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The recruitment of participants for research studies may be subject to bias due to an overrepresentation of those more willing to participate voluntarily. No study has analysed the effect of genetic predisposition to Alzheimer’s disease (AD) on study participation. The Prospective Imaging Study of Ageing (PISA), aims to characterise the phenotype and natural history of healthy adult Australians at high future risk of AD. Participants approached to take part in PISA were selected from existing cohort studies with available genome-wide genetic data for both successfully and unsuccessfully recruited participants, allowing us to investigate the genetic contribution to voluntary recruitment. From a recruitment pool of 13,432 individuals (age 40-80), 64% of participants were successfully recruited into the study. Polygenic risk scores (PRS) were computed in order to test to what extent the genetic risk for AD, and related risk factors (including educational attainment, household income and IQ), predicted participation in PISA. We examined the associations between PRS andAPOEε4 with recruitment using logistic regression models. We found significant associations of age and sex with study participation, where older and female participants were more likely to complete the core module. We did not identify a significant association of genetic risk for AD with study participation. Nonetheless, we identified significant associations with genetic scores for key causal risk factors for AD, such as IQ, household income and years of education. Our findings highlight the importance of considering bias in key risk factors for AD in the recruitment of individuals for cohort studies.

Highlights • Detailed protocol of the Prospective Imaging Study of Ageing (PISA) Study. • Genetic risk prediction to identify those at differing risk of Alzheimer’s disease. • Longitudinal cohort for the study of precursors and lifestyle risk factors. • Use of online surveys and cognitive testing for large scale phenotyping. • Functional, structural and molecular neuroimaging with neurocognitive testing., This prospective cohort study, “Prospective Imaging Study of Ageing: Genes, Brain and Behaviour” (PISA) seeks to characterise the phenotype and natural history of healthy adult Australians at high future risk of Alzheimer’s disease (AD). In particular, we are recruiting midlife and older Australians with high and low genetic risk of dementia to discover biological markers of early neuropathology, identify modifiable risk factors, and establish the very earliest phenotypic and neuronal signs of disease onset. PISA utilises genetic prediction to recruit and enrich a prospective cohort and follow them longitudinally. Online surveys and cognitive testing are used to characterise an Australia-wide sample currently totalling over 3800 participants. Participants from a defined at-risk cohort and positive controls (clinical cohort of patients with mild cognitive impairment or early AD) are invited for onsite visits for detailed functional, structural and molecular neuroimaging, lifestyle monitoring, detailed neurocognitive testing, plus blood sample donation. This paper describes recruitment of the PISA cohort, study methodology and baseline demographics.

This prospective cohort study, “Prospective Imaging Study of Ageing: Genes, Brain and Behaviour” (PISA) seeks to characterise the phenotype and natural history of healthy adult Australians at high future risk of Alzheimer’s disease (AD). In particular, we are recruiting mid-life Australians with high and low genetic risk of dementia to discover biological markers of early neuropathology, identify modifiable risk factors, and establish the very earliest phenotypic and neuronal signs of disease onset. PISA utilises genetic prediction to recruit and enrich a prospective cohort and follow them longitudinally. Online surveys and cognitive testing are used to characterise an Australia-wide sample currently totalling nearly 3,000 participants. Participants from a defined at-risk cohort and positive controls (clinical cohort of patients with mild cognitive impairment or early AD) are invited for onsite visits for lifestyle monitoring, detailed neurocognitive testing, blood sample donation, plus functional, structural and molecular neuroimaging. This paper describes recruitment of the PISA cohort, study methodology and baseline demographics.Author ApprovalAll authors have seen and approved this manuscript.