Get Newsletter
AlzRisk Paper Detail

Reference: Lindsay, 2002
Cohort: Canadian Study of Health and Aging
Risk Factor: Hormone Therapy

Average Follow-up Time Detail
Initial cohort assessment occurred in 1991-1992 (CSHA-1) and follow-up occurred in 1996-1997 (CSHA-2).

Exposure Detail
Information about risk factors, including estrogen replacement therapy, was obtained via self-administered questionnaire at baseline. The paper does not provide details about the types of hormone use (e.g., use of unopposed estrogen, use of estrogen combined with progestin) that constituted HRT use.

Ethnicity Detail
The CSHA is based on a representative, nationwide sample of Canadians.

Age Detail
Entry criteria required all participants to be 65+ in 1989-1990. The mean age reported here is the mean age at the baseline interview, which we calculated as a weighted average from the numbers provided in Table 1.

Screening and Diagnosis Detail
Screening Method:
3MSEModified Mini-Mental State Examination (Teng 1987)

AD Diagnosis:
DSM IV Diagnostic and Statistical Manual IV
NINCDS ADRDA National Institute of Neurological and Communicative Diseases and Stroke/Alzheimer's Disease and Related Disorders Association Criteria (McKhann 1984)

"All participants were screened for dementia by using the Modified Mini-Mental State (3MS) Examination.14,15 Those who screened positive (a 3MS Examination score of below 78/100) and a random sample of those who screened negative (a score of 78 or above) were invited to participate in an extensive clinical evaluation, which followed a three stage protocol. A nurse first readministered the 3MS Examination and collected information on the participant’s medical and family history. Next, a physician conducted a standardized physical and neurologic examination. Finally, for those participants deemed testable (a 3MS Examination score of50 or above), a psychometrist administered a series of neuropsychological tests16, which were interpreted later by a neuropsychologist."

AD diagnosis was determined according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition.

Covariates & Analysis Detail
Analysis Type:
Logistic regression

"This analysis included only those participants living in the community as of CSHA-1. A case-control analysis was conducted, with incident cases and controls selected at CSHA-2. To be included, participants' initial screening results had to be negative or, at CSHA-1, participants had to be clinically diagnosed without 1) cognitive impairment, no dementia, or 2) dementia. Cases were diagnosed with probable or possible AD at CSHA-2. Comparisons were made with controls who, at CSHA-2, remained without cognitive impairment, no dementia or dementia according to the clinical evaluation or screening test at follow-up"

All participants who met these criteria were included in the analyses.

Though the authors refer to their analysis as a case-control analysis, this study was conducted in an established cohort,whose members were selected to be dementia-free at the start of follow-up. The authors refer to "controls" as cohort members who did not develop cognitive impairment or dementia over the course of follow-up.

AD Covariates: