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Graduate Course Proposal Form Submission Detail - PHC7038

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Current Status: -
Campus: Tampa
Submission Type: New
Course Change Information (for course changes only): I am seeking a permanent number for this course.

  1. Department and Contact Information

    Tracking Number Date & Time Submitted
    3123 2013-03-07
    Department College Budget Account Number
    Epidemiology and Biostatistics PH 640300
    Contact Person Phone Email
    Amy R. Borenstein 8138571178

  2. Course Information

    Prefix Number Full Title
    PHC 7038 Epidemiology of Alzheimer's Disease

    Is the course title variable? N
    Is a permit required for registration? N
    Are the credit hours variable? N
    Is this course repeatable? Y
    If repeatable, how many times? 1

    Credit Hours Section Type Grading Option
    3 C - Class Lecture (Primarily) R - Regular
    Abbreviated Title (30 characters maximum)
    Course Online? Percentage Online
    O - Online (100% online) 0


    PHC 6000, PHC 6050


    Course Description

    This course covers the descriptive and analytic epidemiology of Alzheimer’s Disease and related cognitive outcomes of aging.

    Registration restrictions: Prerequisities only

  3. Justification

    A. Please briefly explain why it is necessary and/or desirable to add this course.

    Replacing Selected Topics with Permanent number; already listed in program

    B. What is the need or demand for this course? (Indicate if this course is part of a required sequence in the major.) What other programs would this course service?

    Alzheimer's disease is becoming the next global epidemic, with annual costs in the US of $200 billion, and climbing as the baby boom generation enters the age at risk. Epidemiology programs traditionally have taught a unique course in cardiovascular epidemiology and cancer epidemiology. Now that Alzheimer's disease is the 3rd leading cause of death and mortality from heart disease and cancer are declining, more attention needs to be focused on pressing new public health needs. In a Google search conducted 3/25/2013, USF is the ONLY University that has a course on this topic, and many other universities will need this course in the future. Therefore, USF will be a leader in offering this course. The demand for the course will increase with time as students become more interested in diseases such as Alzheimer's, that has an explosive prevalence. Students in Public Health programs (PhD, Masters), Medicine, Statistics, and Gerontology will demand this course.

    C. Has this course been offered as Selected Topics/Experimental Topics course? If yes, how many times?

    Yes, 2 times

    D. What qualifications for training and/or experience are necessary to teach this course? (List minimum qualifications for the instructor.)

    Expertise in conducting research in the Epidemiology of Dementias/Alzheimer's disease

  4. Other Course Information

    A. Objectives

    1. Describe biologic pathways of amyloid precursor protein processing, abnormal cleavage of APP

    molecule, evidence for the Aβ hypothesis, immunotherapy against Aβ;

    2. Identify the history of Alzheimer’s disease;

    3. Explain the clinical symptoms, including disease onset and progressive stages of Alzheimer’s Disease, identify CDR stages and describe research criteria for MCI, AD, VaD and Lewy Body Dementia; as well as the role of neuropsychologic testing in defining clinical states and progression;

    4. Argue why Alzheimer’s Disease is underestimated in the top 10 causes of death and describe the excess mortality due to AD;

    5. Describe the burden of Alzheimer’s disease in terms of prevalence, formal and informal costs to families and societies around the world; and identify methodologic issues that may hinder the comparison of rates across studies;

    6. Discuss prevalence ratios of Alzheimer’s Disease to Vascular dementias in the East vs. the West, describe prevalence rates in different countries; describe the dementia epidemic and its financial and social costs that will occur in the coming decades;

    7. Identify methods to study the prevalence and incidence rates of the dementias and standardization required to conduct cross-cultural/national studies;

    8. Understand the relation of prevalence to incidence specifically for Alzheimer’s disease, their relations to age and sex, and distribution of disease in different countries;

