Epidemiology of Dementia in Cache County, Utah

卡什县研究成立于1994年，是一项以人群为基础的痴呆症遗传和环境因素的纵向调查。这项重要工作的更新将利用这一流行病学队列的9年前瞻性观察，并将对整个样本进行纵向认知评估。利用这些观察结果，我们将根据经验定义临床前阿尔茨海默病（AD）的早期认知轨迹，以及先前暴露与痴呆的衰退速度和分类结果之间的关系。本项目的具体目标主要有以下四个方面：1。再进行两次三年一次的筛查（第3和第4轮），在之前的筛查中没有痴呆的卡什县居民中进行。使用9年的观察来检查认知变化到痴呆的轨迹，并获得对AD发病率的更精确的估计，特别是85岁以后。2. 对提议的波3和波4使用扩展的认知筛选电池。检查新电池的效率，作为痴呆症的筛查。此外，使用由此产生的扩展信息库将现有的认知功能轨迹数据扩展到9年的时间间隔。有了这些新信息，研究：a)认知功能障碍的个体（横断面）特征，或此类特征的集群，最能预测痴呆的后续发展；b)这些特征或其集群随时间变化的性质和程度，具体包括寻找最能预测痴呆症发展的变化；c)各种操作定义的认知障碍类别（例如，“轻度认知障碍”[MCI]等），并比较它们预测后续痴呆的能力。3. 扩展先前关于遗传和环境因素对阿尔茨海默病风险影响的研究，注意这些因素是否可以预测作为阿尔茨海默病前驱症状的认知能力下降的悲剧。4. 继续并扩展现有的研究尸检项目，将其目标扩展到临床诊断的痴呆亚型和未受影响的参与者，特别是那些有痴呆风险因素的参与者（85岁以上，MCI）。

Established in 1994, the Cache County Study is a population-based longitudinal investigation of dementia in relation to genetic and environmental antecedents. The renewal of this important work will capitalize on nine years of prospective observation in this epidemiological cohort and will have available longitudinal cognitive assessments in the entire sample. Using these observations, we will empirically define the early cognitive trajectory of preclinical Alzheimer's disease (AD) and the relationship of antecedent exposures to the rate of decline and to categorical outcomes of dementia. There are four major specific aims of the project, which are as follows: 1. Conduct two more triennial waves of screening (Waves 3 and 4) among Cache County residents not demented at prior screenings. Use the nine years of observation to examine the trajectory of cognitive change to dementia and to obtain more precise estimates of the incidence of AD, especially after age 85. 2. Use an expanded cognitive screening battery for proposed Waves 3 and 4. Examine the efficiency of the new battery as a screen for dementia. Also, use the resulting expanded information base to extend existing data on trajectory of cognitive functioning to a nine-year time interval. With this new information, examine: a) Individual (cross sectional) features of cognitive dysfunction, or clusters of such features, that most strongly predict subsequent development of dementia; b) Nature and extent of change in such features or their clusters over time, including specifically a search for changes that most strongly predict the development of dementia; c) Various operationally defined categories of cognitive impairment (e.g., "Mild Cognitive Impairment" [MCI], etc.) and compare their abilities to predict subsequent dementia. 3. Extend prior studies of the influence of genetic and environmental factors on risk of AD, noting whether these same factors predict tragectory of cognitive decline as a prodrome of AD. 4. Continue and extend the study's existing autopsy program, expanding its aims to clinically diagnosed dementia subtypes and to unaffected participants, particularly those with risk factors for dementia (age 85+, MCI).