@article {6302, title = {Development and validation of a brief dementia screening indicator for primary care.}, journal = {Alzheimers Dement}, volume = {10}, year = {2014}, month = {2014 Nov}, pages = {656-665.e1}, abstract = {

BACKGROUND: Detection of "any cognitive impairment" is mandated as part of the Medicare annual wellness visit, but screening all patients may result in excessive false positives.

METHODS: We developed and validated a brief Dementia Screening Indicator using data from four large, ongoing cohort studies (the Cardiovascular Health Study [CHS]; the Framingham Heart Study [FHS]; the Health and Retirement Study [HRS]; the Sacramento Area Latino Study on Aging [SALSA]) to help clinicians identify a subgroup of high-risk patients to target for cognitive screening.

RESULTS: The final Dementia Screening Indicator included age (1 point/year; ages, 65-79 years), less than 12~years of education (9 points), stroke (6 points), diabetes mellitus (3 points), body mass index less than 18.5~kg/m(2) (8 points), requiring assistance with money or medications (10 points), and~depressive symptoms (6 points). Accuracy was good across the cohorts (Harrell{\textquoteright}s C statistic: CHS, 0.68; FHS, 0.77; HRS, 0.76; SALSA, 0.78).

CONCLUSIONS: The Dementia Screening Indicator is a simple tool that may be useful in primary care settings to identify high-risk patients to target for cognitive screening.

}, keywords = {Aged, Cohort Studies, Dementia, Female, Humans, Male, Mass Screening, Predictive Value of Tests, Primary Health Care, Proportional Hazards Models, Risk Assessment}, issn = {1552-5279}, doi = {10.1016/j.jalz.2013.11.006}, author = {Barnes, Deborah E and Beiser, Alexa S and Lee, Anne and Langa, Kenneth M and Koyama, Alain and Preis, Sarah R and Neuhaus, John and McCammon, Ryan J and Yaffe, Kristine and Seshadri, Sudha and Haan, Mary N and Weir, David R} } @article {8278, title = {Heterogeneous Exposure Associations in Observational Cohort Studies: The Example of Blood Pressure in Older Adults.}, journal = {Am J Epidemiol}, year = {2019}, month = {2019 Oct 08}, abstract = {

Heterogeneous exposure associations (HEAs) can be defined as differences in the association of a exposure with an outcome among subgroups that differ by a set of characteristics. This manuscript intends to foster discussion of HEAs in the epidemiological literature, and present a variant of the random forest algorithm that can be used to identify HEAs. We demonstrate the use of this algorithm in the setting of the association of systolic blood pressure and death in older adults. The training set included pooled data from the baseline examination of the Cardiovascular Health Study (1989-1993), the Health, Aging, and Body Composition study (1997-1998), and the Sacramento Area Latino Study on Aging (1998-1999). The test set included data from the National Health and Nutrition Examination Survey (1999-2002). The hazard ratios ranged from 1.25 (95\% CI: 1.13, 1.37) per 10 mmHg higher systolic blood pressure in men aged <=67 years with diastolic blood pressure >80 mmHg, to 1.00 (0.96, 1.03) in women with creatinine <0.7 mg/dL and a history of hypertension. HEAs have the potential to improve our understanding of disease mechanisms in diverse populations, and guide the design of randomized controlled trials to control exposures in heterogeneous populations.

}, issn = {1476-6256}, doi = {10.1093/aje/kwz218}, author = {Odden, Michelle C and Rawlings, Andreea M and Khodadadi, Abtin and Fern, Xiaoli and Shlipak, Michael G and Bibbins-Domingo, Kirsten and Covinsky, Kenneth and Kanaya, Alka M and Lee, Anne and Haan, Mary N and Newman, Anne B and Psaty, Bruce M and Peralta, Carmen A} }