    9. Define Mild Cognitive Impairment and its subtypes, its prevalence and incidence;

    10. Describe the major neuropathologic studies of dementia in the field, identify different criteria for the neuropathologic diagnosis of AD and describe the neuropathologic progression of AD, describe the interactive nature of pathologic lesions, including vascular pathology;

    11. Identify the reasons for the lack of 1:1 correspondence between the clinical and neuropathologic presentations of disease and describe reasons for the observation that about 1/3 of individuals meeting neuropathologic criteria are not demented during life;

    12. Describe neural/brain and cognitive reserve and understand their interactions with pathology to produce clinical disease;

    13. Explain the history of epidemiology of dementia and Alzheimer’s disease from the 1980s onward.

    14. Identify methodologic limitations of case-control studies and cohort studies in the study of Alzheimer’s disease;

    15. Explain why dementia is a threshold disease;

    16. Describe the genetics of Alzheimer’s Disease, including “how genetic is Alzheimer’s disease?”

    17. Explain how Down’s Syndrome is related to Alzheimer’s Disease;

    18. Identify why Alzheimer’s disease is viewed as a life-long disease and describe early-life risk and protective factors for late-life cognitive disorders;

    19. Describe risk factors for Alzheimer pathology and those for clinical expression and understand why they are unrelated to one another;

    20. Demonstrate knowledge of risk factors: genetics, head trauma, vascular diseases and risk factors, smoking and alcohol consumption,

    21. Demonstrate knowledge of inversely associated factors: diet, physical activity, social engagement, cognitive activity, non-steroidal anti-inflammatory compounds, statins, hormone replacement therapy;

    22. Identify and describe methodologic strengths and weaknesses as well as design issues in the field of Alzheimer’s disease epidemiology;

    23. Describe epidemiologic and other markers preceding the clinical onset of dementia/Alzheimer’s disease;

    24. Describe future steps that must be undertaken to ultimately prevent the dementias.

    B. Learning Outcomes

    The goal of the course is to understand and identify the epidemic of dementia, its burden, distribution and risk factors, as well as understand the roles of early detection and prevention. Students will listen to modules prepared by the Instructor and guest lecturers, complete homework assignments embedded in these modules, critique epidemiologic papers relevant to the modules and take a mid-term and final examination, which will be short and long-answer format; there may also be some multiple choice questions.

    1. Homework

    2. Critique of assigned papers

    3. Mid-term exam

    4. Final exam

    C. Major Topics

    1. Introduction

    2. History

    3. Biology (Dr. Morgan)

    4. Clinical Presentation and Criteria

    5. Progression and Staging

    6. Survival and Mortality

    7. Neuropathology (Dr. Mortimer)

    8. Prevalence

    9. Incidence

    10. Mild Cognitive Impairment

    11. Brain Reserve

    12. Analytic Epidemiology

    13. Family history, genetics, Down Syndrome

    14. Early-life factors

    15. Head trauma

    16. Smoking and Drinking Alcohol

    17. Vascular disease

    18. Diet 1

    Diet 2

    19. Physical Activity

    20. Social Engagement

    21. Cognitive Activity

    22. NSAIDs/statins/Hormone replacement therapy

    23. Epidemiologic markers

    D. Textbooks

    None - see Readings

    E. Course Readings, Online Resources, and Other Purchases

    Stelzmann RA, Schnitzlein N, Murtagh FR. An English translation of Alzheimer’s 1907 paper, “Uber eine eigenartige Erkankung der Hirnrinde”. Clinical Anatomy 1995;8:42-31.

    Selkoe DJ. Biochemistry and molecular biology of amyloid beta-protein and the mechanism of Alzheimer’s disease. In: Handbook of Clinical Neurology, vol 89 (3rd series) Dementias. C.Duyckaerts, I. Litvan, Eds, 2008

    McKhann G, Drachman D, Folstein M, et al. Clinical diagnosis of Alzheimer’s disease: Report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Azheimer’s disease. Neurology 1984;34:939-941.

