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Diabetes assessed at initial home interview. Diabetes defined as, "use of antidiabetes medications or a random or postload serum glucose greater than 11 mmol/L [equivalent to 200 mg/dL]" (WHO criteria).
All participants were living in a suburb of Rotterdam, The Netherlands. According to a
of the cohort, no other information on ethnicity or race has been reported.
Screening and Diagnosis Detail
Geriatric Mental State Schedule (Copeland 1976)
Mini-Mental State Examination (Folstein 1975)
National Institute of Neurological and Communicative Diseases and Stroke/Alzheimer's Disease and Related Disorders Association Criteria (McKhann 1984)
Community surveillance by patients' general practitioners, as well as dementia care and nursing home facilities.
Total Dementia Definition:
AD; or dementia via DSM IIIR; or vascular dementia via National Institute for Neurologic Disorders and Stroke-Association Internationale pour la Recherche et l'Enseignement en Neurosciences (NINDS-AIREN; Roman 1993).
“Both at baseline and follow-up, dementia was diagnosed with a similar three step protocol, consisting of a screening test (combined Mini-Mental State Examination
and Geriatric Mental State schedule,
organic level), further testing of screenpositives, and a diagnostic workup.
Brain NMR (MRI) scans were not part of the core protocol of the Rotterdam Study, but we tried to obtain neuroimaging in persons suspected of dementia. MRI scans were obtained in one quarter of the dementia patients. In addition to active screening, during the entire follow-up period, general practitioners of participants reported incident cognitive disorders. We also closely cooperated with the regional institute for outpatient mental health care, which is responsible for dementia care facilities and nursing home indications. Of interval cases reported with memory problems or dementia and of subjects who could not be re-examined in person (due to death or refusal), we studied medical files. Thus we obtained complete follow-up of the population at risk.
“A panel consisting of a neurologist, neuropsychologist, and the study physician reviewed all existing information to make a diagnosis of dementia. Diagnostic criteria for AD were from the National Institute of Neurologic and Communicative Disorders and Stroke–Alzheimer’s Disease and Related Disorders Association
and for vascular dementia from the National Institute of Neurologic Disorders and Stroke–Association Internationale pour la Recherche et l’Enseignement en Neurosciences.
As proposed in the latter criteria, we recognized an Alzheimer’s subgroup with cerebrovascular disease. For other dementias, criteria from the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., revised) were used.
Covariates & Analysis Detail
Cox proportional hazards regression