Associations of vascular risk factors with Alzheimer disease

(risk score predicted dementia well)

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Late-onset Alzheimer disease (LOAD) is the most frequent cause of dementia in Western societies. It is estimated that approximately 5 million people in the United States and 17 million worldwide have the disease. By age 85 years and older, 15% to 30% are affected, and the incidence rate increases from approximately 1% among people aged 65 to 70 years to approximately 6% to 8% for people aged 85 years and older. It is expected that these numbers will quadruple by the year 2040, by which time 1 of 45 Americans will be affected, leading to a considerable public health burden. As there is no curative treatment available, extensive efforts for the prevention of dementia in persons at risk are needed. Delaying LOAD onset, by modifying risk or lifestyle, could significantly decrease the prevalence and public health burden. For example, a delay in onset of 1 year would translate to almost 1 million fewer prevalent cases in the United States.
Valuable tools for targeting preventive measures to those at risk of the disease are risk scores. They have been frequently used in population-based settings, in particular to predict the risks of vascular disorders such as stroke, cardiovascular events, diabetes, and mortality from vascular causes. They commonly include few known risk factors that are easily measurable to calculate the subsequent risk of an event or disease within a given time frame. Although the absolute risk of an event may differ across populations, risk ranking by use of risk scores is consistent. An additional benefit of risk scores is that they can be used to transmit easily understandable information about risk factors to the general population.
Although vascular disease and vascular risk factors including stroke, diabetes, hypertension, smoking, heart disease, dyslipidemia, and obesity have been implicated in the risk of LOAD, only Kivipelto et al have published a score for predicting dementia based on common and easily measurable risk factors; this score was based on risk factor profiles present in middle age.
Barnes et al developed a dementia risk index for use in late life that can accurately stratify older adults into those with a low, moderate, or high risk of developing dementia within 6 years. However, it includes measures that may not be readily available, such as cerebral magnetic resonance imaging and Doppler sonography of the carotid arteries.
We previously reported associations of stroke, diabetes, hyperinsulinemia, hypertension, smoking, obesity, and dyslipidemia with cognitive impairment and dementia in the elderly. In this study, we developed a tool for predicting dementia risk in elderly individuals that is based on easily available measures and can be used to identify persons at risk as well as to adjust for confounders in epidemiologic studies of risk factors for LOAD. More: archneur.ama-assn.org

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