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AlzRisk Paper Detail
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Reference: Kuller, 2003
Cohort: Cardiovascular Health Cognition Study/Cardiovascular Health Study Cognition Study
Risk Factor: Blood Pressure


Average Follow-up Time Detail
The study cohort included CHCS participants who were recruited between 1989 and 1991 and who underwent an MRI examination between 1991 and 1994. Participants in the CHCS underwent yearly examinations as well as a detailed clinical examination in 1999.

Exposure Detail
Participants underwent annual clinical examinations from 1989 through 1999. No details about assessment of hypertension or about the timing of hypertension considered in the analysis were provided.

Age Detail
Entry criteria required all participants to be age 65 or older at study entry.

Screening and Diagnosis Detail
Screening Method:
IQ-CODEInformant Questionnaire for Cognitive Decline in the Elderly (Jorm 1989)
3MSEModified Mini-Mental State Examination (Teng 1987)
Other
TICSTelephone Interview of Cognitive Status

AD Diagnosis:
Other

Total dementia definition: Other

In 1998-1999 the authors attempted to identify cases of dementia prevalent at the time or MRI as well as incident cases that occurred after the MRI. To do so, participants were initially classified as being at high risk for dementia or being at low risk, according to a retrospective review of study records including cognitive testing. Those at high risk were subsequently invited to the study clinic for an in-person evaluation including a neuropsychological battery and a psychiatric assessment. At the end of the visit, a neurologist classified persons as normal, having MCI, or having dementia. Participants at low risk were not followed-up in three of the four clinics. In the fourth clinic all participants were followed-up to provide insight into the performance of the classification strategy. Information on participants who did not come to the clinic, including those who were deceased was gathered from medical record reviews, historical cohort records, telephone interviews, or proxy respondents.

"The diagnosis of dementia was based on a progressive or static cognitive deficit of sufficient severity to affect the subjects' activities of daily living and a history of normal intellectual function before the onset of cognitive abnormalities. Patients were required to have impairments in two cognitive domains, which did not necessarily include memory. All information was then sent to the Pittsburgh center irrespective of the diagnoses by the local neurologist or psychiatrist, i.e. normal, MCI or dementia. A neurologist with extensive experience in dementia diagnosis reviewed each of the cases in the study from every center and classified the cases as dementia, MCI or normal. All cases classified as possible dementia and MCI cases from Pittsburgh were then reviewed by the adjudication committee. They classified each participant first without availability of the MRI (pre-MRI) and after review of the MRI (post-MRI). The classification of specific types of dementia was done both before and after MRI. This paper is based only on the pre-MRI diagnosis of specific types of dementia."

Covariates & Analysis Detail
Analysis Type:
Cox proportional hazards regression

Participants with MCI were included in study analyses as non-demented persons.

AD Covariates:
Aage
Eeducation
Ggender
APOE4APOE e4 genotype
MMSEbaseline MMSE
DMdiabetes mellitus
MImycardial infarction history
Oother
RErace/ethnicity
SHstroke history

TD Covariates:
Aage
Eeducation
Ggender
APOE4APOE e4 genotype
MMSEbaseline MMSE
DMdiabetes mellitus
MImycardial infarction history
Oother
RErace/ethnicity
SHstroke history