Methodological issues in dementia epidemiology

The aim of this partnering award is to establish a collaboration between the Million Women Study, an MRC-funded cohort study run by the University of Oxford, and experts in dementia research at the Harvard T.H. Chan School of Public Health and Massachusetts General Hospital in the US.

The applicant Dr Floud is an early career epidemiologist working on research into lifestyle risk factors for dementia in the Million Women Study cohort. The Million Women Study began 20 years ago, recruiting 1.3 million women, 1 in every 4 UK women born in 1935-1950. It still follows 99% of survivors for hospital admissions and deaths by electronic linkage to routinely collected NHS databases. As such it is a unique resource in which to study the factors in midlife that might increase the risk of dementia later in life and those that might prevent dementia.

Dr Floud plans to visit the US to meet Professor Blacker at a workshop and also for a two-week visit to the Harvard T.H. Chan School of Public Health.

Dr Floud proposes to collaborate with Professor Blacker, who is a geriatric psychiatrist and epidemiologist, with a long history of research on the epidemiology of dementia. She receives funding from the National Institutes of Health in the US. She jointly leads clinical research in the Massachusetts Alzheimer's Disease Research Center and is a lead investigator for the Harvard Aging Brain Study. Prof Blacker is also Deputy Chair of the Department of Epidemiology at the Harvard T.H. Chan School of Public Health, where Dr Floud's visit will take place.

The objectives of the visit are
(i) for Dr Floud to learn about the diagnosis of mild cognitive impairment and dementia in a clinical and research setting. This will be achieved by observing Prof Blacker at work in the Mass General Hospital and meeting with her colleagues working on diagnosing cognitive impairment and dementia and on the identification of the subtypes of dementia (eg Alzheimer's disease or vascular dementia);

(ii) for Dr Floud to learn more about methods for detecting and accounting for bias and confounding in epidemiological studies of dementia. This will be achieved by meeting with Professor Blacker and her colleagues at the Harvard School of Public Health;

(iii) for Dr Floud to collaborate with Professor Blacker in an analysis of data from the Million Women Study on the proposed protective effect of engaging in intellectual activities in delaying or preventing the onset of dementia.

The aim of this partnering award is to establish a collaboration between the Million Women Study, an MRC-funded cohort study run by the University of Oxford, and experts in dementia research at the Harvard T.H. Chan School of Public Health (HSPH) and Massachusetts General Hospital (MGH) in the US.

The Principal Investigator is Dr Sarah Floud, an early career researcher working on risk factors for dementia in the Million Women Study. She proposes to visit Professor Deborah Blacker, who is an experienced geriatric psychiatrist and epidemiologist at MSG and HSPH.

The first objective is for Dr Floud to learn more about the diagnosis of mild cognitive impairment and dementia in a clinical and research setting. Prof. Blacker co-leads the clinical core for the Massachusetts Alzheimer's Disease Research Center (MADRC) and sees patients in the affiliated clinical Memory Disorders Unit. Dr Floud will observe both clinical and research evaluations, attend the Memory Disorders Unit weekly seminar, and attend the weekly research consensus meetings reviewing diagnoses and other outcomes. Dr Floud will also visit the MADRC Brain Bank and the Vascular Cognitive Impairment Research Group at MGH. This close attention to clinical and research diagnosis will benefit Dr Floud's understanding of hospital admission data on dementia and its many subtypes in the Million Women Study.

The second objective is to learn from Professor Blacker and her colleagues at HSPH about approaches and specific methods to address bias, confounding, and reverse causation in dementia risk factor research. Dr Floud will also attend seminars of specific relevance to her methodological interests (e.g. the Epidemiology and Neuro-epidemiology seminars).

The third objective is to collaborate on a joint report on the short- and long-term associations of dementia with intellectual activities, since engaging in such activities has been proposed as a strategy to prevent dementia.