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Background/objectives: CAN-THUMBS UP is designed as a comprehensive and innovative fully remote program to 1) develop an interactive and compelling online Brain Health Support Program intervention, with potential to positively influence dementia literacy, self-efficacy and lifestyle risk factors; 2) enroll and retain a community-dwelling Platform Trial Cohort of individuals at risk of dementia who will participate in the intervention; 3) support an open platform trial to test a variety of multidomain interventions that might further benefit individuals at risk of dementia. This manuscript presents the Brain Health Support Program Study protocol., Design/setting: Twelve-month prospective multi-center longitudinal study to evaluate a fully remote web-based educational intervention. Participants will subsequently be part of a Platform Trial Cohort and may be eligible to participate in further dementia prevention clinical trials., Participants: Three hundred fifty older adults who are cognitively unimpaired or have mild cognitive impairment, with at least 1 well established dementia risk factor., Intervention: Participants engage in the Brain Health Support Program intervention for 45-weeks and complete pre/post intervention measures. This intervention is designed to convey best available evidence for dementia prevention, consists of 181 chapters within 8 modules that are progressively delivered, and is available online in English and French. The program has been developed as a collaborative effort by investigators with recognized expertise in the program's content areas, along with input from older-adult citizen advisors., Measurements: This study utilizes adapted remote assessments with accessible technologies (e.g. videoconferencing, cognitive testing via computer and mobile phone, wearable devices to track physical activity and sleep, self-administered saliva sample collection). The primary outcome is change in dementia literacy, as measured by the Alzheimer's Disease Knowledge Scale. Secondary outcomes include change in self-efficacy; engagement using the online program; user satisfaction ratings; and evaluation of usability and acceptance. Exploratory outcomes include changes in attitudes toward dementia, modifiable risk factors, performance on the Neuropsychological Test Battery, performance on self-administered online cognitive assessments, and levels of physical activity and sleep; success of the national recruitment plan; and the distribution of age adjusted polygenic hazard scores., Conclusions: This fully remote study provides an accessible approach to research with all study activities being completed in the participants' home environment. This approach may reduce barriers to participation, provide an easier and less demanding participant experience, and reach a broader geography with recruitment from all regions of Canada. CAN-THUMBS UP represents a Canadian contribution to the global World-Wide FINGERS program (alz.org/wwfingers)., Competing Interests: HF reports grant funding from CIHR to the CCNA (CNA-163902) that supported this study. Outside of this study, he also reports grant funding from Annovis (QR Pharma), Vivoryon (Probiodrug), AC Immune, and LuMind; service agreements for consulting activities with LuMind, Genentech (DSMB), Roche/Banner (DMC), Tau Consortium (SAB), Samus Therapeutics, Biosplice Therapeutics, Axon Neurosciences, Novo Nordisk Inc., Janssen Research and Development LLC; and travel funding from World Events Forum (ADDF) with no personal funds received and all payments to UCSD. He also reports a philanthropic donation from the Epstein Family Alzheimer’s Disease Collaboration for therapeutic research in AD with no personal funds received and all payments to UCSD. SB reports grant funding to CCNA from CIHR and ASC that supported this study. Outside of this study, she also reports consulting fees and participation on an advisory board for Lucilab and an unpaid role of scientific advisor for the Quebec Federation of Alzheimer’s Societies. HN reports consulting fees from Hoffman-La Roche and Biogen. AL reports a Centre for Aging Brain Health Innovation Grant (CCNA-1-00295) that helped support this study. NA reports grants from CIHR, Social Sciences and Humanities Research Council of Canada, Natural Sciences and Engineering Research Council of Canada, Centre for Aging + Brain Health Innovation, Canadian Foundation for Innovation, Fonds de Recherché Société et Culture Québec, and ASC. She also reports book royalties from Oxford University Press and consulting fees from the National Eye Institute. JW reports grant funding to her institution from AGE-WELL and MIRI (McMaster Institute for Research in Aging) to support a postdoctoral fellowship and CIHR funding to CCNA Team 18 to support Indigenous research in the CCNA. She also reports unpaid roles as a member of the Federal Ministerial Advisory Committee on Dementia and the Medical and Scientific Advisory Board for Alzheimer’s Disease International. MS reports unpaid roles as a member of the Data Safety and Monitoring Board (DSMB) for Intervention in Parkinson’s Disease and the Chair of the DSMB for Intervention in Depression. As Scientific Director of CCNA, HC reports grants from CIHR, Baycrest Health Sciences Foundation, Women’s Brain Health Initiative, Alzheimer Society of Canada, Brain Canada, Saskatchewan Health Research Foundation, Alberta Innovates, and Weston Foundation (Weston Brain Institute). As a site investigator for clinical trials, he also receives support from Roche, Lilly, Anavex, and Alector. He reports being a member of the Ministerial Advisory Board on Dementia (2019-2022) and part of the membership organizing committee for Canadian Conference on Dementia.

Background: Identification of those who are most at risk of developing specific patterns of disease across different populations is required for directing public health policy. Here, we contrast prevalence and patterns of cross-national disease incidence, co-occurrence and related risk factors across population samples from the U.S., Canada, England and Ireland., Methods: Participants (n = 62,111) were drawn from the US Health and Retirement Study (n = 10,858); the Canadian Longitudinal Study on Ageing (n = 36,647); the English Longitudinal Study of Ageing (n = 7938) and The Irish Longitudinal Study on Ageing (n = 6668). Self-reported lifetime prevalence of 10 medical conditions, predominant clusters of multimorbidity and their specific risk factors were compared across countries using latent class analysis., Results: The U.S. had significantly higher prevalence of multimorbid disease patterns and nearly all diseases when compared to the three other countries, even after adjusting for age, sex, BMI, income, employment status, education, alcohol consumption and smoking history. For the U.S. the most at-risk group were younger on average compared to Canada, England and Ireland. Socioeconomic gradients for specific disease combinations were more pronounced for the U.S., Canada and England than they were for Ireland. The rates of obesity trends over the last 50 years align with the prevalence of eight of the 10 diseases examined. While patterns of disease clusters and the risk factors related to each of the disease clusters were similar, the probabilities of the diseases within each cluster differed across countries., Conclusions: This information can be used to better understand the complex nature of multimorbidity and identify appropriate prevention and management strategies for treating multimorbidity across countries., (© 2021. The Author(s).)

Background: Body fat accrual trajectories can be used to monitor trends in body fat mass and identify potential health risks. Currently, no body fat percent (BF%) centile distance and velocity curves exist for Canadian youth., Objectives: To develop sex-specific and ethnic-specific BF% centile distance and velocity curves for White and Asian-Canadian youth., Methods: We utilized 4734 observations from 944 participants (female = 487; Asian = 532) to create sex-specific BF% velocity curves for age 10 to 18 years and sex-specific and ethnic-specific BF% percentile distance curves for ages 9 to 18 years for White and Asian children. BF% was derived from whole body DXA scans., Results: BF% centile distance curves for Asian and White girls were similar. BF% at most centiles plateaued around age 16 for Asian but not for White boys. Velocity curves for boys declined from age 11 to 13 years and then increased until age 18 years. For girls from 10 to 15 years, velocity curves converged towards the 50th centile then remained flat from 16 to 18 years., Conclusions: BF% distance and velocity centiles can be used to identify when an individual veers from an average BF% accrual trajectory. In future, these curves may be used to investigate differences in fat mass and accrual across Canada., (© 2019 World Obesity Federation.)