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AlzRisk Paper Detail
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Reference: Wolfson, 2002
Cohort: Canadian Study of Health and Aging
Risk Factor: Non-Steroidal Anti-Inflammatory Drugs


Average Follow-up Time Detail
The analysis for all subjects was based on the 3-year exposure window (NSAID use) prior to the onset of symptoms, not diagnosis.

Exposure Detail
Interviewers ascertained exposure information through linkage of pharmaceutical services database. The following information was retained: anonymous patient identifier, demographic data on the recipient, name of drug, date of dispensing, dose per unit of administration, prescribed duration of treatment and quantity. The investigators reported results separately for current vs. former vs. never any NSAID use and duration of any NSAID use. This entry pertains to results on current vs. former vs. never any NSAID use.

The investigators compared incident AD risk in four groups: the group of participants who used NSAIDs in the year before the index year and no exposure in year 2 or 3 before onset ("Current use"), the group of participants who used NSAIDs in year 2 or 3 prior to the index year only and no exposure in the year prior to the index year ("Former use"), the group of participants who used NSAIDs in year 2 or 3 prior to the index year and used NSAIDs in year 1 prior to the index date ("Continuous use"), and the reference group of participants who did not use NSAIDs during the three years prior to the index year ("Never use").

Ethnicity Detail
No information on the ethnic background of participants has been provided.

Age Detail
Because cases were all at least 75 years old, only controls who were 75 years and older were included. Approximately 81% of the participants were of ages between 75 to 84, and approximately 19% of the participants were older than 85 years old at the time of screening.

Screening and Diagnosis Detail
Screening Method:
3MSEModified Mini-Mental State Examination (Teng 1987)

AD Diagnosis:
DSM IIIR Diagnostic and Statistical Manual III-Revised
NINCDS ADRDA National Institute of Neurological and Communicative Diseases and Stroke/Alzheimer's Disease and Related Disorders Association Criteria (McKhann 1984)
Neurologic examination

"...community-dwelling random samples of people aged 65 and over were screened in their homes for cognitive impairment
using the Modified Mini-Mental Status (3MS) Examination
[20]. Those who screened positive for cognitive impairment (3MS score < 78) and a random sample of those who screened negative for cognitive impairment (3MS score of 78 or greater) were invited to undergo a clinical assessment to determine the presence of dementia and to provide a specific diagnosis. The diagnostic criteria were
based on the criteria of the Diagnostic and Statistical Manual of Mental Disorders, 3rd edition, revised [21], to define dementia and the NINCDS-ADRDA criteria for AD [22]. The clinical exam was developed in collaboration with the Consortium to Establish a Registry for Alzheimer’s Disease [23], of which the Québec centers form a part."

Covariates & Analysis Detail
Analysis Type:
Logistic regression

"Multivariable analyses were carried out using logistic regression. This approach allowed the assessment of the relationship between pre-onset NSAID exposure (however defined) and the diagnostic category, taking into account possible confounders (age, sex and index year). For all analyses, the reference category was ‘no use during the 3
years prior to the index year’."

AD Covariates:
Aage
Ggender
IYindex year