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AlzRisk Paper Detail

Reference: In 'T Veld, 2001
Cohort: Rotterdam Study
Risk Factor: Non-Steroidal Anti-Inflammatory Drugs

Average Follow-up Time Detail
The study period ran from January 1, 1991 through December 31, 1998.

Exposure Detail
Interviewers ascertained exposure information by administering interviews at home in each study cycle. Complete information on NSAID and other drug prescriptions was available in automated form during the study period from January 1, 1991, through December 31, 1998 and included the product name and other information (e.g., the international non-proprietary name of the drug, number of tablets, capsules, or other vehicle in the filled prescription, the date of delivery of the product, the prescribed daily number of tablets to be taken, the drug dosage, and the duration of the prescription period). The investigators reported results separately for ever vs. never non-ASA NSAID use, duration of non-ASA NSAID use, non-ASA NSAID dosage, and duration of ASA use. This entry pertains to results on dosage of non-ASA NSAID use.

Dosage was dichotomized around the median (1 defined daily dose per day, which is the average dosage of a drug for the main indication). Among the subjects with two or more years of cumulative use of non-ASA NSAIDs, the investigators compared incident AD risk in two groups: the group of participants who used more than 1 defined daily dose of non-ASA NSAIDs per day ("<1 defined daily dose per day") and the reference group of participants who used at most 1 defined daily dose of non-ASA NSAIDs per day ("≤1 defined daily dose per day"). The distribution of non-ASA NSAID use by dosage was not reported.

Ethnicity Detail
The distribution of ethnicity is not reported. The participants included residents of Ommoord, a suburb of Rotterdam, the Netherlands.

Age Detail
There were 3162 (45.2%) participants who were less than or equal to 65 years old; 2323 (33.2%) participants who were of ages 66-75; and 1504 (21.5) participants who were greater than 75 years old

Screening and Diagnosis Detail
Screening Method:
Brain Imaging
CAMDEXCambridge Examination for Mental Disorders of the Elderly
GMSGeriatric Mental State Schedule (Copeland 1976)
MMSEMini-Mental State Examination (Folstein 1975)
Neuropsych Testing

AD Diagnosis:
DSM IIIR Diagnostic and Statistical Manual III-Revised

"Both at baseline examination and follow-up examinations, the subjects were examined for dementia according to a three-step protocol." This included the MMSE, GMS, CAMDEX, neuropsychological examination, and an MRI."

"In addition to undergoing screening for dementia, the subjects were continuously monitored for cases of dementia during followup (33). A clinical diagnosis of dementia was made according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders, third edition, revised, by a panel that reviewed all existing information. A subdiagnosis of Alzheimer’s disease was made according to the criteria of the National Institute of Neurological and Communicative Diseases and Stroke–Alzheimer’s Disease and Related Disorders Association (39). A subdiagnosis of vascular dementia was made according to the criteria of the National Institute of Neurological Disorders and Stroke–Association Internationale pour la Recherche et l’Enseignement en Neurosciences (40)."

Covariates & Analysis Detail
Analysis Type:
Cox proportional hazards regression

"We calculated the relative risks of dementia (and 95 percent confidence intervals) with the use of a Cox proportional-hazards model(41); the cumulative use of each drug was represented by a time-dependent covariate. In the Cox model, age in days was used as the time axis to ensure optimal adjustment for age. (42)"

AD Covariates:
AHDantihypertensive drug use
H2Ahistamine H-2 receptor antagonists use
HGUhypoglycemic drug use
SMsmoking status

There were no results for TD. Age in days was used as the time axis for the COX model. The duration of use of hypoglycemic agents was used as a proxy for the duration of diabetes mellitus.