ArticleNeurology2024
Guide to Decomposition of Causal Effects Into Mediation, Interaction, and Direct Effects: Case Study on Aerobic Exercise and Parkinson Disease.
Article in Neurology, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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Who cites it
4 citing papers in PubMed.
- Impact of Cerebral Small Vessel Disease on Functional Decline: Bleeding With Antithrombotic Therapy 2 Study.Stroke · 2026Observational
- Impact of Intracranial Atherosclerosis and Cerebral Small Vessel Disease on Overt Vascular Events During Antithrombotic Therapy.European journal of neurology · 2026Observational
- Exploring How the Interplay Between Neighborhood Perceptions and Social Cohesion Relates to Self-Assessed Health: A Four-Way Decomposition with a 10-Year Follow Up.Journal of urban health : bulletin of the New York Academy of Medicine · 2026Article
- Clarifying what BP Predicts: Commentary on CSF Aβ42/40, p-tau181, and centiloid in unimpaired populations.The journal of prevention of Alzheimer's disease · 2025Article
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Authors and funding
6 authors.
Funding
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Abstract
Mediation analysis can be applied in medical research with the aim of understanding the pathways that operate between an exposure and its effects on an outcome. This method can help to improve our understanding of pathophysiologic mechanisms and may guide the choice of potential treatment strategies. Traditional mediation analysis decomposes the total effect of an intervention on the outcome into 2 effects: (1) an indirect effect, from exposure using a mediator to the outcome, and (2) a direct effect, directly from exposure to outcome. A limitation of this method is that it assumes no interaction between the exposure and the mediator, which can either lead to an over- or underestimation of clinically relevant effects. The "4-way decomposition" method has the advantage of overcoming this limitation. Specifically, the total effect of an exposure on the outcome is decomposed into 4 elements: (1) reference interaction (interaction only), (2) mediated interaction (mediation and interaction), (3) the pure indirect effect (mediation but not interaction), and (4) the direct effect (no mediation and no interaction). We provide a guide to select the most appropriate method to investigate and decompose any causal effect given the research question at hand. We explain the application of the 4-way decomposition and illustrate this with a real-world example of how aerobic exercise may influence motor function in persons with Parkinson disease.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.