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AlzRisk Paper Detail
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Reference: Xu, 2004
Cohort: Kungsholmen Project
Risk Factor: Diabetes Mellitus


Average Follow-up Time Detail
1301 individuals made up the incident sample. 314 individuals died between baseline (1987-1989) and first follow-up (1991-1993). The remaining 987 individuals were assessed for dementia. A further 176 died and another 44 refused assessment, between the first and second follow-up (1994-1996), leaving 568 assessed for dementia at the second follow-up.

The follow-up time ranged from 0.01 to 8.3 years (median = 4.7 years).

Exposure Detail
This analysis focused on individuals for whom blood glucose data was available at baseline. Individuals were categorized based on their random blood glucose test results (< 11 mmol/l vs > 11 mmol/l) and the hazard of AD was compared across these levels.

"Blood samples were taken at baseline, and blood glucose level was measured using a glucose oxidase procedure(26). Data on blood glucose were available for 95.9% (n = 1,248) of the subjects."

Ethnicity Detail
All participants lived in the Kungsholmen district of Stockholm, Sweden. According to a description of the cohort, no other information on ethnicity or race has been reported.

Screening and Diagnosis Detail
AD Diagnosis:
Death Records
Medical History
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-III-R.

"The incident cases were all subjects who developed dementia over the two follow-up periods. The Diagnostic and Statistical Manual of Mental Disorders, revised third edition (DSM-III-R) criteria (33) were used to define dementia with a three-step diagnostic procedure, i.e., two examining physicians independently made a preliminary diagnosis and a third opinion was asked for in case of disagreement. (34) The cases fulfilling the DSM-III-R criteria were denominated “clinically definite dementia,” in contrast with a category of “questionable dementia,” which was used when there was evident memory impairment but dysfunction of a second cognitive ability was questionable. In this analysis, we treated both groups as dementia. The diagnosis of AD required gradual onset, progressive deterioration, and lack of any other specific causes of dementia. The diagnosis of VaD required abrupt onset, stepwise deterioration, history of stroke, or focal deficits. Hachinski’s ischemic scale (35) was used to support the differential diagnosis between AD and VaD. The diagnosis of dementia subtype was made clinically, without using the neuroimaging or pathologic data. Our diagnostic criteria for AD and VaD were equivalent to probable AD according to the National Institute of Neurological and Communicative Disorders and Stroke–Alzheimer’s Disease and Related Disorders Association criteria(36) and to possible VaD according to National Institute of Neurological Disorders and Stroke–Association Internationale pour la Recherche en l’Enseignement en Neurosciences criteria.(37) For the deceased subjects, the diagnosis of dementia and subtypes was made by two physicians through reviewing the medical records and death certificates."

Covariates & Analysis Detail
Analysis Type:
Cox proportional hazards regression

AD Covariates:
Aage
Eeducation
Ggender
AHDantihypertensive drug use
BMIbody mass index
CHDcoronary heart disease
DBPdiastolic blood pressure
SHstroke history
SBPsystolic blood pressure

TD Covariates:
Aage
Eeducation
Ggender
AHDantihypertensive drug use
BMIbody mass index
CHDcoronary heart disease
DBPdiastolic blood pressure
SHstroke history
SBPsystolic blood pressure