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AlzRisk Paper Detail

Reference: Zandi, 2002
Cohort: Cache County Study
Risk Factor: Hormone Therapy

Average Follow-up Time Detail
The first wave of the study occurred between 1995-1997, with follow-up between 1998-2000.

Exposure Detail
At the baseline interview, women were asked if they had ever taken HRT, and if so, for how long. They were also asked about the use of any medicine (including HRT) during the two weeks before the interview. HRT users included both users of unopposed estrogen and users of estrogen combined with progestin. Among the current HRT users, 72% were taking unopposed oral estrogen.

Results are reported for three separate exposure categories in this paper:
1) Any v No HRT use
2) Duration of use (< 3y, 3 - 10y, > 10y)
3) Current v. Former (current v. former also broken down by duration: <3y, 3-10y, >10y)

The exposure reported here is current or former HRT use v. No HRT use

Ethnicity Detail
Not reported in this paper. All participants were residents of Cache County, Utah, USA. Ethnicity information based on a description of the cohort.

Age Detail
Age data in the paper provide ages at the time of the analysis.

Screening and Diagnosis Detail
Screening Method:
DQDementia Questionnaire (Silverman 1986)
Informant interview
3MSEModified Mini-Mental State Examination (Teng 1987)

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

"Participants were screened with the Modified Mini-Mental State examination(3MS)20 or, for those unable to participate,an informant questionnaire21 followed by the Dementia Questionnaire(DQ)22 administered to collateral informants (spouses, companions, or others knowledgeable about the respondents). Participants with screening results suggesting a cognitive disturbance then underwent a clinical assessment. Collateral informants provided a medical history, a dementia symptom checklist, and a chronological history of cognitive symptoms; specially trained nurses conducted a structured neurological examination; and psychometric technicians administered a 1-hour battery of neuropsychological tests. A geriatric psychiatrist and neuropsychologist then reviewed the results and assigned working diagnoses of dementia (Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition criteria)or other cognitive syndromes; 83.9% of these subjects still living were then examined by a board-certified geriatric psychiatrist, and among these, 65.9% underwent routine laboratory diagnostic testing for differential diagnosis. All this information was then considered by a panel of experts, who identified dementia and assigned diagnoses of AD23 and other disorders using standard criteria."

Covariates & Analysis Detail
Analysis Type:
Discrete-time survival modeling

Discrete-time logistic models were used.

AD Covariates:
APOE4APOE e4 genotype

The multivariable-adjusted model included terms for age, age-squared, years of education, dummy-coded terms for the presence of 1 or 2 APOE e4 alleles, and interactions between age and the dummy-coded APOE terms. This model was based on a previously used model for AD incidence found to be a good fit to the data for both men and women.3