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：阿尔茨海默病和相关痴呆症（ADRD）是一个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 关于日常活动功能限制的问题（即洗澡困难）。然而，在以下方面存在很大的差异： 实施评估。在237篇关于ADRD患病率和发病率的科学出版物中， 研究人员使用了230种不同的测量方法。在具体的测试、问题、 和算法方法。这种异质性带来了挑战，并且可能是观察到的 对糖尿病等可改变的风险因素的流行率和影响的估计不一致， 这一风险将随着预期的暴露流行率的增加而变得越来越重要。的首要目标 本研究旨在为未来的流行病学研究提供更好的痴呆测量方法。 具体目的：我们旨在描述研究设计特征对以下因素之间关联的影响： 关于认知和功能障碍的ADRD和个人调查问题。具体而言，在目标1中，我们将 评估地理环境如何影响跨国痴呆症研究的测量。在目标2中，我们将 在横断面研究中评估痴呆测量之间的差异，重点是确定 流行性痴呆和纵向研究的重点是确定事件性痴呆。这两个目标将： (1)描述调查中管理的特定问题之间的关联变化， 认知功能或痴呆，以及（2）量化测量改善对 糖尿病（ADRD的一个既定风险因素）与认知功能或痴呆之间的关联。 方法：对于目标1，我们将使用来自统一认知评估协议（HCAP）调查的数据 在美国、墨西哥、英国、南非和印度。我们将比较 每个调查问题与认知功能，使用验证性因素分析和logistic回归。 我们还将使用逻辑回归来评估糖尿病与传统vs. 认知功能的简短测量。Aim 2将利用来自宗教团体的丰富纵向数据 研究记忆和衰老项目（ROSMAP）研究。首先，我们将使用逻辑回归模型， 广义估计方程，以评估每个调查问题之间的关联差异， 流行性与偶发性痴呆其次，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：Emma Nichols是约翰霍普金斯大学流行病学系的博士生， 霍普金斯布隆伯格公共卫生学院。通过指导研究，课程和专业技能 发展，拟议的培训计划将装备尼科尔斯女士所需的工具和技能，成为 一个创新的，独立的研究人员在认知老化和痴呆症的流行病学。