A fully functional Digital Engagement Portal (DEP) has been deployed at 3 sites in Sweden (Wave 1). While advanced features such as screening tools, guided interfaces, and user accounts remain gated pending GDPR and ethical approvals, these components are technically integrated and ready for activation. Foundational QA/QC testing using non-identifiable configurations and early engagement analytics have been implemented, establishing a robust technical and operational foundation for further refinement and expansion in subsequent waves.
A 2-stage approach is being used to test and validate DCAs and BBMs, starting with a pilot stage focused on assessing the feasibility and usability of DCAs, and continuing with larger-scale testing of both DCAs and BBMs, in alignment with implementation evaluation work. 102 participants have so far been included in the pilot DCA study. Recruitment for prospective validation of BBMs for the early diagnosis of AD in patients with cognitive symptoms has also been initiated. A Community of Practice has been established with study sites to support coordination and shared learning across the different components of the implementation evaluation. A baseline front-line providers survey and follow-on interviews guides were generated and a pilot of the baseline survey to ensure feasibility was completed.
The full version of the Data Flow and the Data Map were completed, which are both “living documents” evolving with the project, to reflect any changes in the datasets or sharing within the project. The legally required Data Protection Impact Assessment (DPIA) has also been completed.
Development and/or testing of predictive algorithms/models was conducted in parallel in existing observational cohorts (early risk and disease detection) and multidomain lifestyle-based intervention RCTs (response to intervention). Preliminary findings showed that plasma p tau217 was the strongest BBM for predicting amyloid status, with performance influenced by population characteristics, clinical and genetic factors. Other BBMs, neuroimaging and risk scores showed mixed or complementary associations with cognitive decline and brain changes. FINGER and WW FINGERS findings indicated that multiple plasma BBMs, omics profiles, genetic risk, and MRI markers were linked to early cognitive changes, with several biomarkers potentially modifying responses to lifestyle interventions.
A series of reviews addressed ethical considerations in population level dementia risk screening, the potential of health impact bonds as financing mechanisms, and health technology assessment evidence requirements across Europe. Key ethical issues, including e.g. autonomy, stigma, bias, equity, and economic implications, will inform the final ethical and societal guidance report. Most HIB programs with disclosed results met their performance targets. A complementary dementia prevention health economic model integrating cardiovascular effects was developed. An HTA Standing Forum has been actively discussing case studies and agency experiences from across Europe. Other work focused on better understanding the clinical prediction models in Ad-Riddle, their roles, if they are likely to require reimbursement, and the evidence being generated to train and validate the models.
Work has continued on the sustainability workstream to identify, prioritize and select the project assets in advance, with the aim of maximizing the sustainability of AD-RIDDLE and its impact on the field.
