Study protocol for development and validation of a single tool to assess risks of stroke, diabetes mellitus, myocardial infarction and dementia: DemNCD-Risk

Scherazad Kootar; Md Hamidul Huque; Kim M Kiely; Craig S Anderson; Louisa Jorm; Miia Kivipelto; Nicola T Lautenschlager; Fiona Matthews; Jonathan E Shaw; Rachel A Whitmer; Ruth Peters; Kaarin J Anstey

doi:10.1136/bmjopen-2023-076860

Study protocol for development and validation of a single tool to assess risks of stroke, diabetes mellitus, myocardial infarction and dementia: DemNCD-Risk

BMJ Open. 2023 Sep 22;13(9):e076860. doi: 10.1136/bmjopen-2023-076860.

Authors

Scherazad Kootar^{1

2}, Md Hamidul Huque^{1

2}, Kim M Kiely^{1

2}, Craig S Anderson^{3

4}, Louisa Jorm⁵, Miia Kivipelto⁶, Nicola T Lautenschlager^{7

8}, Fiona Matthews⁹, Jonathan E Shaw¹⁰, Rachel A Whitmer¹¹, Ruth Peters¹², Kaarin J Anstey^{13

2}

Affiliations

¹ Neuroscience Research Australia, Randwick, New South Wales, Australia.
² School of Psychology, University of New South Wales, Sydney, New South Wales, Australia.
³ The George Institute for Global Health, George Institute for Global Health, Newtown, New South Wales, Australia.
⁴ Faculty of Medicine, University of New South Wales, Kensington, NSW, Australia.
⁵ Centre for Big Data Research in Health, University of New South Wales, Randwick, New South Wales, Australia.
⁶ Division of Geriatric Epidemiology, Karolinska Institutet, Stockholm, Sweden.
⁷ Academic Unit of Psychiatry of Old Age, Department of Psychiatry, The University of Melbourne, Parkville, Victoria, Australia.
⁸ Older Adult Mental Health Program, Royal Melbourne Hospital Mental Health Service, Parkville, Victoria, Australia.
⁹ Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.
¹⁰ Clinical and Population Health, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.
¹¹ University of California Davis, Davis, California, USA.
¹² University of New South Wales, Sydney, New South Wales, Australia.
¹³ Neuroscience Research Australia, Randwick, New South Wales, Australia k.anstey@unsw.edu.au.

Abstract

Introduction: Current efforts to reduce dementia focus on prevention and risk reduction by targeting modifiable risk factors. As dementia and cardiometabolic non-communicable diseases (NCDs) share risk factors, a single risk-estimating tool for dementia and multiple NCDs could be cost-effective and facilitate concurrent assessments as compared with a conventional single approach. The aim of this study is to develop and validate a new risk tool that estimates an individual's risk of developing dementia and other NCDs including diabetes mellitus, stroke and myocardial infarction. Once validated, it could be used by the public and general practitioners.

Methods and analysis: Ten high-quality cohort studies from multiple countries were identified, which met eligibility criteria, including large representative samples, long-term follow-up, data on clinical diagnoses of dementia and NCDs, recognised modifiable risk factors for the four NCDs and mortality data. Pooled harmonised data from the cohorts will be used, with 65% randomly allocated for development of the predictive model and 35% for testing. Predictors include sociodemographic characteristics, general health risk factors and lifestyle/behavioural risk factors. A subdistribution hazard model will assess the risk factors' contribution to the outcome, adjusting for competing mortality risks. Point-based scoring algorithms will be built using predictor weights, internally validated and the discriminative ability and calibration of the model will be assessed for the outcomes. Sensitivity analyses will include recalculating risk scores using logistic regression.

Ethics and dissemination: Ethics approval is provided by the University of New South Wales Human Research Ethics Committee (UNSW HREC; protocol numbers HC200515, HC3413). All data are deidentified and securely stored on servers at Neuroscience Research Australia. Study findings will be presented at conferences and published in peer-reviewed journals. The tool will be accessible as a public health resource. Knowledge translation and implementation work will explore strategies to apply the tool in clinical practice.

Keywords: dementia; diabetes & endocrinology; myocardial infarction; primary prevention; risk factors; stroke.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Dementia* / diagnosis
Dementia* / epidemiology
Diabetes Mellitus* / diagnosis
Diabetes Mellitus* / epidemiology
Humans
Myocardial Infarction* / diagnosis
Myocardial Infarction* / epidemiology
Myocardial Infarction* / etiology
Noncommunicable Diseases*
Risk Factors
Stroke* / diagnosis
Stroke* / epidemiology
Stroke* / etiology

Grants and funding

P30 AG072972/AG/NIA NIH HHS/United States