    McKhann GM, Knopman DS, Chertkow H, et al. The diagnosis of dementia due to Alzheimer’s disease: Recommendations from the National Institute on Aging and the Alzheimer’s Association workgroup. Alzheimer’s & Dementia 2011; May,7(3):263-9.

    Petersen RC, Smith GE, Waring SC, Ivnik RJ, Tangalos EG, Kokmen E. Mild Cognitive Impairment: Clinical characterization and outcome. Archives of Neurology;56:303-8.

    Optional: Dubois B, Feldman HH, Jacova C, et al. Research criteria for the diagnosis of Alzheimer’s disease: revising the NINCDS-ADRDA criteria. Lancet Neurology


    Reisberg B, Ferris SH, De Leon MJ, Crook T. The Global Deterioration Scale for Assessment of Primary Degenerative Dementia. Am J Psychiatr 1982;139:1136-9.

    Hughes CP, Berg L, Danziger WL, Coben LA, Martin RL. A new clinical scale for the staging of dementia. The British Journal of Psychiatry 1982;140:566-72.

    Wilson RS, Aggarwal NT, Barnes LL, Bienias JL, Mendes de Leon M, Evans DA. Biracial population study of mortality in Mild Cognitive Impairment and Alzheimer Disease. Arch

    Neurol 2009;66(6):767-72.

    Bennett DA, Schneider JA, Wilson RS, Bienias JL, Arnold SE. Neurofibrillary Tangles Mediate the Association of Amyloid Load with Clinical Alzheimer Disease and Level of

    Cognitive Function. Arch Neurol 2004;61:378-84.

    Snowdon DA, Greiner LH, Mortimer JA, Riley KP, Greiner PA, Markesbery WR. Brain Infarction and the Clinical Expression of Alzheimer Disease. JAMA 1997;277:813-7.

    Optional: Khachaturian ZS. Diagnosis of Alzheimer’s Disease. Arch Neurol 1985;42: 1097-1105.

    NIA and Reagan Institute Working Group on Diagnostic Criteria for the neuropathological assessment of Alzheimer’s Disease. Neurobiology of Aging 1997;18(S4):S1-2.

    Evans DA, Funkenstein H, Albert MS, et al. Prevalence of Alzheimer’s Disease in a Community Population of Older Persons: Higher than Previously Reported. JAMA


    Letters to the Editor: JAMA 1990;May 9, Vol 263:2447-2449. Charles L. Bowden, EmreKokmen et al, Larry R. Kirkland, Lissy F. Jarvik, Replies: Denis A. Evans et al; Eric B. Larson.

    Graves AB, Larson EB, Edland SD, et al. Prevalence of Dementia and its Subtypes in the Japanese American Population of King County, Washington State. American Journal of Epidemiology 1996;144:760-71.

    Yamada M, Saski H, Mimori Y, et al. Prevalence and Risks of Dementia in the Japanese Population: RERF’s Adult Health Study Hiroshima Subjects. Journal of the American

    Geriatrics Society, 1999;47(2): 189-95.

    White L, Petrovitch H, Ross W, et al. Prevalence of Dementia in Older Japanese-American Men in Hawaii: The Honolulu-Asia Aging Study. JAMA 1996;276:955-60.

    Optional: Larson EB, McCurry SM, Graves AB, et al. Standardization of the Clinical Diagnosis of the Dementia Syndrome and its Subtypes in a Cross-National Study: The Ni-Hon-Sea Experience. Journal of Gerontology, MEDICAL SCI, 1998, Vol. 53A, No 4: M313-9.

    Tang MX, Cross H, Andrews H, et al. Incidence of AD in African-Americans, Caribbean Hispanics, and Caucasians in northern Manhattan. Neurology 2001;56:49-56.

    Bennett DA, Schneider JA, Wilson RS, Bienias JL, Arnold SE. Neurofibrillary Tangles Mediate the Association of Amyloid Load with Clinical Alzheimer Disease and Level of Cognitive Function. Arch Neurol 2004;61:378-84.

