Implementation of a standardized Video-based Asynchronous Neurological Examination (VANE) in a multi-center observational study of Alzheimer’s disease (AD) and AD related dementias

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Abstract
Introduction: The Diabetes Prevention Program Outcomes Study (DPPOS) is an established cohort of aging persons with pre-diabetes and type 2 diabetes with 25 years of median follow-up. In 2022 DPPOS added Alzheimer’s disease (AD), and AD related dementias (ADRD) phenotyping using the National Alzheimer’s Coordinating Center (NACC) Uniform Data Set (UDSv3), which included a standardized neurological examination across 25 clinical sites, administered by clinical staff and interpreted centrally by clinicians. Methods: A DPPOS video-based asynchronous neurological examination (DPPOS-VANE) was developed iteratively through consensus from research clinicians and staff feedback to harmonize with UDSv3 to identify common neurological diagnoses aside from dementia including diabetic cranial neuropathies, stroke and parkinsonism. DPPOS-VANE was designed to be conducted without direct participant contact by the examiner, reproducible, and independent of clinical skills of PCs. An iPad™ camera recorded the video exam, comprised of assessments of extraocular and facial movements, visual fields, speech, gross motor strength, pronator drift, praxis and parkinsonism. A 10-minute training video demonstrated the examination step-by-step with scripts and instructions in English and Spanish. Site-specific performance review, feedback, and staff certification preceded central reading of video recordings by physicians. After two years of implementation, 1286 DPPOS-VANEs led to 1284 examination reviews. Of these, 1204 (93%) were completed by having the examiner follow the standard script. Overall, 1237 examinations (96%) were delivered as planned, 41 (3%) had minor errors but were still usable, and 6 (0.4%) had major deviations in exam technique; two additional recorded evaluations were not usable as recorded videos were inaccessible due to technical errors. Each examination was completed within 10-15 minutes. Each site on average completed 51.4 examinations (range 14-92). Discussion: Engaging 55 research staff across 25 sites and 3 physician-reviewers, this study is the first to demonstrate feasibility of a VANE as an efficient neurological examination model enabled by commonly used devices. Such a multisite standardized VANE represents a novel paradigm for large epidemiological studies.
Funding Information
  • National Institute of Diabetes and Digestive and Kidney Diseases (U01 DK048489)
  • National Institute of Diabetes and Digestive and Kidney Diseases (U01 DK048339)
  • National Institute of Diabetes and Digestive and Kidney Diseases (U01 DK048377)
  • National Institute of Diabetes and Digestive and Kidney Diseases (U01 DK048349)
  • National Institute of Diabetes and Digestive and Kidney Diseases (U01 DK048381)
  • National Institute of Diabetes and Digestive and Kidney Diseases (U01 DK048468)
  • National Institute of Diabetes and Digestive and Kidney Diseases (U01 DK048434)
  • National Institute of Diabetes and Digestive and Kidney Diseases (U01 DK048485)
  • National Institute of Diabetes and Digestive and Kidney Diseases (U01 DK048375)
  • National Institute of Diabetes and Digestive and Kidney Diseases (U01 DK048514)
  • National Institute of Diabetes and Digestive and Kidney Diseases (U01 DK048437)
  • National Institute of Diabetes and Digestive and Kidney Diseases (U01 DK048413)
  • National Institute of Diabetes and Digestive and Kidney Diseases (U01 DK048411)
  • National Institute of Diabetes and Digestive and Kidney Diseases (U01 DK048406)
  • National Institute of Diabetes and Digestive and Kidney Diseases (U01 DK048380)
  • National Institute of Diabetes and Digestive and Kidney Diseases (U01 DK048397)
  • National Institute of Diabetes and Digestive and Kidney Diseases (U01 DK048412)
  • National Institute of Diabetes and Digestive and Kidney Diseases (U01 DK048404)
  • National Institute of Diabetes and Digestive and Kidney Diseases (U01 DK048387)
  • National Institute of Diabetes and Digestive and Kidney Diseases (U01 DK048407)
  • National Institute of Diabetes and Digestive and Kidney Diseases (U01 DK048443)
  • National Institute of Diabetes and Digestive and Kidney Diseases (U01 DK048400)

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