Development of a New Method for Assessing Global Risk of Alzheimer's Disease for Use in Population Health Approaches to Prevention
Development of a New Method for Assessing Global Risk of Alzheimer's Disease for Use in Population Health Approaches to Prevention
复制标题
DOI：
10.1007/s11121-012-0313-2
复制
发表时间：
2013-08-01
影响因子：
3.5
通讯作者：
Herath, Pushpani M.
中科院分区：
文献类型：
--
作者：
Anstey, Kaarin J.;Cherbuin, Nicolas;Herath, Pushpani M.
阿尔茨海默病 (AD) 影响着全球约 3500 万人。越来越多的证据表明，AD 的许多危险因素是可以改变的。 AD 病理学发展了数十年。因此，降低风险干预措施需要很长时间的随访才能显示对 AD 发病率的影响。关注 AD 风险而不是诊断，为预防策略提供了更现实的目标。我们开发了一种新颖的方法，可以产生 AD 风险评估的全球方法，用于基于人群的环境和干预措施。该方法用于开发风险评估工具，该工具可以随着更多证据的出现而更新。首先，系统性搜索策略确定了 AD 的风险和保护因素。确定了 AD 的 11 种危险因素和 4 种保护因素，其比值比已发表或可以计算（年龄、性别、教育、体重指数、糖尿病、抑郁、血清胆固醇、创伤性脑损伤、吸烟、饮酒、社交参与、体力活动、认知活动、鱼类摄入量和农药接触）。开发了一种算法将比值比结合到 AD 风险评分中。该方法考虑到风险因素之间的相互作用，从而对生命历程产生不同的影响，因为当前证据表明中年是某些风险因素的关键时期。最后，制定问卷，通过自我报告评估风险和保护因素。与在单一队列研究中制定风险指数相比，这种方法可以纳入更多的风险因素，结果具有更大的普遍性，并根据生命历程不同阶段的发现纳入相互作用。
Alzheimer's disease (AD) affects approximately 35 million people worldwide. Increasing evidence suggests that many risk factors for AD are modifiable. AD pathology develops over decades. Hence risk reduction interventions require very long follow-ups to show effects on AD incidence. Focussing on AD risk, instead of diagnosis, provides a more realistic target for prevention strategies. We developed a novel methodology that yields a global approach to risk assessment for AD for use in population-based settings and interventions. The methodology was used to develop a risk assessment tool that can be updated as more evidence becomes available. First, a systematic search strategy identified risk and protective factors for AD. Eleven risk factors and four protective factors for AD were identified for which odds ratios were published or could be calculated (age, sex, education, body mass index, diabetes, depression, serum cholesterol, traumatic brain injury, smoking, alcohol intake, social engagement, physical activity, cognitive activity, fish intake, and pesticide exposure). An algorithm was developed to combine the odds ratios into an AD risk score. The approach allows for interactions among risk factors which provides for their varying impact over the life-course as current evidence suggests midlife is a critical period for some risk factors. Finally, a questionnaire was developed to assess the risk and protective factors by self-report. Compared with developing risk indices on single cohort studies, this approach allows for more risk factors to be included, greater generalizeability of results, and incorporation of interactions based on findings from different stages of the lifecourse.