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


Exposure Detail
This analysis compared the hazard of AD between those with 'incident diabetes' (no previous diabetes diagnosis, but blood glucose test results indicative of diabetes) and those without a history of diabetes or in-study blood glucose levels indicative of diabetes.

The 'incident diabetes' group includes those who did not report a diabetes diagnosis but were found to have either a fasting glucose >126 mg/dl (7 mmol/l) or a 2-h glucose > 200 mg/dl (11.1 mmol/l) when tested. The reference group comprised those with blood glucose levels below these thresholds. None of the participants in this analysis reported a history of diabetes.

Ethnicity Detail
All members of the HAAS cohort are Japanese-American.

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 VaD 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 VaD. For these diagnoses, clinical criteria and neuroimaging data were used, as suggested by the DSM-IV criteria (22)."

Covariates & Analysis Detail
Analysis Type:
Logistic regression

AD Covariates:
Aage
Eeducation
ABIankle-brachial index
APOE4APOE e4 genotype
BMIbody mass index
Oother
SHstroke history
SBPsystolic blood pressure
TCtotal cholesterol

TD Covariates:
Aage
Eeducation
ABIankle-brachial index
APOE4APOE e4 genotype
BMIbody mass index
Oother
SHstroke history
SBPsystolic blood pressure
TCtotal cholesterol