Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, United States of America.
Department of Neurological Sciences, Rush Medical College, Chicago, Illinois, United States of America.
PLoS One. 2022 Mar 17;17(3):e0265379. doi: 10.1371/journal.pone.0265379. eCollection 2022.
There is no practical dementia risk score in the clinical setting.
To derive and validate a score obtained by a rapid and simple assessment, which guides primary care providers in predicting the risk of dementia among older adults.
A total of 4178 participants from three longitudinal cohorts (mean age at baseline = 76.8 [SD = 7.6] years), without baseline dementia, followed annually for a median of 10 years (IQR: 5 to16 years, Reverse Kaplan-Meier).
To derive the score, we used data from 1,780 participants from the Rush Memory and Aging Project (93% White). To validate the score, we used data from 1,299 participants from the Religious Order Study (92% White), and to assess generalizability, 679 participants from the Minority Aging Research Study (100% Black).
Clinician-based dementia diagnosis at any time after baseline and predictive variables associated with dementia risk that can be collected in a primary care setting: demographics, clinical indicators, medical history, memory complaints, cognitive and motor tests, and questions to assess functional disability, depressive symptoms, sleep, social isolation, and genetics (APOE e4 and AD polygenic risk score).
At baseline, age, memory complaint, the ability to handle finances, the recall of the month, recall of the room, and recall of three words, were associated with the cumulative incidence of dementia, in the derivation cohort. The discrimination of the RADaR (Rapid Risk Assessment of Dementia) was good for the derivation and external-validation cohorts (AUC3 years = 0.82-0.86), compared to the overall discrimination of age alone (AUC3 years = 0.73), a major risk factor for dementia. Adding genetic data did not increase discrimination.
Participants were volunteers, may not represent the general population.
The RADaR, derived from community-dwelling older persons, is a brief and valid tool to predict dementia risk at 3 years in older White and Black persons.
目前在临床实践中尚无实用的痴呆风险评分。
制定并验证一种通过快速简便评估获得的评分，以便初级保健提供者能够预测老年人痴呆的风险。
共有来自三个纵向队列的 4178 名参与者（基线时的平均年龄=76.8[SD=7.6]岁），无基线痴呆，中位随访时间为 10 年（IQR：5 至 16 年，反向 Kaplan-Meier）。
为了得出评分，我们使用了来自 Rush 记忆与衰老项目的 1780 名参与者的数据（93%为白人）。为了验证评分，我们使用了来自宗教秩序研究的 1299 名参与者的数据，为了评估可推广性，我们使用了来自少数族裔衰老研究的 679 名参与者的数据（100%为黑人）。
基线后任何时间的临床医生诊断为痴呆，以及可在初级保健环境中收集的与痴呆风险相关的预测变量：人口统计学、临床指标、病史、记忆主诉、认知和运动测试，以及评估功能障碍、抑郁症状、睡眠、社会隔离和遗传学（APOE e4 和 AD 多基因风险评分）的问题。
在基线时，年龄、记忆主诉、处理财务的能力、回忆月份、回忆房间和回忆三个单词，与推导队列中痴呆的累积发生率相关。RADaR（痴呆快速风险评估）的区分度在推导和外部验证队列中均较好（3 年 AUC=0.82-0.86），优于年龄的整体区分度（3 年 AUC=0.73），后者是痴呆的主要危险因素。添加遗传数据并未提高区分度。
参与者为志愿者，可能无法代表一般人群。
RADaR 源自社区居住的老年人，是一种简单有效的工具，可在 3 年内预测白人和黑人老年人的痴呆风险。
