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AlzRisk Paper Detail
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Reference: Forti, 2010
Cohort: Conselice Study of Brain Aging
Risk Factor: Diabetes Mellitus


Average Follow-up Time Detail
Participants were recruited in 1999-2000 and followed up in 2003-2004. 884 individuals constituted the incident sample. This analysis was based on 749 individuals and excluded those missing laboratory or metabolic syndrome data (n = 50), and those whose follow-up cognitive status could not be classified, due to either unknown status, refusal, death, or loss to follow-up (n = 85, in total)

The authors report results stratified by age at baseline. This row of the table reports results for the 283 individuals aged 75 and above at baseline.

Exposure Detail
Blood test results, standardized interviews and medical records were used to classify patients across exposure levels. Specifically, participants were considered to be hyperglycemic if their blood samples revealed fasting glucose >= 6.1 mmol/l (>= 100 mg/dl), or if they were found to be using antidiabetic medication, determined either from their interview, or from their medical history.

The number of hyperglycemic individuals with known diabetes diagnoses was not reported.

"The screening phase included a standardized personal interview for collection of data on sociodemographic characteristics, lifestyle, medical history, functional status, evaluation of depressive symptoms, and measurement of global cognitive function with the Italian version of the Mini Mental State Examination (MMSE)12; a standardized medical and neurological examination; and collection of fasting venous blood samples...Fasting venous blood samples were rapidly sent for processing. Serum total and HDL-C, triglycerides, albumin, and glucose were measured on fresh blood using an enzymatic assay (Roche Diagnostics, Monza, Italy) on a HITACHI 917 System autoanalyzer (Boehringer Mannheim, Mannheim, Germany)."

Ethnicity Detail
According to other descriptions of the cohort, participants were all residents of a municipality in northern Italy. No other information on ethnicity or race has been reported.

Age Detail
The authors report results stratified by age at baseline. This row of the table reports results for those age 75 and above.

Screening and Diagnosis Detail
Screening Method:
MMSEMini-Mental State Examination (Folstein 1975)

AD Diagnosis:
DSM IV Diagnostic and Statistical Manual IV
NINCDS ADRDA National Institute of Neurological and Communicative Diseases and Stroke/Alzheimer's Disease and Related Disorders Association Criteria (McKhann 1984)

Total dementia definition: DSM IV.

"The screening phase included a standardized personal interview for collection of data on sociodemographic characteristics, lifestyle, medical history, functional status, evaluation of depressive symptoms, and measurement of global cognitive function with the Italian version of the Mini Mental State Examination (MMSE)12; a standardized medical and neurological examination; and collection of fasting venous blood samples. For subjects unable to answer because of physical or mental impairments, information was obtained from relatives and general practitioners. Previous medical records were available for approximately 90% of participants and prevailed in any case of discrepancy with health data from the participants themselves. Participants with MMSE score less than 24 and greater than 9 underwent further standardized neuropsychological assessment validated for use in Italian subjects.13 Whenever recent neuroradiological data were not available, the subject was scheduled for a noncontrast computed tomography brain scan. Standardized information about functional and mental status of subjects positive at cognitive screening was also obtained from a collateral informant (a relative or any other person with a reliable knowledge of the individual, including the subject's medical practitioner). International standard criteria were used for diagnosis of dementia,14 AD,15 and VaD.16"

Covariates & Analysis Detail
Analysis Type:
Cox proportional hazards regression

"Date of dementia onset was estimated as the midpoint of the interval from baseline until follow-up or death. Individuals with dementia not caused by the subtype of interest were censored at the time of dementia onset."

"Literature data suggest an effect of age on the association of interest,5 and a significant interaction was found between age and MetS (P<0.001). Therefore, analyses were performed separately for subjects younger than 75 and those aged 75 and older, roughly corresponding to the top tertile of age distribution."

AD Covariates:
Aage
Eeducation
Ggender
AOabdominal obeisity
APOE4APOE e4 genotype
CVDcardiovascular disease
HDLHDL cholesterol
HHChyperhomocysteinemia
HTNhypertension
HTGhypertriglyceridemia
ISinflammation status
SLsedentary lifestyle
SHstroke history

TD Covariates:
Aage
Eeducation
Ggender
AOabdominal obeisity
APOE4APOE e4 genotype
CVDcardiovascular disease
HDLHDL cholesterol
HHChyperhomocysteinemia
HTNhypertension
HTGhypertriglyceridemia
ISinflammation status
SLsedentary lifestyle
SHstroke history