BackgroundWith the onset of prevention trials for individuals at high risk for Alzheimer disease, there is increasing need for accurate risk prediction to inform study design and enrollment, but available risk estimates are limited. We developed risk estimates for the incidence of mild cognitive impairment (MCI) or dementia among cognitively unimpaired individuals by APOE-e4 dose for the genetic disclosure process of the Alzheimer’s Prevention Initiative Generation Study, a prevention trial in cognitively unimpaired APOE-e4/e4 homozygote individuals.Methods and findingsWe included cognitively unimpaired individuals aged 60–75 y, consistent with Generation Study eligibility criteria, from the National Alzheimer’s Coordinating Center (NACC) (n = 5,073, 158 APOE-e4/e4), the Rotterdam Study (n = 6,399, 156 APOE-e4/e4), the Framingham Heart Study (n = 4,078, 67 APOE-e4/e4), and the Sacramento Area Latino Study on Aging (SALSA) (n = 1,294, 11 APOE-e4/e4). We computed stratified cumulative incidence curves by age (60–64, 65–69, 70–75 y) and APOE-e4 dose, adjusting for the competing risk of mortality, and determined risk of MCI and/or dementia by genotype and baseline age. We also used subdistribution hazard regression to model relative hazard based on age, APOE genotype, sex, education, family history of dementia, vascular risk, subjective memory concerns, and baseline cognitive performance. The four cohorts varied considerably in age, education, ethnicity/race, and APOE-e4 allele frequency. Overall, cumulative incidence was uniformly higher in NACC than in the population-based cohorts. Among APOE-e4/e4 individuals, 5-y cumulative incidence was as follows: in the 60–64-y age stratum, it ranged from 0% to 5.88% in the three population-based cohorts versus 23.06% in NACC; in the 65–69-y age stratum, from 9.42% to 10.39% versus 34.62%; and in the 70–75-y age stratum, from 18.64% to 33.33% versus 38.34%. Five-year incidence of dementia was negligible except for APOE-e4/e4 individuals and those over 70 y. Lifetime incidence (to age 80–85 y) of MCI or dementia for the APOE-e4/e4 individuals in the long-term Framingham and Rotterdam cohorts was 34.69%–38.45% at age 60–64 y, 30.76%–40.26% at 65–69 y, and 33.3%–35.17% at 70–75 y. Confidence limits for these estimates are often wide, particularly for APOE-e4/e4 individuals and for the dementia outcome at 5 y. In regression models, APOE-e4 dose and age both consistently increased risk, as did lower education, subjective memory concerns, poorer baseline cognitive performance, and family history of dementia. We discuss several limitations of the study, including the small numbers of APOE-e4/e4 individuals, missing data and differential dropout, limited ethnic and racial diversity, and differences in definitions of exposure and outcome variables.ConclusionsEstimates of the absolute risk of MCI or dementia, particularly over short time intervals, are sensitive to sampling and a variety of methodological factors. Nonetheless, such estimates were fairly consistent across the population-...

Objective:  To document the breastfeeding practices of Aboriginal mothers delivering in Perth. Design and methods:  A cohort of mothers was followed from the time of delivery for six months to obtain details of infant feeding practices. Subjects:  A total of 455 mothers delivered during the study period and were asked to participate. A total of 425 mothers completed the initial questionnaire. Setting:  The study was undertaken in six public hospitals in Perth, Western Australia. Data analyses:  The data were analysed using spss. Breastfeeding duration was calculated using Kaplan–Meier survival analysis. Main outcome measures:  Breastfeeding initiation and duration. Results:  The mean age of the Aboriginal mothers was 21.8 years (range 14–39 years, SD 5.32) and the average gestational age was 38.3 weeks. Almost 50% of the mothers in the study delivered by Caesarean section. At discharge from hospital 89.4% (CI 86.6–92.1) of mothers were breastfeeding, declining to 58.8% (CI 53.5–64.1) at six months. When compared with non‐Aboriginal mothers, the Aboriginal breastfeeding rates were higher than the non‐Aboriginal average breastfeeding rates, but lower than the highest socioeconomic group. Conclusions:  The breastfeeding rates of Aboriginal mothers are higher than for other Australians. This is despite the low maternal age and level of education and the high rates of low‐birth‐weight infants and Caesarean section among this population. The World Health Organization recommendation for infant feeding is exclusive breastfeeding until six months, but less than one‐third of Aboriginal mothers achieved this recommendation.

No abstract

Objective: To document the smoking practices of Aboriginal mothers living in Perth during pregnancy and during the subsequent year while feeding their infants.

No abstract