Screening for Memory in Primary Care (PRISM)

EXPERTISE

1. Mobile Device Proficiency
2. Technology experience profile

NEUROIMAGING ASSESSMENT

MRI

ANATOMICAL: 3DT1w
PATHOLOGICAL: PD and T2w
VASCULAR: FLAIR and T2*
CONNECTIVITY / FUNCTIONAL

1. 30-direction DTI
2. Resting state BOLD
3. Task related activation

BLOOD BIOSAMPLES

1. Plasma
2. Serum
3. Red blood cells
4. PBMCs / iPSC / Neuron-stem cells
5. DNA / Buffy coat
6. RNA

RESULTS:

1. p-Tau 181 / p-Tau 231
2. Apo E genotype
3. BDNF mRNA (80 participants)

CSF BIOSAMPLES

(60 participants) RESULTS:

1. A$\beta$40 / A$\beta$42 / A$\beta$38
2. Total Tau

BRAIN BANK

• 4 Brains

PLANNED ANALYSIS:

1. Thal phase of A$\beta$ deposits
2. Braak Scale of neurofibrillary degeneration and Tau
3. Detailed vascular pathology
4. CERAD score for neuritic plaques
5. Brack Scale ($\alpha$-synuclein/Lewy bodies)
6. Protein Transactive Response DNA-binding protein-43 (including LATE)
7. Diagnosis

COVID-19 / SPECIAL PROJECT

Data collected during the COVID-19 lockdown

Through a collaboration, CIMA-Q participants were interviewed during the first lockdown regarding health parameters suspected to be affected by the sanitary measures and the COVID-19 pandemic. The following set of questionnaires assessed COVID-19-related stress, psychiatric symptoms, subjective cognitive complaints, changes in social, cognitive, and physical stimulation, as well as adherence to social distancing recommendations.

1. Socio-demographic information
2. T-MMSE
3. COVID-19 restrictions
4. COVID-19 virus
5. Social distancing
6. Social network
7. Changes in sleep routine
8. Sleep habits
9. Insomnia Severity Index (ISI)
10. Physical activity
11. Geriatric Anxiety Inventory (GAI)
12. Problems and symptoms related to the pandemic
13. Auto-perception of health
14. Geriatric Depression Scale (GDS-30)
15. Cognitive/ Memory complaint question (Jessen)
16. Short QAM
17. Pain Self-Assessment Questionnaire (short form)
18. Alcohol and drug use

Get access

The study protocol and the procedures for accessing data and biological samples are available here: Data from CIMA-Q Please note that biological samples may be requested only by investigators from the province of Quebec.