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yXQVeKrtMVgkHhIWio25oUWvemI2vMR2bqmGEDxohNFPrQIvJd6esPsK6jSjASontdt4SQqzr7dp4Zefw6ZPYCVU3fbXJg7anhE4j5kxwM6MEgbLHPxvDT2abjY

LEADS Data and Biospecimen Request Application

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Currently, only baseline data is available for sharing with external investigators.

Please ensure your project does not overlap with the primary aims of the LEAD Study.

Application Date

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M-D-Y

Application Title

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First Name

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Last Name

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Degree(s)

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PhD

MSc

Other

Academic Position

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Institution / Company

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Department

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Street Address

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City

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State / Province

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Postal / Zip Code

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Country

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Study Title

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Hypothesis

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Background

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Aims

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Types of Data Requested (basic)

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Clinical

Imaging

Biospecimen

Proposed Methods (including statistical methods and use for all data requested)

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Provide an overview statement of your research study plans (2-3 sentences)

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Intended use of the data (publications, abstracts, grant applications)

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Keywords (minimum 3)

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If additional files are needed for review, please upload them here.

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Are you a LEADS investigator?

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Yes

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Are you requesting an update to a previous dataset?

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Yes

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If yes, list the application title and date of approval.

Are there other investigators on your team? If so, please list.

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If applicable, please provide the IRB Number and IRB Expiration Date.

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LEADS Annotated CRFs:

Attachment:Compiled LEADS Annotated CRFs_09.16.2025.pdf

Demographic Data

Demographic data

Select the specific Demographic Data forms that you would like:

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NACC Form A1: Subject/Participant Demographics (NACC UDS v3 & v4)

NACC Form A1a: Social Determinants of Health (NACC UDS v4)

NACC Form A2: Co-participant Demographics (NACC UDS v3 & v4)

LEADS Participant Demographics Form

Clinical Data

Vitals (NACC Form B1)

General medical and neurological examinations

Medical History

Family History

Early Developmental History (LEADS Form)

Medications

Clinical diagnosis

Diagnostic subtype

APOE status

Select the specific General Medical & Neurological Examinations forms that you would like:

* must provide value

NACC Form A5 - D2: Participant Health History / Clinician-assessed Medical Conditions (NACC UDS v4)

NACC Form B1: Physical (NACC UDS v3)

NACC Form B3: Unified Parkinson's Disease Rating Scale (UPDRS) - Motor Exam (NACC UDS v4)

NACC Form B3F: Supplemental UPDRS (NACC UDS/FTLD v3)

NACC Form B4: CDR Dementia Staging Instrument Plus NACC FTLD Behavior & Language Domains (CDR Plus NACC FTLD) (NACC UDS v3 & v4)

NACC Form B8: Physical/Neurological Examination Findings (NACC UDS v3 & v4)

NACC Form B9: Clinician Judgment of Symptoms (NACC UDS v3 & v4)

LEADS UDS Supplemental - B9 Clinician Judgment of Symptoms Form

LEADS Physical Examination Form

LEADS Neurological Examination Form

Select the specific Medical History forms that you would like:

* must provide value

NACC Form A5: Subject Health History (NACC UDS v3)

NACC Form A5 - D2: Participant Health History / Clinician-assessed Medical Conditions (NACC UDS v4)

NACC Form D2: Clinician-assessed Medical Conditions (NACC UDS v3)

LEADS UDS Supplemental - A5 Subject Health History Form

LEADS Initial Health Assessment Form

LEADS Autoimmune History Questionnaire

LEADS Sex and Reproductive Health Questionnaire

Select the specific Family History forms that you would like:

* must provide value

NACC Form A3: Subject/Participant Family History (NACC UDS v3 & v4)

LEADS UDS Supplemental - A3 Subject Family History Form

LEADS Subject Family History - Other Relatives Form

Select the specific Medications forms that you would like:

* must provide value

NACC Form A4: Subject/Participant Medications (NACC UDS v3 & v4)

NACC Form A4a: ADRD-Specific Treatments (NACC UDS v4)

LEADS Concurrent Medications Log

LEADS Alzheimer's Disease Medication Exposure Form

LEADS Anti-Amyloid Treatment Information Form

Select the specific Clinical Diagnosis forms that you would like:

