The effects of study design characteristics on dementia assessment: Recommendations for future epidemiologic studies

研究设计特征对痴呆症评估的影响：对未来流行病学研究的建议

• 批准号: 10460806
• 负责人: Emma Nichols
• 金额: $ 3.14万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-01 至 2023-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10460806
• 关键词: Address; Affect; Aging; Algorithms; Alzheimer' s disease related dementia; Alzheimer' s disease risk; Bathing; Characteristics; Classification; Clinical; Cognition; Cognition Disorders; Cognitive; Cognitive aging; Consensus; Country; Cross-Sectional Studies; Data; Dementia; Diabetes Mellitus; Diagnosis; Disease; Education; England; Epidemiology; Equation; Etiology; Event; Factor Analysis; Fellowship; Future; Geographic Locations; Geography; Goals; Gold; Guidelines; Health Planning; Heterogeneity; Incidence; India; Individual; Lead; Logistic Regressions; Longitudinal Studies; Measurement; Measures; Memory; Mentors; Methodology; Methods; Mexico; Modeling; Outcome; Performance; Persons; Positioning Attribute; Prevalence; Progressive Disease; Protocols documentation; Public Health; Public Health Schools; Publications; Recommendation; Religion and Spirituality; Reporting; Research; Research Design; Research Personnel; Research Training; Risk; Risk Factors; Sampling; Severity of illness; South Africa; Surveys; Testing; Time; Training; United States; Validation; Variant; adjudicate; aging population; base; cognitive ability; cognitive function; cognitive testing; cost; data harmonization; data standards; dementia risk; design; diabetes risk; doctoral student; epidemiology study; functional disability; implementation evaluation; improved; innovation; interest; literacy; mental state; modifiable risk; prevent; religious order study; research clinical testing; research study; skill acquisition; standard measure; study characteristics; tool; trend; validation studies

PROJECT SUMMARY Significance: Alzheimer’s disease and related dementias (ADRD) are a major public health challenge. Epidemiologic research on ADRD relies on the diagnosis of dementia via cognitive testing and survey questions on functional limitations in daily activities (i.e difficulty bathing). However, there is wide variability in the implementation of assessments. Across 237 scientific publications on ADRD prevalence and incidence, researchers used 230 different measurement methods. Methods varied widely in the specific tests, questions, and algorithmic approaches used. This heterogeneity poses challenges, and is likely responsible for observed inconsistencies in the estimation of both prevalence and the effects of modifiable risk factors such as diabetes, a risk that will grow in importance with anticipated increases in exposure prevalence. The overarching goal of this research is to develop guidelines to improve dementia measurement in future epidemiologic studies. Specific Aims: We aim to characterize the effect of study design characteristics on the association between ADRD and individual survey questions on cognition and functional impairment. Specifically, in Aim 1, we will assess how geographic setting affects measurement in cross-national dementia research. In Aim 2, we will assess differences between dementia measurement in cross-sectional studies focused on the ascertainment of prevalent dementia and longitudinal studies focused on the ascertainment of incident dementia. Both Aims will: (1) characterize variations in the associations between specific questions administered on surveys and either cognitive functioning or dementia, and (2) quantify the impact of improvements in measurement on the association between diabetes (an established risk factor for ADRD) and cognitive functioning or dementia. Approach: For Aim 1 we will use data from the Harmonized Cognitive Assessment Protocol (HCAP) surveys in the United States, Mexico, England, South Africa, and India. We will compare the associations between each survey question with cognitive functioning, using both confirmatory factor analysis and logistic regression. We will also use logistic regression to evaluate the association between diabetes and traditional vs. improved short measures of cognitive functioning. Aim 2 will leverage rich longitudinal data from the Religious Orders Study-Memory and Aging Project (ROSMAP) studies. First, we will use logistic regression models with generalized estimating equations to assess differences in the associations between each survey question and prevalent versus incident dementia. Second, we will assess the impact of improvements to dementia algorithms for use in longitudinal time-to-event models for the association between diabetes and dementia risk. Fellowship Training: Emma Nichols is a PhD student in the Department of Epidemiology at the Johns Hopkins Bloomberg School of Public Health. Through mentored research, coursework, and professional skills development, the proposed training plan will equip Ms. Nichols with the tools and skillset required to become an innovative, independent researcher in the epidemiology of cognitive aging and dementia.

项目摘要 意义：阿尔茨海默氏病和相关痴呆症（ADRD）是一个主要的公共卫生挑战。 关于ADRD的流行病学研究依赖于通过认知测试和调查的痴呆症诊断 关于日常活动中功能限制的问题（即困难的沐浴）。但是，存在很大的可变性 评估的实施。在237个科学出版物有关ADRD患病率和事件的科学出版物中， 研究人员使用了230种不同的测量方法。方法在特定的测试，问题， 和使用算法方法。这种异质性具有挑战，很可能是造成观察的 估计患病率和可修改危险因素（例如糖尿病）的影响的不一致性， 随着暴露率的预期增加，这种风险将在重要性上越来越重要。总体目标 这项研究是为了制定指南以改善未来流行病学研究的痴呆症测量。 具体目的：我们旨在表征研究设计特征对关联的影响 关于认知和功能障碍的ADRD和个人调查问题。具体来说，在AIM 1中，我们将 评估地理环境如何影响跨国痴呆研究的测量。在AIM 2中，我们将 评估痴呆症测量之间的差异，横断面研究集中于确定 普遍的痴呆症和纵向研究集中于确定入射痴呆症。两个目标都将： （1）表征了在调查中管理的特定问题与要么 认知功能或痴呆症，（2）量化改进测量的影响 糖尿病（已建立的ADRD风险因素）与认知功能或痴呆症之间的关联。 方法：对于目标1，我们将使用统一认知评估协议（HCAP）调查中的数据 在美国，墨西哥，英国，南非和印度。我们将比较 每个调查问题都使用认知功能，同时使用确认因子分析和逻辑回归。 我们还将使用逻辑回归来评估糖尿病与传统与改善之间的关联 认知功能的简短测量。 AIM 2将利用宗教命令的丰富纵向数据 研究记忆和老化项目（ROSMAP）研究。首先，我们将使用带有逻辑回归模型 广义估算方程式以评估每个调查问题与 流行与事件痴呆症。其次，我们将评估改善对痴呆症的影响 用于糖尿病与痴呆症风险之间关联的纵向时间模型中的算法。 奖学金培训：艾玛·尼科尔斯（Emma Nichols）是约翰斯流行病学系的博士生 霍普金斯彭博公共卫生学院。通过指导的研究，课程和专业技能 开发，拟议的培训计划将使尼科尔斯女士配备成为所需的工具和技能。 认知衰老和痴呆症流行病学的创新，独立的研究人员。