Date Available

7-25-2016

Year of Publication

2016

Degree Name

Doctor of Philosophy (PhD)

Document Type

Doctoral Dissertation

College

Public Health

Department/School/Program

Epidemiology and Biostatistics

First Advisor

Dr. Erin Abner

Second Advisor

Dr. Richard Kryscio

Abstract

Dementia is increasing recognized as a major problem to public health worldwide. Prevention and treatment strategies are in critical need. Nowadays, research for dementia usually featured as complex longitudinal studies, which provide extensive information and also propose challenge to statistical methodology. The purpose of this dissertation research was to apply statistical methodology in the field of dementia to strengthen the understanding of dementia from three perspectives: 1) Application of statistical methodology to investigate the association between potential risk factors and incident dementia. 2) Application of statistical methodology to analyze changes over time, or trajectory, in cognitive tests and symptoms. 3) Application of statistical learning methods to predict development of dementia in the future.

Prevention of Alzheimer’s disease with Vitamin E and Selenium (PREADViSE) (7547 subjects included) and Alzheimer’s disease Neuroimaging Initiative (ADNI) (591 participants included) were used in this dissertation. The first study, “Self-reported sleep apnea and dementia risk: Findings from the PREADViSE Alzheimer’s disease prevention trial ”, shows that self-reported baseline history of sleep apnea was borderline significantly associated with risk of dementia after adjustment for confounding. Stratified analysis by APOE ε4 carrier status showed that baseline history of sleep apnea was associated with significantly increased risk of dementia in APOE ε4 non-carriers. The second study, “comparison of trajectories of episodic memory for over 10 years between baseline normal and MCI ADNI subjects,” shows that estimated 30% normal subjects at baseline assigned to group 3 and 6 stay stable for over 9 years, and normal subjects at baseline assigned to Group 1 (18.18%) and Group 5 (16.67%) were more likely to develop into dementia. In contrast to groups identified for normal subjects, all trajectory groups for MCI subjects at baseline showed the tendency to decline. The third study, “comparison between neural network and logistic regression in PREADViSE trial,” demonstrates that neural network has slightly better predictive performance than logistic regression, and also it can reveal complex relationships among covariates. In third study, the effect of years of education on response variable depends on years of age, status of APOE ɛ4 allele and memory change.

Digital Object Identifier (DOI)

http://dx.doi.org/10.13023/ETD.2016.336

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