ADRD; Alzheimer's disease and related dementias; longitudinal extension of the average attributable fraction ( LE‐AAF); multimorbidity; population attributable fraction ( PAF); population attributable risk; Humans; Male; Aged; Female; Aged, 80 and over; United States/epidemiology; Incidence; Longitudinal Studies; Risk Factors; Multimorbidity; Dementia/epidemiology; Medicare/statistics & numerical data; Dementia; Medicare; United States; Epidemiology; Health Policy; Developmental Neuroscience; Neurology (clinical); Geriatrics and Gerontology; Cellular and Molecular Neuroscience; Psychiatry and Mental Health
Abstract :
[en] INTRODUCTION: Multimorbidity is associated with increased risk of dementia, but previous estimation of the joint contribution of constituent conditions to dementia incidence did not model additive contributions or temporal proximity in the sequential onset of conditions.
METHODS: Data were analyzed from 9944 Health and Retirement Study participants and Medicare fee-for-service beneficiaries, ages 68-99, without Alzheimer's disease and related dementias (ADRD) at baseline, from 1998-2016. ADRD and chronic condition were encoded using validated claims algorithms. We estimated the absolute contribution of eight conditions to ADRD with the longitudinal extension of the average attributable fraction (LE-AAF).
RESULTS: Hypertension, acute myocardial infarction, atrial fibrillation, diabetes, heart failure, ischemic heart disease, stroke, and arthritis additively accounted for 71.8% (95% confidence interval [CI]: 62.9%-79.1%) of ADRD incident cases based on LE-AAF.
DISCUSSION: Our findings suggest that multimorbidity plays a pivotal role in ADRD incidence. Targeting constituents of a cardiovascular path to dementia may contribute most to lowering dementia risk.
HIGHLIGHTS: Most dementia cases (71.8%) were attributable to eight chronic conditions. Hypertension was the largest contributor to dementia risk. Confidence intervals were smallest for constituents of a cardiovascular path to dementia. Longitudinal extension of the average attributable fractions (LE-AAFs) explicitly consider longitudinal patterns of comorbidities. Acute myocardial infarction did not contribute significantly to dementia incidence.
Research center :
Integrative Research Unit: Social and Individual Development (INSIDE) > PEARL Institute for Research on Socio-Economic Inequality (IRSEI)
Disciplines :
Public health, health care sciences & services Neurosciences & behavior Geriatrics
Author, co-author :
KLEE, Matthias ; University of Luxembourg > Faculty of Humanities, Education and Social Sciences > Department of Social Sciences > Team Anja LEIST
Markwardt, Sheila; OHSU-PSU School of Public Health, Oregon Health & Science University, Portland, Oregon, USA
Elman, Miriam R; OHSU-PSU School of Public Health, Oregon Health & Science University, Portland, Oregon, USA
Han, Ling; Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
LEIST, Anja ; University of Luxembourg > Faculty of Humanities, Education and Social Sciences (FHSE) > Department of Social Sciences (DSOC) > Socio-Economic Inequality
Allore, Heather ; Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA ; Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut, USA
Quiñones, Ana; OHSU-PSU School of Public Health, Oregon Health & Science University, Portland, Oregon, USA ; Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, USA
External co-authors :
yes
Language :
English
Title :
Examining multimorbidity contributors to dementia over time.
Publication date :
February 2025
Journal title :
Alzheimer's and Dementia: the Journal of the Alzheimer's Association
ISSN :
1552-5260
eISSN :
1552-5279
Publisher :
John Wiley and Sons Inc, United States
Volume :
21
Issue :
2
Pages :
e14589
Peer reviewed :
Peer Reviewed verified by ORBi
Development Goals :
3. Good health and well-being
European Projects :
H2020 - 803239 - CRISP - Cognitive Aging: From Educational Opportunities to Individual Risk Profiles
Funders :
European Union
Funding text :
Dr. Klee and Dr. Leist are funded by the European Research Council. This work was supported by the European Research Council (ERC) under the European Union's Horizon 2020 research and innovation programme (grant number 803239, to A.K.L.); by the National Institute on Aging at the National Institutes of Health (RF1AG058545 to A.R.Q.; R01AG047891 to H.G.A.; H.G.A. and L.H. both contributed from the Yale Claude D. Pepper Older Americans Independence Center P30AG021342; A.R.Q. and H.G.A., with support from R33AG057806; and H.G.A., with support from the Yale Alzheimer's Disease Research Center P30AG066508). The funders did not have any influence on the design of the study, data collection, analysis, interpretation of data, writing of the manuscript, or decision to submit this article for publication.
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