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.

项目概要 意义：阿尔茨海默病和相关痴呆症 (ADRD) 是一项重大的公共卫生挑战。 ADRD 的流行病学研究依赖于通过认知测试和调查来诊断痴呆症 关于日常活动功能限制（即洗澡困难）的问题然而，存在很大差异。 对 237 份关于 ADRD 患病率和发病率的科学出版物进行评估， 研究人员使用了 230 种不同的测量方法，具体测试、问题、方法差异很大。 这种异质性带来了挑战，并且可能是观察到的现象的原因。 对糖尿病等可改变危险因素的患病率和影响的估计不一致， 随着预期暴露率的增加，这一风险将变得越来越重要。 这项研究旨在制定指南，以改善未来流行病学研究中的痴呆症测量。 具体目标：我们的目标是描述研究设计特征对之间关联的影响 具体来说，在目标 1 中，我们将讨论关于认知和功能障碍的 ADRD 和个人调查问题。 在目标 2 中，我们将评估地理环境如何影响跨国痴呆症研究的测量。 评估横断面研究中痴呆测量之间的差异，重点是确定 流行的痴呆症和侧重于确定痴呆症的纵向研究将： (1) 描述调查中管理的具体问题与任一问题之间关联的变化特征 认知功能或痴呆症，以及（2）量化测量改进对认知功能或痴呆症的影响 糖尿病（ADRD 的既定危险因素）与认知功能或痴呆之间的关联。 方法：对于目标 1，我们将使用协调认知评估协议 (HCAP) 调查的数据 我们将比较美国、墨西哥、英国、南非和印度之间的关联。 每个调查问题都涉及认知功能，使用验证性因素分析和逻辑回归。 我们还将使用逻辑回归来评估糖尿病与传统与改进之间的关联 目标 2 将利用来自宗教团体的丰富纵向数据。 研究记忆与衰老项目（ROSMAP）研究首先，我们将使用逻辑回归模型。 广义估计方程来评估每个调查问题和 其次，我们将评估痴呆症改善的影响。 用于糖尿病和痴呆风险之间关联的纵向事件时间模型的算法。 奖学金培训：艾玛·尼科尔斯是约翰斯大学流行病学系的博士生 霍普金斯大学彭博公共卫生学院通过指导研究、课程作业和专业技能。 发展，拟议的培训计划将为尼科尔斯女士提供成为所需的工具和技能 认知衰老和痴呆症流行病学领域的创新、独立研究员。