    Mortimer JA, Snowdon DA, Markesbery WR. Head Circumference, Education and Risk of Dementia: Findings from the Nun Study. J Clin Experimental Neuropsychology 2003;25(5):671-9.

    Stern Y. What is Cognitive Reserve? Theory and Research application of the reserve concept. Journal of the International Neuropsychological Society 2002;8:448-460.

    Borenstein Graves A. Alzheimer’s Disease and Vascular Dementia. In: Nelson LM, Tanner CM, Van Den Eeden SK, McGuire VM. Neuroepidemiology: From Principles to Practice. New York: Oxford University Press, 2004: 102-130.

    Optional: Heyman A, Wilkinson WE, Stafford JA, Helms MJ, Sigmon AH, Weinberg T. Alzheimer’s Disease: A Study of Epidemiological Aspects. Ann Neurol 1984;15:335-41.

    French LR, Schuman LM, Mortimer JA, Hutton JT, Boatman RA, Christians B. A Case-Control study of Dementia of the Alzheimer Type. American Journal of Epidemiology 1985;121(3):414-421.

    Borenstein Graves A, White E, Koepsell TD, Reifler BV, van Belle G, Larson EB, Raskind M. A Case-Control Study of Alzheimer’s Disease. Ann Neurol 1990;28:766-74.

    van Duijn CM, Clayton D, Chandra V, et al. Familial Aggregation of Alzheimer’s Disease and Related Disorders: A Collaborative Re-Analysis of Case-Control Studies. Int J Epidemiol 1991;20(2):S13-20.

    Slooter AJ, Cruts M, Kalmijn S, et al. Risk Estimates of Dementia by Apolipoprotein E Genotypes from a Population-Based Incidence Study: The Rotterdam Study. Arch Neurol


    Huang W, Qiu C, von Strauss E, Winblad B, Fratiglioni L. APOE Genotype, Family History of Dementia and Alzheimer’s Disease Risk. Arch Neurol 2004;61:1930-4.

    CRITIQUE PAPER: Friedland RP, Fritsch T, Smyth KA, et al. Patients with Alzheimer’s Disease have Reduced Activities in Midlife Compared with Healthy Control-Group Members. PNAS 2011;98:6:3440-5.

    Mortimer JA, Graves AB. Education and Other Socioeconomic Determinants of Dementia and Alzheimer’s Disease. Neurology 1993;43(Suppl 4):S39-44.

    Borenstein AR, Copenhaver CI, Mortimer JA. Early-Life Risk Factors for Alzheimer Disease.Alzheimer Disease and Associated Disorders 2006;20(1):63-72. Review.

    Snowdon DA, Kemper SJ, Mortimer JA, Greiner LH, Wekstein DR, Markesbery WR. Linguistic Ability in Early Life and Cognitive Function and Alzheimer’s Disease in Late Life. JAMA 1996;275:528-32

    Mortimer JA, van Duijn CM, Chandra V, et al. Head Trauma as a Risk Factor for Alzheimer’s Disease: A Collaborative Re-Analysis of Case-Control Studies. Int J Epidemiol

    1991;20(2)(Suppl 2): S28-35.

    Mehta KM, Ott A, Kalmijn S, Slooter AJC, van Duijn CM, Hofman A, Breteler MMB. Head Trauma and Risk of Dementia and Alzheimer’s Disease: The Rotterdam Study. Neurology


    Graves AB, van Duijn CM, Chandra V, et al. Alcohol and Tobacco Consumption as Risk Factors for Alzheimer’s Disease: A Collaborative Re-Analysis of Case-Control Studies. Int J Epidemiol 1991;20(2)(Suppl 2): S48-57.

    Tyas SL, White LR, Petrovitch H, et al. Mid-Life Smoking and Late-Life Dementia: The Honolulu-Asia Aging Study. Neurobiol Aging 2003;24:589-96.

