Alzforum: AlzRisk Paper Detail

AlzRisk Paper Detail

Risk Factors

Alcohol

Inflammatory Biomarkers

Non-Steroidal Anti-Inflammatory Drugs

Nutritional Antioxidants

Obesity

Physical Activity

Statin use

Reference:	Akbaraly, 2009

Cohort:	Three-City Study

Risk Factor:	Cognitive Activity

Average Follow-up Time Detail
The average follow-up time was not reported. The maximum follow-up time was 4 years.

Exposure Detail
Participants completed questionnaires at baseline about their participation in various common leisure activities, and received a score for each activity based on their frequency of participation in that activity. Activities considered to be primarily cognitive in nature were grouped together as "stimulating leisure activities". These activities were: (i) doing crossword puzzles, (ii) playing cards, (iii) attending organizations, (iv) attending the cinema/theatre, and (v) practising an artistic activity. Participants received a score from 0 to 3 for each of these five items, according to their participation frequency. Total scores ranged from 0 to 15 and were categorized for analysis into tertiles, corresponding to "low" (total score <3), "mild" (3 ≤ total score ≤ 4) and "high" (total score >4) levels of stimulating leisure activity.

"In the monthly questionnaire, participants were asked about monthly frequency (0, never or rarely; 1, 1–3 per month; 2, 1 per week; 3, 2 per week) with which they engaged in the following usual activities: inviting friends, inviting relatives, visiting friends, visiting relatives, attending organizations (e.g., charity, institution), doing crosswords, playing cards, going to the cinema/theater, practising an artistic activity. Within each type of frequency questionnaire, the categorization of leisure activities according to their predominantly mental, physical, or social characteristics was drawn from the existing literature.^15,16 At the end, 4 independent composite scores were built by summing the corresponding items scores as following.

"Among the monthly leisure activities, doing crosswords, playing cards, attending organizations, going to cinema/theater, and practising an artistic activity were grouped in “stimulating leisure activities” (score ranging from 0 to 15, median score: 3), as they were described as cognitive activities in which seeking or processing information played a central role in several reports.¹⁷...In the present analyses, leisure activities were considered as categorical variables. Given the non-normal distribution of the dependent variables, they were categorized by tertiles: high (tertile 3), mild (tertile 2), and low (tertile 1) levels of activity being defined for each of the 4 variables."

Ethnicity Detail
The vast majority (97%) of participants were French-speaking and 88% were born in France.

Screening and Diagnosis Detail
Screening Method:

IST	Isaacs' Set Test (Isaacs & Kennie 1973)
MMSE	Mini-Mental State Examination (Folstein 1975)

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 diagnosis: DSM-IV

"At baseline, diagnosis of dementia was based on a 3-step procedure.¹⁴ First, trained psychologists administered a battery of neuropsychological tests detailed elsewhere.¹⁴ Second, all the participants in Montpellier were then examined by a neurologist, whereas in Dijon, because of the larger number of participants, only those who screened positive underwent further examination. Finally, an independent committee of neurologists reviewed all potential prevalent and incident cases of dementia to obtain a consensus on its diagnosis and etiology according to the criteria of the DSM-IV.²⁰ Similar procedures were performed at follow-up for incident dementia screening. Cases of AD were classified according to the National Institute of Neurological and Communicative Disorders and Stroke–Alzheimer’s Disease and Related Disorders Association²¹ and cases of mixed/vascular dementia according to the National Institute of Neurological Disorders and Stroke Association Internationale pour la Recherche en l’Enseignement en Neurosciences²² criteria."

Covariates & Analysis Detail
Analysis Type:
Cox proportional hazards regression

Participant age was used as the time scale in the proportional hazards analysis.

AD Covariates:

A	age
E	education
G	gender
ADLI	activities of daily living impairment
APOE4	APOE e4 genotype
MMSE	baseline MMSE
DEP	depression
DM	diabetes mellitus
HC	high cholesterol
HTN	hypertension
MS	marital status
OS	Occupational status
SP	study population
VD	vascular disease

TD Covariates:

A	age
E	education
G	gender
ADLI	activities of daily living impairment
APOE4	APOE e4 genotype
MMSE	baseline MMSE
DEP	depression
DM	diabetes mellitus
HC	high cholesterol
HTN	hypertension
MS	marital status
OS	Occupational status
SP	study population
VD	vascular disease