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AlzRisk Paper Detail

Reference: Peila, 2002
Cohort: Honolulu-Asia Aging Study
Risk Factor: Diabetes Mellitus

Average Follow-up Time Detail
This report from the HAAS cohort ascertained diabetes at the fourth examination between 1991 and 1993, and dementia at the fifth examination between 1994 and 1996. See the row for Curb et al. in this table for a related study from this cohort.

Exposure Detail
Diabetes diagnosis was ascertained through self-reports of history of diabetes and use of insulin or diabetes medications, and on the basis of blood glucose test results in participants without a self-reported diabetes diagnosis. In this study, classification as diabetic reflects having had a diabetes diagnosis at any time, including the fourth examination. (compare with Curb et al.).

"Diabetes was assessed on the basis of self-report of a doctor’s diagnosis of diabetes, use of oral hypoglycemic medications or insulin intake, or fasting and postchallenge glucose levels measured at the fourth exam. At the time of the study, only subjects who did not report diabetes (with no gastrectomy, no active peptic ulcer, and no stomach cancer) received a 75-g glucose drink (n=1,729). In these subjects, diabetes was defined according to the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus (29) and included individuals with fasting blood glucose >126 mg/dl or with 2-h postload glucose >200 mg/dl. A total of 551 subjects without previously reported diabetes were not tested for 2-h postload glucose level and were classified based on the fasting glucose level. However, among older adults, there are a significant number of individuals with normal fasting glucose and isolated postload hyperglycemia with vascular risk factors as high as those with diabetes (30)."

Ethnicity Detail
This was a cohort of Japanese-American men living in Hawaii. See the cohort description for more details.

Age Detail
This is the age at the fourth examination of the HAAS cohort when follow-up for this study began.

Screening and Diagnosis Detail
Screening Method:
CASICognitive Abilities Screening Instrument (Teng 1994)

AD Diagnosis:
NINCDS ADRDA National Institute of Neurological and Communicative Diseases and Stroke/Alzheimer's Disease and Related Disorders Association Criteria (McKhann 1984)

Total Dementia Definition: Dementia via DSM IIIR.

"In the prevalent and incident phases, all subjects
were administrated the 100-point Cognitive Abilities Screening Instrument (CASI) (16), a well recognized instrument to assess cognitive function validated among Japanese and Western sample populations (17). In the prevalent phase, CASI score and age were used to identify a subgroup for dementia evaluation (15). At the follow-up exam, subjects with a CASI score less than an education-adjusted cutoff (77 for those with low education and 79 for those with high education) or an absolute drop >9 CASI points (n = 749) underwent a specific dementia examination (18). At each exam, evaluation of clinical dementia included a proxy interview, detailed neuropsychological assessment, neurological examination, and neuroimaging. Final diagnosis of clinical dementia was determined by a consensus committee that included the
study neurologist and at least two other physicians expert in geriatric medicine and dementia.

"Dementia was diagnosed according to DSM-III R criteria (19). Probable and possible AD were diagnosed following the criteria of the National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer’s Disease and Related Disorders Association (20), and diagnosis of VsD was based on the California Alzheimer’s Disease Diagnostic and Treatment Centers guidelines (21). Diagnosis of dementia due to multiple etiologies included AD with cerebrovascular disease (CVD) for which probable or possible AD was either the primary or secondary cause of dementia and that was accompanied by probable or possible VsD. For these diagnoses, clinical criteria and neruoimaging data were used, as suggested by the DSM-IV criteria (22). Diagnosis of VsD without apparent AD included individuals with probable VsD and additional non-AD disease (depression, alcohol abuse, B12 deficiency, or subdural hematoma). Dementia caused by other medical conditions included: Parkinson’s disease (n=10), dementia with Lewy bodies (DLB; n = 5), Pick’s disease, head trauma, B12 deficiency, hypothyroidism, progressive supranuclear palsy, and other unknown causes (total number of subjects = 13). Clinical diagnosis of DLB was based on the guidelines from the consortium on DLB (23,24)."

Covariates & Analysis Detail
Analysis Type:
Logistic regression

AD Covariates:
ALCalcohol intake
APOE4APOE e4 genotype
SMsmoking status

TD Covariates:
ALCalcohol intake
APOE4APOE e4 genotype
SMsmoking status

Other covariate was diabetes medications.