    Launer LJ. Demonstrating the case that AD is a vascular disease: epidemiologic evidence. Ageing Research Reviews 2002;1:61-77.

    Luchsinger JA, Brickman AM, Reitz C, et al. Subclinical cerebrovascular disease in mild cognitive impairment. Neurology 2009;73:450-6.

    Optional: Craft S. The Role of Metabolic Disorders in Alzheimer Disease and Vascular Dementia: Two Roads Converged. Review. Arch Neurol 2009;66(3):300-5.

    Dai Q, Borenstein AR, Wu Y, Jackson JC, Larson EB. Fruit and Vegetable Juices and Alzheimer’s Disease: The Kame Project. Am J Medicine 2006;119:751-9.

    Scarmeas N, Stern Y, Tang MX, Mayeux R, Luchsinger JA. Mediterranean Diet and Risk for Alzheimer’s Disease. Ann Neurol 2006;59:912-21.

    Féart C, Samieri C, Rondeau V, et al. Adherence to a Mediterranean Diet, Cognitive Decline, and Risk of Dementia. JAMA 2009;302(6):638-48.

    CRITIQUE PAPER: Morris MC, Evans DA, Bienias JL, et al. Consumption of Fish and n-3 Fatty Acids and Risk of Incident Alzheimer Disease. Arch Neurol 2003;60:940-6.

    November 12 Lautenschlager NT, Cox KL, Flicker L, et al. Effect of Physical Activity on Cognitive Function in

    Older Adults at Risk for Alzheimer Disease: A Randomized Trial. JAMA 2008;300(9):1027-1037.

    Rovio S, Spulber G, Nieminen LJ, et al. The Effect of Midlife Physical Activity on Structural Brain Changes in the Elderly. Neurobiol of Aging 2010;31:1927-36.

    Voss MW, Nagamatsu LS, Liu-Ambrose T, Kramer AF. Exercise, brain and cognition Across the Lifespan. ApplPhysiol , April 28, 2011.

    Fratiglioni L, Wang HX, Ericsson K, Maytan M, Winblad B. Influence of social network on occurrence of dementia: a community-based longitudinal study. Lancet 2000;355:1315-9.

    Saczynski JS, Pfiefer LA, Masaki K, et al. The Effect of Social Engagment on Incident Dementia: The Honolulu –Asia Aging Study. Amer J Epidemiol 2006;163(5): 433-440.

    Wilson RS, Krueger KR, Arnold SE, et al. Loneliness and Risk of Alzheimer Disease. Arch Gen Psychiatr 2007;64:234-40.

    Akbaraly TN, Portet F, Fustinoni S, et al. Leisure activities and the risk of dementia in the elderly:

    Results from the Three-City Study. Neurology 2009;73:854-61.

    Wilson RS, Mendes De Leon CF, Barnes LL, et al. Participation in Cognitively Stimulating Activities

    and Risk of Incident Alzheimer Disease. JAMA 2002;287:742-8.

    Tang MX, Jacobs D, Stern Y, et al. Effect of Oestrogen during Menopause on Risk and Age at Onset of Alzheimer’s Disease. The Lancet 1996;348:429-32.

    Shumaker SA, Legault C, Rapp SR, et al. Estrogen Plus Progestin and the Incidence of Dementia and Mild Cognitive Impairment in Postmenopausal Women. The Women’s Health Initiative Memory Study: A Randomized Controlled Trial. JAMA-EXPRESS 2003;289(20:2651-62.

    In’t Veld BA, Ruitenberg A, Hofman A, et al. Nonsteroidal Antiinflammatory Drugs and the Risk of Alzheimer’s Disease. New Engl J Med 2001;345(21):1515-21.

