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AlzRisk Paper Detail

Reference: In 'T Veld, 1998
Cohort: Rotterdam Study
Risk Factor: Non-Steroidal Anti-Inflammatory Drugs

Average Follow-up Time Detail
Between 1990 and 1993, all inhabitants of Ommoord, a suburb of Rotterdam in the Netherlands, who were at least 55 years old and living in the district for at least 1 year were invited to participate in the study. The following participants were excluded from the study: participants with dementia, participants whose medical records could not be retrieved, and participants who had less than 10 years of medical history available. The final analytical sample included 306 subjects.

Exposure Detail
The interviewers ascertained exposure information by administering interviews at home. Information on socioeconomic background, medial history, and medication use was collected. Prescription data, such as generic name, prescription date, (calculated) end date, and dosage were obtained from medical records. The investigators reported results separately for duration of non-ASA NSAID use for two exposure windows of time (10-0.5 years prior to diagnosis and 10-2 years prior to diagnosis) and ever vs. never non-ASA NSAID use for the exposure window of 2-0.5 years prior to diagnosis. This entry pertains to results on duration of non-ASA NSAID use 10-2 years prior to diagnosis.

The investigators compared incident AD risk in four groups: the reference group of participants who did not use non-ASA NSAIDs at any time ("Non-use"), the group of participants who used non-ASA NSAIDs for less than 2 months ("Short-term use"), the group of participants who used non-ASA NSAIDs between 2 to 6 months ("Intermediate-term use"), and the group of participants who used non-ASA NSAIDs for at least 6 months ("Long-term use").

Ethnicity Detail
The distribution of ethnicity is not reported. The participants included residents of Ommoord, a suburb of Rotterdam, the Netherlands.

Screening and Diagnosis Detail
Screening Method:
CAMDEXCambridge Examination for Mental Disorders of the Elderly
GMSGeriatric Mental State Schedule (Copeland 1976)
MMSEMini-Mental State Examination (Folstein 1975)

AD Diagnosis:
Brain Imaging
DSM IIIR Diagnostic and Statistical Manual III-Revised
NINCDS ADRDA National Institute of Neurological and Communicative Diseases and Stroke/Alzheimer's Disease and Related Disorders Association Criteria (McKhann 1984)
Neurologic examination
Neuropsychological examination

Covariates & Analysis Detail
Analysis Type:
Conditional logistic regression

"Univariate comparisons between cases and controls were tested
with the x2 statistic, a linear test for trend and conditional logistic regression analysis. The relative risk for AD associated with NSAID use was estimated by calculation of the odds ratios (95% confidence interval) using conditional logistic regression analysis. The main analysis was supplemented with three subanalyses. We restricted the exposure window to 10–2 years prior to the index date. This was done to examine the possibility that the subclinical disease process already affected drug-utilization patterns in an early phase and because the disease process may already have progressed to a stage at which NSAIDs are no longer protective (21). Secondly, an exposure of 2 months may be too short to see an effect. Therefore, we split the group of long-term users into one group exposed 2–6 months and one group exposed for more than 6 months, which is approximately the upper 10% of use. Finally, we stratified NSAID exposure into two age classes according to the median age of the cases: 85 years or younger (n=144) and those aged over 85 years (n=162). Multivariate conditional logistic regression was performed to adjust for the confounding variables."

AD Covariates:
ALCalcohol intake
HYShistory of hysterectomy
ALONliving alone
SHstroke history