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Cox proportional hazard models with Bonferroni correction identified ADRD\u2010associated exposures. We used the XGBoost classifier to build a predictive model and further developed an exposomic risk score (ERS) for risk stratification.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>\n                      During a 15.3\u2010year median follow\u2010up, 8881 participants (1.77%) developed ADRD, including 4000 with Alzheimer's disease. ExWAS identified 76 exposures after Bonferroni correction. The prediction model achieved area under the curve (AUC)\u00a0=\u00a00.718, outperforming demographics+apolipoprotein E (\n                      <jats:italic>APOE<\/jats:italic>\n                      ) status alone (AUC\u00a0=\u00a00.678). The ERS stratified ADRD risk (highest vs lowest quartile hazard ratio [HR]\u00a0=\u00a02.97, 95% confidence interval [CI]: 2.59\u20133.41).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>DISCUSSION<\/jats:title>\n                    <jats:p>The ERS has the potential to contribute to clinically relevant prevention strategies for ADRD.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/alz.71842","type":"journal-article","created":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T06:40:23Z","timestamp":1790750423000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Exposome\u2010wide association study and predictive risk score for incident Alzheimer's disease and related dementias"],"prefix":"10.1002","volume":"22","author":[{"given":"Chenshuang","family":"Li","sequence":"first","affiliation":[{"name":"Department of Environmental Health Harvard T.H. 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Chan School of Public Health  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shalini","family":"Jain","sequence":"additional","affiliation":[{"name":"USF Center for Microbiome Research Microbiomes Institute University of South Florida  Tampa Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hariom","family":"Yadav","sequence":"additional","affiliation":[{"name":"USF Center for Microbiome Research Microbiomes Institute University of South Florida  Tampa Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4311-584X","authenticated-orcid":false,"given":"Peng","family":"Gao","sequence":"additional","affiliation":[{"name":"Department of Environmental Health Harvard T.H. Chan School of Public Health  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8756-8525","authenticated-orcid":false,"given":"Chirag J","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Biomedical Informatics Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,29]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2468\u20102667(21)00249\u20108"},{"key":"e_1_2_8_3_1","unstructured":"U.S. Department of Health and Human Services.National plan to address Alzheimer's disease: 2024 update.U.S. Department of Health and Human Services;2024. 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