|Art der Förderung:||Standard Projekt|
|Institution:||Universität Frankfurt, Klinik für Psychiatrie und Psychotherapie|
|Projektleiter:||Prof. Dr. Lutz Frölich|
|Laufzeit:||01. November 1997 - 31. Oktober 1999|
Epidemiological research provides an important strategy to elucidate mechanisms involved in the development of Alzheimer’s disease. While biological basic research may add to the understanding of why a certain exposure causes or prevents a disease, only epidemiology allows the quantification of the magnitude of the expose - disease relationship in humans and offers the possibility of altering the risk through intervention. In Alzheimer’s disease, several genetic and various environmental factors are believed to influence each other and lead to the development of symptoms. Earlier case-control studies in Alzheimer’s disease have provided some evidence for a possible etiologic relevance of psychosocial and toxicological factors. Epidemiologists agree that case-control studies offer the most cost-efficient method of identifying risk factors. Such hospital-based case-control studies have an advantage over some other epidemiological studies in that these investigations are performed on subjects (‘cases’) who to the best clinical knowledge are diagnosed as dementia and probable Alzheimer’s disease (e.g. the NINCDA/ADR-DA criteria).
Several epidemiological studies have focused on ‘constitutional’ factors like age, sex, birth order, and dementia in the family and ‘life style’ factors like smoking and alcohol consumption. However, only few studies have investigated the role of psychosocial and toxicological factors at work and during leisure time. In a case-control study on newly diagnosed cases obtained from a University outpatient memory clinic, we will investigate several occupational and psychosocial factors indicative of mental deprivation for their importance in the development of Alzheimer’s disease.
Two hundred Alzheimer’s disease cases will be recruited. For assessment of the risk associated with Alzheimer’s disease, two control groups will be recruited. The first control group consists of 200 healthy subjects. The second control group are patients aged up to 75 who contact the ‘Gedächtnisprechstunde’ in 1998 or 1999 and are diagnosed as suffering from vascular dementia. The risk factors to be investigated will encompass basic data (age, gender, season of birth, psychiatric history, family history for Alzheimer’s disease, possible head trauma etc.), smoking habits and alcohol consumption, toxicological exposures (aluminium, lead, organic solvents), exposure to electromagnetic fields. Second, a detailed assessment of education and occupation with special attention to periods of unemployment, together with a detailed analysis of the psychosocial network and psychosocial activities for the period from adulthood to 5 years prior to the diagnosis of dementia is taken as a measure of mental deprivation.
Potential positive findings may provide clear-cut evidence of an involvement of the factors studied as being causative for Alzheimer’s disease. Thus, such findings may provide a rational for psychosocial intervention strategies in subgroups of patients and may even induce political and medical decisions affecting the health of the general public.
Since April 1998 we developed a questionnaire to assess occupational risk-factors, biographical data and an exact analysis of social contacts and activities. The interviews with this questionnaire will start in August 1998.
For the documentation of clinical and laboratory works already done by the general practitioner we developed a medical examination form. Until now we have contacted three general practitioners in order to recruit 200 cases with Alzheimer's disease as well as 200 control persons with vascular dementia. Furthermore, an information and an approval-explanation for all test persons as well as a letter to the selected population controls were developed. The population sample was based on a 2 percent census of the Frankfurt population.
The commission of ethics of the Johann Wolfgang Goethe University has approved the application to our case control study
Bernhardt, T., Seidler, A., Frölich, L. (2002). Der Einfluss von psychosozialen Faktoren auf das Demenzerkrankungsrisiko. Fortschr Neurol Psychiat, 70:1-6.
Seidler, A., Bernhardt, T., Nienhaus, A., Frölich, L. (2003). Association between the psychosocial network and dementia - a case-control study. J Psychiat Res, 37:89-98.