Prediction of dementia risk in low-income and middle-income countries (the 10/66 Study): an independent external validation of existing models
Prediction of dementia risk in low-income and middle-income countries (the 10/66 Study): an independent external validation of existing models
复制标题
DOI：
10.1016/s2214-109x(20)30062-0
复制
发表时间：
2020-04-01
影响因子：
34.3
通讯作者：
Prina, Matthew
中科院分区：
文献类型：
--
作者：
Stephan, Blossom C. M.;Pakpahan, Eduwin;Prina, Matthew
背景到目前为止，痴呆症预测模型只在高收入国家(HIC)开发和测试。然而，大多数痴呆症患者生活在低收入和中等收入国家(LMIC)，那里几乎不存在痴呆症风险预测研究，目前的模型预测痴呆症的能力也是未知的。本研究探讨HICS中开发的痴呆预测模型是否适用于LMICs。从中国、古巴、多米尼加共和国、墨西哥、秘鲁、波多黎各和委内瑞拉选出年龄在65岁或以上且基线上没有痴呆症的人。痴呆症的发病率在3-5年期间进行评估，诊断依据10/66研究诊断算法。对五个模型进行了辨别和校准测试：心血管风险因素、衰老和痴呆风险评分(CAIDE)；衰老、认知和痴呆研究(AgeCoDe)模型；澳大利亚国立大学阿尔茨海默病风险指数(ANU-ADRI)；简要痴呆筛查指标(BDSI)；以及鹿特丹研究基本痴呆风险模型(BDRM)。模型用COX回归进行检验。使用Harrell的一致性(C)统计量对每个模型的判别精度进行评估，0.70或更高的值被认为表示可接受的判别能力。校正(模型匹配)使用Gronensby和Bgan检验进行统计评估。发现11 143名没有基线痴呆且有可用随访数据的个体被纳入分析。在随访期间(平均3.8年[SD 1.3])，1069人在所有地点进展为痴呆症(发病率为每1000人年24.9例)。这些模型的性能各不相同。跨国家，CAIDE的区分能力(0.52
Background To date, dementia prediction models have been exclusively developed and tested in high-income countries (HICs). However, most people with dementia live in low-income and middle-income countries (LMICs), where dementia risk prediction research is almost non-existent and the ability of current models to predict dementia is unknown. This study investigated whether dementia prediction models developed in HICs are applicable to LMICs.Methods Data were from the 10/66 Study. Individuals aged 65 years or older and without dementia at baseline were selected from China, Cuba, the Dominican Republic, Mexico, Peru, Puerto Rico, and Venezuela. Dementia incidence was assessed over 3-5 years, with diagnosis according to the 10/66 Study diagnostic algorithm. Discrimination and calibration were tested for five models: the Cardiovascular Risk Factors, Aging and Dementia risk score (CAIDE); the Study on Aging, Cognition and Dementia (AgeCoDe) model; the Australian National University Alzheimer's Disease Risk Index (ANU-ADRI); the Brief Dementia Screening Indicator (BDSI); and the Rotterdam Study Basic Dementia Risk Model (BDRM). Models were tested with use of Cox regression. The discriminative accuracy of each model was assessed using Harrell's concordance (c)-statistic, with a value of 0.70 or higher considered to indicate acceptable discriminative ability. Calibration (model fit) was assessed statistically using the Gronnesby and Borgan test.Findings 11 143 individuals without baseline dementia and with available follow-up data were included in the analysis. During follow-up (mean 3.8 years [SD 1.3]), 1069 people progressed to dementia across all sites (incidence rate 24.9 cases per 1000 person-years). Performance of the models varied. Across countries, the discriminative ability of the CAIDE (0.52