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risk factors for dementia

Etiology: risk factors - Parkinson's disease (RR=6) [52]; 10 year risk 9-27% [67] - essential tremor (RR=3) [52] - metabolic & endocrine disorders, toxins - diabetes mellitus* - variability in hemoglobin A1c (<8%) - head trauma, traumatic brain injury - service in the U.S. military [45] - late-onset unprovoked seizures increases risk 2-fold within 6 years [1] - seizure within 1 year increases risk of mild cognitive impairment converting to dementia within 1 year (RR=1.6) [70] - poor physical performance is a risk factor in the oldest old (> 90 years) [2] - anemia is a risk factor [3] - personality disorder may be risk factor [4] - neuroticism [4,5,6] - social isolation [4,7,8] (RR=1.3) - being less agreeable [6] - being less conscientious [6] - schizophrenia is a risk factor, 28% at age 66 years [9] - depression is a modifiable risk factor [10,39] - living alone, social isolation, loneliness [7,68] - anxiety is a modifiable risk factor [63] - apathy is a risk factor [11,12] - adult ADHD is associated with an increased risk of dementia (RR-2.8-3;6) [43} - midlife orthostatic hypotension is a risk factor [16] - hypertension [66] - higher systolic blood pressure variability (RR=1.02-1.10) [17] - cardiovascular disease [69] - heart failure - atrial fibrillation - coronary artery disease [69] - coronary artery disease before age 45 years [46] - atherosclerotic intracranial arterial stenosis - congenital heart disease may be a risk factor (RR=1.6) [24] - air pollution* - fine particulate matter PM2.5 [36], nitrogen dioxide* - higher residential PM2.5 levels, especially from agriculture & wildfires, associated with higher risk of incident dementia [36] - long-term exposure to wildfire smoke [57] - noise - residential exposure to transportation noise [20] - higher outdoor nighttime light exposure is associated with higher prevalence of Alzheimer's disease [61] - sensory deprivation: - hearing impairment [21], visual impairment [41], anosmia - hearing loss linked to dementia: use of hearing aids reduces risk [21] - visual impairment, especially contrast sensitivity & visual acuity [60] - olfactory impairment is an independent risk factor for cognitive impairment in the elderly [42] (see olfaction & Alzheimer's disease) - injurious falls in the elderly (RR=1.1-1.2) [65] - pre-eclampsia might increase risk for dementia later in life [22] - acute kidney injury [64] - taller men may have lower risk for dementia (RR=0.9) [23] - obesity at age 18-70 years is associated with increased risk for dementia (especially women) [54] - obesity developed after age 70 years may br associated with decreased risk for dementia [54] - weight loss & variability in late middle age (50-65 years) associated with increased risk of dementia after age 65 years [47] - resting heart rate > 80/min vs 60-69/min associated with increased risk for dementia (RR=1.55) [25] - hospitalization with infection associated with increased risk for dementia [27] - elective surgery with general anesthesia not associated with increased risk for dementia [26,49] - frailty is a risk factor for mild cognitive impairment & dementia [28] - osteoporosis may be a risk factor for dementia [35] - nonalcoholic fatty liver disease (RR=1.4) [29] - Herpes simplex [51] - medications, toxins, vaccines - androgen deprivation therapy increases risk (RR=2.3) [13] - menopausal hormone replacement therapy increases risk of all-cause dementia (RR=1.2) [38] - anticholinergic agent exposure increases risk [14] - proton pump inhibitor use: reports conflicting (see proton pump inhibitor) [15,37] - tramadol [72] - alcohol consumption* 1-7 drinks weekly not associated with risk for dementia (lowest risk) - abstinence or more then 7 drinks weekly associated with higher risk [18] - maintaining mild-moderate alcohol consumption or initiation of mild alcohol consumption is associated with decreased risk of dementia [32] - heavy alcohol consumption is associated with an increased risk of dementia [32] - alcohol use frequency [53]* - trans fats, elaidic acid [19] - osmotic laxative use & multiple different laxatives use associated with increased risk for all-cause dementia (RR=1.64) & vascular dementia (RR=1.97) [34] - conflicting vaccine data - common vaccinations (especially influenza virus vaccine, pneumococcal vaccine & Shingrix) may increase risk of dementia in elderly after a 2-year lag period (RR=1.4) [30] - may have more to do with patient characteristics than vaccine(s) - Shingrix vaccine may lower risk or delay onset of dementia [58] - 164 additional days at end of life without a diagnosis of dementia - dementia risk score in the UK Biobank (predictive variables) [40] - age - education - parental history of dementia - material deprivation (poverty) - diabetes mellitus* - stroke - depression - hypertension [66] - high cholesterol - living alone - sex (M > F) contrasts with other risk scores - risk factors in adolescence [31] a) alcohol intoxication b) stroke c) use of antipsychotics d) depression e) father's dementia f) drug intoxication other than alcohol g) low cognitive function h) short stature i) high blood pressure * most deleterious modifiable risk factors [53] Laboratory: - high blood levels of four proteins GFAP, NEFL, GDF15 & LTBP2 strongly associated with dementia - association strongest with GFAP (RR=2) [50] Special laboratory: - brain care score Management: - see prevention of dementia - also see Clinical trials Clinical trials: - Kaiser-Permanente: (SMARRT Randomized Clinical Trial) - 172 elderly 70-89 years of age with > 1 risk factor* for dementia - data collected from August 2018 to August 2022 & analyzed from October 2022 to September 2023 - intervention: personalized risk-reduction goals with health coaching & nurse visits - control: health education - primary outcome: change in a composite modified Neuropsychological Test Battery - secondary outcomes: change in risk factors & quality of life - outcomes assessed at baseline & 6, 12, 18, & 24 months - results: personalized, multidomain intervention led to modest improvements in cognition, dementia risk factors, & quality of life after 2 years [44] - Tai chi - cognitively intensive Tai chi results in greater improvement of cognition measures than standard Tai chi or stretching in elderly with mild cognitive impairment [48] * modifiable risk factors (SMARRT) - physical inactivity - uncontrolled hypertension - poor sleep - prescription medication that may adversely affect cognition - high depressive symptoms - uncontrolled diabetes - social isolation - currently smoking * 40% of dementia cases associated with 12 potentially modifiable risk factors [55] - low education - hypertension - hearing impairment - visual impairment - smoking - obesity - depression - physical inactivity - unhealthy diet - red meat consumption (RR=1.14) [59] - high serum LDL cholesterol [59] - diabetes mellitus - social isolation - alcohol abuse - traumatic brain injury - air pollution * other modifiable risk factors - cognitive stimulation in the workplace [61]

Related

causes of dementia dementia; Alzheimer's disease & related dementias (ADRD) Prevention Of Dementia

Specific

etiology/risk of Alzheimer's disease risk factors & protective factors for vascular dementia

General

health risk factor(s)

References

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