Abstract
The National Institute on Aging Alzheimer's Disease and Related Dementias Research Implementation
Milestones articulate the goals of the Institute for advancing Alzheimer's disease (AD) research. The
Leadership Award for AD and Related Disorders requires that the applicant address objectives of the
Milestones and provide mentorship to new and early stage investigators. The research proposed must
be groundbreaking and paradigm changing. Among the eight focus areas within the Implementation
Milestones' framework are Trial Innovation and Translation and Clinical Research – Pharmacological.
The Alzheimer's Clinical Trial InnOvationN (ACTION) Initiative proposed here embraces both the
research and mentoring aspects of the Leadership Award. The ACTION Initiative will include
development of a Clinical Trials Observatory (CTO) and an embedded mentorship program. The CTO
builds on the principal investigator's prior analyses of clinicaltrials.gov. This federal registry contains all
trials conducted in the US and many trials conducted ex-US. It includes Phase 1, 2 and 3 clinical trials
of preclinical, prodromal, and AD dementia trials. The PI has conducted and published research on the
trial design, biomarker, and clinical outcomes data from the registry. In 2016, Congress passed a law
requiring that trial outcomes be posted on the site within 1 year of completion of the trial. The PI proposes
to build a multi-disciplinary team of engineers, computer scientists, statisticians, and bioinformatic experts
to interrogate the range of data now available using artificial intelligence techniques including machine
learning and deep learning. An external advisory committee will ensure quality and dissemination. The
Alzheimer's Association will collaborate on results dissemination. An accessible web portal for the
database will make reviewed data readily available for analyses and prediction/modeling of planned
clinical trials. The growing database of real-world AD trial data will allow increasingly precise prediction
of trial outcomes based on complex relationships among baseline features, trajectories of decline, drug
mechanisms, and clinical and biomarker characteristics across all stages of AD. The data will be used
by the PI, mentees, academic trial leaders, and industry trial sponsors. Three initial mentees are identified
from neuropsychology, psychiatry, and engineering; more will be added with growth of the program. The
ACTION Initiative has the potential to transform clinical trial planning and outcomes, leading to substantial
impact on the Implementation Milestones of the NIA and accelerating development of new therapies for
patients with AD and those at risk. Mentees will power the future of AD drug development and clinical
trial planning.