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AlzRisk Paper Detail

Reference: Ruitenberg, 2002
Cohort: Rotterdam Study
Risk Factor: Alcohol

Exposure Detail
No alcohol (reported that they do not drink alcohol)
<1 drink/week
1 or more drink/week but <1/day
1–3 drinks/day
4 drinks/day

Alcohol consumption was measured through a food-frequency questionnaire.

"First, we asked participants whether they ever drank alcohol. If the answer was affirmative, we asked about the frequency of drinking. People who reported that they drank alcohol at least twice a month were further asked about the average amounts of specific beverages (wine, beer, liquor, and fortified wine [eg, sherry, port]) that they drank. Participants were furthermore asked if they had changed their pattern of alcohol consumption during the preceding 5 years (less than they used to drink, more than they used to drink) and if they had consumed more than six alcoholic beverages on one day during the last year (binge drinking)."

Ethnicity Detail
Investigators do not provide data on ethnicity. All residents were residents of a suburb of Rotterdam, Netherlands.

Screening and Diagnosis Detail
Screening Method:
GMSGeriatric Mental State Schedule (Copeland 1976)
MMSEMini-Mental State Examination (Folstein 1975)

AD Diagnosis:
DSM IIIR Diagnostic and Statistical Manual III-Revised
NINDS-AIREN National Institute for Neurologic Disorders and Stroke-Association Internationale pour la Recherche et l'Enseignement en Neurosciences (Roman 1993)
NINCDS ADRDA National Institute of Neurological and Communicative Diseases and Stroke/Alzheimer's Disease and Related Disorders Association Criteria (McKhann 1984)

Total dementia definition: Dementia via DSM-III-R, NINCDS-ADRDA, NINDSAIREN

"Dementia screening and diagnosis during baseline and follow-up examinations followed a three-step protocol, as described in detail elsewhere.15 Briefly, all participants were screened with a short test of cognition (MMSE and GMS, organic level). Screen-positives underwent further cognitive testing, and an informant was interviewed on daily functioning of the participant. People who were suspected of having dementia were examined by a neurologist, and underwent neuropsychological testing, and, if possible, magnetic resonance imaging of the brain. Additionally, the total cohort was continuously monitored for incident dementia cases via linkage between the study database and computerised medical records from general practitioners and from the Regional Institute for Outpatient Mental Health Care (RIAGG).15

Of the individuals screened in person and those monitored through general practitioners and RIAGG, the study diagnosis of dementia was made according to established criteria (NINCDS-ADRDA, NINDSAIREN, DSM-III-R) by a panel that reviewed all existing information.15–18 Briefly, for the distinction between Alzheimer’s disease and vascular dementia, review of the data focused on cerebrovascular disorders as determined by neurological examination or on magnetic resonance imaging; their association with the onset of dementia; the acuteness of onset and pattern of disease progression; and the distribution of cognitive deficits over the distinct domains of cognition. A cerebrovascular event that occurred less than 3 months before the onset of dementia strongly suggested a diagnosis of vascular dementia. However, the presence of cerebrovascular disorders did not prohibit a diagnosis of Alzheimer’s disease. In individuals with the clinical presentation of Alzheimer’s disease, a history of stroke was regarded as not directly causally related to dementia if the stroke had occurred long before or after the onset of dementia."

Covariates & Analysis Detail
Analysis Type:
Cox proportional hazards regression

"We assessed alcohol as a categorical and as a continuous (number of glasses per day) variable."

AD Covariates:
BMIbody mass index
DMdiabetes mellitus
SMsmoking status
SBPsystolic blood pressure

TD Covariates:
BMIbody mass index
DMdiabetes mellitus
SMsmoking status
SBPsystolic blood pressure

"The following baseline variables were used as possible confounders: age; sex; diabetes (defined according to WHO criteria as the use of medication for diabetes or a random or post-load serum glucose concentration >11 mmol/L); systolic blood pressure (measured in sitting position at the right upper arm with a random-zero sphygmomanometer); education (dichotomised into primary education or less, and more than primary education); smoking (categorised as never, past, or current smoking); and body-mass index (weight [kg]/height [m2]). A history of stroke was assessed at baseline and afterwards through our monitoring system and verified with medical records by a neurologist. A history of myocardial infarction was assessed by direct questioning and through the monitoring system, and was verified by electrocardiography and by the patient’s general practitioner or cardiologist."

The authors also examined interaction by APOE genotyope, but APOE was not included as a covariate in the main analysis.