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NACC Form D1: Clinician Diagnosis (NACC UDS v3)

NACC Form D1a: Clinical Syndrome (NACC UDS v4)

NACC Form D1b: Etiological Diagnosis and Biomarker Support (NACC UDS v4)

LEADS Diagnostic Impression Form

Select the specific Diagnostic Subtype forms that you would like:

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NACC Form B9F: Clinical PPA and bvFTD Features (NACC UDS/FLTD v3)

LEADS PCA Phenotype Formulation Form

LEADS PPA Phenotype Formulation Form

Cognitive/Behavioral Assessment Data

NACC UDS Neuropsychological Battery (Form C2)

NACC FTLD Neuropsychological Battery (Form C1F)

Other NACC FTLD Assessments (Forms C2F - C6F)

Rey AVLT (NACC Form C2 - UDS v4; LEADS Form)

Digit Symbol Substitution Test (LEADS Form)

ADAS-Cog (LEADS Form)

TabCAT (Flanker, Match, Line Length, and Line Orientation; LEADS Form)

Functional Assessment Scale (FAS) (NACC Form B7)

GDS (NACC Form B6)

NPI-Q (NACC Form B5)

Amsterdam IADL (LEADS Form)

Select the specific Other NACC FTLD Assessments forms that you would like:

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NACC Form C2F: Social Norms Questionnaire (NACC UDS/FTLD v3)

NACC Form C3F: Social Behavior Observer Checklist (NACC UDS/FTLD v3)

NACC Form C4F: Behavioral Inhibition Scale Co-Participant Questionnaire (NACC UDS/FTLD v3)

NACC Form C5F: Interpersonal Reactivity Index Co-Participant Questionnaire (NACC UDS/FTLD v3)

NACC Form C6F: Revised Self-Monitoring Scale Co-Participant Questionnaire (NACC UDS/FTLD v3)

Imaging

MRI (derivative data)

MRI (raw imaging data)

Amyloid PET scans (derivative data)

Amyloid PET scans (raw imaging data)

Tau PET scans (derivative data)

Tau PET scans (raw imaging data)

FDG PET scans (derivative data)

FDG PET scans (raw imaging data)

Select the specific MRI (derivative data) forms that you would like:

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NACC Form D1: Clinician Diagnosis (NACC UDS v3)

NACC Form D1b: Etiological Diagnosis and Biomarker Support (NACC UDS v4)

NACC Form E2F: Imaging Available (NACC UDS/FTLD v3)

Select the specific Amyloid PET scans (derivative data) forms that you would like:

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NACC Form D1: Clinician Diagnosis (NACC UDS v3)

NACC Form D1b: Etiological Diagnosis and Biomarker Support (NACC UDS v4)

NACC Form E2F: Imaging Available (NACC UDS/FTLD v3)

Select the specific Tau PET scans (derivative data) forms that you would like:

* must provide value

NACC Form D1: Clinician Diagnosis (NACC UDS v3)

NACC Form D1b: Etiological Diagnosis and Biomarker Support (NACC UDS v4)

NACC Form E2F: Imaging Available (NACC UDS/FTLD v3)

Select the specific FDG PET scans (derivative data) forms that you would like:

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NACC Form D1: Clinician Diagnosis (NACC UDS v3)

NACC Form D1b: Etiological Diagnosis and Biomarker Support (NACC UDS v4)

NACC Form E2F: Imaging Available (NACC UDS/FTLD v3)

Biospecimen

Plasma (samples)

Plasma (biomarker measures)

CSF (samples)

CSF (biomarker measures)

Serum (samples)

PBMC (samples)

DNA (samples)

DNA (derivative data)

RNA (samples)

If requesting a biofluid sample, provide details regarding cohort, volume, and number of samples.

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Select the specific Plasma biomarker measures that you would like:

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Aβ40

Aβ42

Aβ42/40 ratio

p-Tau231

NfL

GFAP

alpha-synuclein seeding results

Select the specific CSF biomarker measures that you would like:

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Aβ40

Aβ42

t-Tau

p-Tau181

NfL

SNAP-25

VILIP-1

Neurogranin

alpha-synuclein seeding results

Select the specific DNA derivative data that you would like:

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APOE

Other genotype data

If requesting other genotype data, provide specific details:

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