Neuroepidemiolgy in a nutshell Christina Wolfson

1. Neuroepidemiolgy in a nutshellChristina Wolfson What is neuroepidemiology?Domains of inquiry? Selected topics Funding opps

2. Neuroepidemiology • Simply • that branch of epi dealing with the study of neurological disease • Journal NEUROEPIDEMIOLOGY (founded in 1982) • Few neuroepidemiologists in Canada • SER 2005 Symposium on neurological diseases

4. Domains of Enquiry • GENETIC • PHARMACO • GLOBAL • INFECTIOUS • CLINICAL • SURVEILLANCE • METHODOLOGY • PERINATAL • LIFECOURSE • WOMEN'S • ENVIRO • ECON • MENTAL • BIOSTATISTICS

5. What? • Epidemiology of Neurodegenerative disorders • Design • Detection • Distribution • Determinants • Prevention • Prognosis • Multiple Sclerosis • Amyotrophic Lateral Sclerosis • Parkinson’s Disease • Alzheimer’s disease With whom? Neurologists, Neuropsychologists, Economists, Statisticians, Physiotherapists, Nutritionists, Family Docs, Sociologists, Ethicists, Lawyers, Engineers, Kinesiologists, Clinical biochemists, Immunologists, Virologists, Geneticists, ......

6. How?Whatever is needed! • Case control • Cohort • Case crossover • Clinical Trial • Prevalence • Statistical methods • Systematic reviews • Databases • Face to face interviews • Telephone interviews • Self administered questionnaires • Physical assessments • Biological samples • Focus Groups

7. Some pending questions • What is the prevalence of • MS in Canada? • ALS in Canada? • Parkinson’s disease in Canada? • How do we identify MS, ALS, PD in population based studies without a full neuro assessment? • What is the best tool to identify cognitive impairment in a population based study? • How do we identify participants who do not have the capacity to consent to research? • Is the incidence of MS increasing in women but not in men? If so, why and what etiological clues might it provide? • How do we fold pediatric multiple sclerosis into what we thought we knew about the susceptibility period of MS (adolescence)? Can pediatric MS provide clues to the etiology of adult onset MS? • What are our best strategies to conduct risk factor studies on ALS, a rare, rapidly fatal disease? • Is the incidence of ALS really increased in deployed Gulf War Veterans? How can we study this? What is the optimal comparison group? • Has survival with MS increased over the past 50 years? • How has the presence of length bias (lack of adjustment) influenced what we believe about survival with neurological disorders?

8. Selected projects (1) • International case control study of MS risk factors • Norway, Italy, Sweden, Serbia, and Canada • Risk factors: Smoking, Vit D through Diet; Sun exposure, Early life infections • 4,000 cases – 16,000 controls • Pilot work – MSc thesis project • MS Latitude Project • Feasibility study for a prevalence study of MS in Qc using capture-recapture methodology • Survey of physician preferences for the care of individuals with MS

9. Selected projects (2) • Profile of Neurological Diseases in Canada (POND) • Systematic review and knowledge synthesis • Prevalence and correlates of successful health care transition in young adults with chronic neurological disorders • MSc Thesis Topic – student generated • The Epidemiology & Impact of Comorbidity on Multiple Sclerosis in Canada • New emerging team

10. Selected topics (3) • Program in Epidemiology Targeting Amyotrophic Lateral Sclerosis (PETALS) • Development and testing of risk factor questionnaires • Implementation of a database including risk factor info • Setting the stage for epidemiological research in Canada • Validation of diagnostic algorithms for Parkinson’s disease • Neurological/neurocognitive outcomes in Gulf War veterans • Canadian Longitudinal Study on Aging

11. Trainee Topics in Neuroepi • MSc (EBOH and Math/Stat) • Impact of misclassified exposure to infectious agents in case-control studies of multiple-sclerosis (thesis) • Measures of change in cognition on AD (Thesis) • *Seasonal variation in Parkinson’s disease risk (Thesis) • *Successful health care transition in young adults with chronic neurological disorders (Thesis) • Lifestyle risk factors & AD (project) • Frequency & correlates of behaviour disturbance in AD (project) • Age at onset of AD – correlates (project) • Methods to study the natural history of MS (thesis Math/Stat) • A new capture-recapture model selection criteria (thesis Math/Stat) • MS prognosis: A review of statistical modelling approaches (thesis Math/Stat) • Validity of the Markov assumption in economic studies of AD medications (thesis Math/Stat • Postdocs • Mental incapacity & long term participation in observational research • *Satisfaction with assistive technologies in MS • Delirium in elderly post surgical patients • PhD students (EBOH) • Spatial statistics & their application to neuroimaging studies of MS patients (Biostatistics) • Fully Bayesian mapping models to identify high risk areas with an application to MS in Sardinia (Biostatistics) • *Physican & caregiver preferences for treatment options in AD • Neurology residents/clinical fellows • MS in Canada • Epstein Barr Virus and MS • Quality of Life in MS • MS in the Middle East • Lead exposure and ALS • Canine Distemper Virus & MS • Surgical resection of brain tumours and survival

12. In 2009 Successfully lobbied the government to commit $15million to epidemiological research into neurological disorders • Prevalence/incidence/burden/risk factors/treatment

13. Funding Opps • CIHR, FRSQ, disease specific societies • MS, PD, ALS etc. • CIHR Neuroinflammation Training Grant (McGill- U de M – Laval consortium) • EndMS Research and Training Network • $20 million initiative to recruit, retain and train student/researchers interested in MS related research • Studentships, summer schools etc.

14. Questions? christina.wolfson@mcgill.ca