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AlzRisk Paper Detail
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Reference: Zandi, 2002
Cohort: Cache County Study
Risk Factor: Non-Steroidal Anti-Inflammatory Drugs


Exposure Detail
Investigators ascertained exposure information on NSAID use through a standardized interview at baseline. Information on prescription and over-the-counter (OTC) medicines was collected. In addition, information on the containers for all medicine in current or former use, such as the name, treatment indication, strength, dosage form, instruction for use, age at first use, and duration of use, was collected. The investigators reported results separately for ever vs. never non-ASA NSAID use, current vs. former vs. never non-ASA NSAID use, duration of non-ASA NSAID use, ever vs. never ASA NSAID use, and duration of ASA NSAID use. This entry pertains to results on ever vs. never non-ASA NSAID use.

The investigators compared incident AD risk in two groups: the group of participants who used non-ASA NSAIDs currently or formerly every day, or at least four doses weekly, for a month or longer ("Ever used") and the reference group of participants who did not use non-ASA NSAIDs at any time ("Never used").

Ethnicity Detail
The distribution of ethnicity is reported specifically in this paper, but nearly all participants in this cohort (95%) are white.

Age Detail
Approximately 90% of the Cache County residents were aged 65 years or older at baseline.

Screening and Diagnosis Detail
Screening Method:
DQDementia Questionnaire (Silverman 1986)
DSM IIIR - dementiaDiagnostic and Statistical Manual III - Revised - dementia
IQ-CODEInformant Questionnaire for Cognitive Decline in the Elderly (Jorm 1989)
3MSEModified Mini-Mental State Examination (Teng 1987)

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-IIIR

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

"We then used discrete time survival analysis (39) to compare the risks of AD among the users of each class of medicine versus a reference group of nonusers. The analyses considered each year under observation as a discrete time interval. Participants entered the analytic pool at the age of their initial Wave I interview and were then considered year by year until they either developed AD or underwent Wave II procedures that confirmed their dementia-free status, as initially observed at Wave I. The discrete time survival analyses yielded estimated hazard ratios associated with various exposures and accommodated statistical adjustment for multiple covariates. All multivariable discrete time survival models were built upon a “base” model that had previously yielded a good fit to the incidence data.(37) This base model included covariate terms for age, the squared deviation of age from the sample’s median value, sex, years of education, the presence of one or two APOE 4 alleles, as well as interactions between age and the APOE 4 terms."

AD Covariates:
Aage
Eeducation
Ggender
APOE4APOE e4 genotype