DETECTION OF DEMENTIA RISK IN PRIMARY CARE: PRELIMINARY INVESTIGATION OF A COMPOSITE DEMENTIA RISK SCORE IN VETERANS

Dementia is becoming a significant public health concern as the United States population rapidly ages. Veterans, accounting for a substantial portion of the United States population, may be at even higher risk for developing dementia as they generally have more risk factors for dementia than the general population. The current study sought to develop a modifiable composite dementia risk score, based on routinely gathered data from the primary care setting, that would predict an individual\u27s risk for developing dementia in 10 years. A composite risk score--based on age, hypercholesterolemia, hypertension, current smoking, alcohol use disorder, and pulse pressure--was created using 10 years of Veterans\u27 electronic medical record information. The predictive accuracy of the composite risk score was in the good range (AUC = 0.78) and less conservative estimates were even more accurate (AUC=0.85). The sensitivity was 50% and the specificity was 80%. This risk score is the first composite dementia risk score created for Veterans and provides optimism for future research in this area. Once further validated, this type of risk score could be seamlessly introduced into the primary care setting where its components are usually available. This type of assessment holds promise of being a considerable step forward in the prevention or delay or dementia onset in a rapidly aging Veteran population

American Gut: an Open Platform for Citizen Science Microbiome Research

McDonald D, Hyde E, Debelius JW, et al. American Gut: an Open Platform for Citizen Science Microbiome Research. mSystems. 2018;3(3):e00031-18

movie_s1.mp4

Longitudinal samples from a large bowel resection. We place longitudinal samples collected prior to and following a large bowel resection in the context of samples from the AGP, the Earth Microbiome Project (https://www.ncbi.nlm.nih.gov/pubmed/29088705), intensive care unit patients (https://www.ncbi.nlm.nih.gov/pubmed/27602409), "extreme" diet samples from (https://www.ncbi.nlm.nih.gov/pubmed/24336217), and samples from the Hadza hunter-gatherers (https://www.ncbi.nlm.nih.gov/pubmed/28839072). Unweighted UniFrac was computed on this sample set, and principal coordinates were assessed. Using EMPeror (https://www.ncbi.nlm.nih.gov/pubmed/24280061), we then animate the plot by connect successive data points gut resection time series, while rotating the data frame. We first show the how the extent of change in the microbial community, and how the samples immediately following surgery resemble fecal samples from ICU patients. In the background of the animation, a black line connects a plant rhizosphere sample to a marine sediment sample, which have the same unweighted UniFrac distance (0.78) as the longitudinal sample immediately preceding and immediately following surgery

Full American Gut Project mapping file

The full American Gut Project mapping file, includes non-fecal samples

Weighted normalized UniFrac distances

The weighted normalized UniFrac distance (Lozupone et al AEM 2007) matrix of the 9511 fecal samples used in the American Gut paper. UniFrac was computed using Striped UniFrac (https://github.com/biocore/unifrac). Prior to execution of UniFrac, Deblur (Amir et al mSystems 2017) was run on the samples, all bloom sOTUs were removed (Amir et al mSystems 2017), and samples were rarefied to a depth of 1250 reads (Weiss et al Microbiome 2017). For the phylogeny, fragments were inserted using SEPP (Mirarab et al Pac Symp Biocomput 2012) into the Greengenes 13_5 99% OTU tree (McDonald et al ISME 2012)

American Gut Project fecal sOTU counts table

The Deblur sOTU counts table for the fecal samples used in the American Gut Project manuscript. The samples were trimmed to a common read length of 125nt, and processed by Deblur (Amir et al mSystems 2017). Blooms were removed (Amir et al mSystems 2017) and any sample with fewer than 1250 sequences was omitted. This table is not rarefied,

movie_s2.mp4

Placing changes in the microbiome in the context of the American Gut. We accumulated samples over sequencing runs to demonstrate the structural consistency in the data. We demonstrate that while the ICU dataset (https://www.ncbi.nlm.nih.gov/pubmed/27602409) falls within the American Gut samples, they do not fall close to most samples at any of the body sites. We then highlight samples from the United Kingdom, Australia, the United States and other countries to show that nationality does not overcome the variation in body site. We then highlight the utility of the American Gut in meta-analysis by reproducing results from (https://www.ncbi.nlm.nih.gov/pubmed/20668239) and (https://www.ncbi.nlm.nih.gov/pubmed/23861384), using the AGP dataset as the context for dynamic microbiome changes instead of the HMP dataset. We show rapid, complete recovery of C. diff patients following fecal material transplantation and also contextualized the change in an infant gut over time until it settles into an adult state. This demonstrates the power of the American Gut dataset, both as a cohesive study and as a context for other investigations