    Sano M, Bell KL, Galasko D, et al. A Randomized, Double-Blind, Placebo-Controlled Trial of Simvastatin to Treat Alzheimer Disease. Neurology 2011, prepublished online July 27, 2011

    Borenstein Graves A, Bowen JD, Rajaram L, et al. Impaired Olfaction as a Marker for Cognitive Decline: Interaction with Apolipoprotein E-e4 status. Neurology 1999;53:1480.

    Barnes LL, Schneider JA, Boyle PA, Bienias JL, Bennett DA. Memory Complaints are Related to Alzheimer Disease Pathology in Older Persons. Neurology 2006;67:1581-5.

    Saczynski JS, Beiser S, Seshadri S, Auerbach S, Wolf PA, Au R. Depressive Symptoms and Risk of Dementia: The Framingham Heart Study. Neurology 2010;75:35-41.

    F. Student Expectations/Requirements and Grading Policy

    Expectations for the class:

    1. Students are expected to keep up with the class, to read the required readings, and to submit assignments and activities by due dates and times. As materials are made available at least 2 weeks ahead of when they are covered, students should plan accordingly to assure that all required components are submitted on time.

    2. Students should log on to Blackboard and check e-mail at least every other day (besides the time to review lectures and complete activities), to check for any announcements, updates, and/or potential issues related to assignment/activity submissions.

    3. Students are expected to independently complete all activities, including all components of the critical review of the assigned case-control and cohort studies.

    4. Students are expected to read the required readings as specified in the syllabus.

    5. To receive maximum points for any assignment, instructions should be followed carefully. Follow word limits as instructed and use Spell Check. There will be deductions if these guidelines are not followed.

    Straight letter grades are given as follows:

    Grading Scale: A= (90-100), B= (80-89.9), C= (70-79.9); D= (60-69.9); F =

    G. Assignments, Exams and Tests

    For Topics, see Section V.

    Assignments include Homework that is embedded within online modules; 2 critiques of assigned papers, a mid-term examination and a final examination (short-answer, true-false, long answer, multiple choice)

    H. Attendance Policy

    Course Attendance at First Class Meeting – Policy for Graduate Students: For structured courses, 6000 and above, the College/Campus Dean will set the first-day class attendance requirement. Check with the College for specific information. This policy is not applicable to courses in the following categories: Educational Outreach, Open University (TV), FEEDS Program, Community Experiential Learning (CEL), Cooperative Education Training, and courses that do not have regularly scheduled meeting days/times (such as, directed reading/research or study, individual research, thesis, dissertation, internship, practica, etc.). Students are responsible for dropping undesired courses in these categories by the 5th day of classes to avoid fee liability and academic penalty. (See USF Regulation – Registration - 4.0101,

    Attendance Policy for the Observance of Religious Days by Students: In accordance with Sections 1006.53 and 1001.74(10)(g) Florida Statutes and Board of Governors Regulation 6C-6.0115, the University of South Florida (University/USF) has established the following policy regarding religious observances: (

    In the event of an emergency, it may be necessary for USF to suspend normal operations. During this time, USF may opt to continue delivery of instruction through methods that include but are not limited to: Blackboard, Elluminate, Skype, and email messaging and/or an alternate schedule. It’s the responsibility of the student to monitor Blackboard site for each class for course specific communication, and the main USF, College, and department websites, emails, and MoBull messages for important general information.

    I. Policy on Make-up Work

    No late work is accepted unless discussed at least 1 week prior to the deadline of due date with the Professor.

    Disruption of the academic process and violations of the policies regarding academic integrity will not be tolerated. Review USF policies on Disruption of the

    No late work is accepted, unless discussed in advance with the Professor.

    Academic Process and the Academic Integrity of Students at:

    J. Program This Course Supports

    PhD in Epidemiology, MPH/MSPH in Epidemiology, Neuroepidemiology certificate (in development)

  5. Course Concurrence Information

    PhD/Masters in Aging Studies/Gerontology

- if you have questions about any of these fields, please contact or