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Reference: Engelhart, 2002
Cohort: Rotterdam Study
Risk Factor: Nutritional Antioxidants


Exposure Detail
Exposure was evaluated using a two-stage protocol at 2 baseline visits; baseline visits occurred between 1990 and 1993. The first stage involved a checklist that asked about all food, drinks, and supplements used at least two times a month for the past year. The second stage involved a 170-item semiquantitative food frequency questionnaire (SFFQ) that asked about foods consumed at least two times per month for the past year.

Both this study and the study by Devore et al (2010) examined dietary vitamin C and AD risk in the Rotterdam Study cohort. The later study by Devore et al (2010) followed participants for about 3.6 additional years and also explored vitamin C in relation to overall dementia risk.

Ethnicity Detail
According to other descriptions of the cohort, participants were sampled from a suburb of Rotterdam, The Netherlands. No information on the ethnic background of participants has been provided.

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

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)

"Case-finding and diagnostic procedures for dementia and Alzheimer disease have been described in detail (11). At baseline visit and both follow-up examinations, a 3-stage protocol was used. Participants were cognitively screened with the Mini-Mental State Examination (MMSE) (12) and the Geriatric Mental State schedule (GMS) organic level (13). If subjects scored lower than 26 on the MMSE or higher than 0 on the GMS organic level, the Cambridge Examination of Mental Disorders in the Elderly (CAMDEX) (14) was administered. The CAMDEX also included an informant interview. Finally, participants in whom dementia was suspected were examined by a neurologist and neuropsychologist, and, if possible, had magnetic resonance imaging of the brain. In addition, the total cohort was continuously monitored for incident dementia cases through computerized linkage between the study database and computerized medical records from general practitioners and the Regional Institute for Outpatient Mental Health Care (11). The diagnoses of dementia and Alzheimer disease were based on Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition (DSM-III-R) (15) criteria and the National Institute of Neurological and Communicative Disorders and Stroke and Alzheimer Disease and Related Disorders Association (NINCDS-ADRDA) criteria (16), respectively, and were made by a panel of a neurologist (J.C.V.S.), neuropsychologist, and research physicians (M.J.E. and A.R.) who reviewed all existing information (11)."

Both this study and the study by Devore et al (2010) examined dietary vitamin C and AD risk in the Rotterdam Study cohort. The later study by Devore et al (2010) followed participants for about 3.6 additional years and also explored vitamin C in relation to overall dementia risk.

Covariates & Analysis Detail
Analysis Type:
Cox proportional hazards regression

Age was used as the time-scale in the model.

Total energy intake was included as a covariate in the analysis.

AD Covariates:
Aage
Eeducation
Ggender
ALCalcohol intake
AOSantioxidative Supplements
ATHatherosclerosis
MMSEbaseline MMSE
BMIbody mass index
Kcalcaloric intake
SMKPYpack-years of smoking
SMKHsmoking habits