Midlife and Late-Life Population Attributable Fractions of Dementia Risk Factors in the United States: A Cohort Study from the Dementia Risk Pooling Project

Joanne M. Li, Abigail M. Gauen,Rachel Zmora,John Stephen,Sanaz Sedaghat,Denise Scholtens,Maxwell Mans olf,Norrina B. Allen

CIRCULATION（2024）

Cited 0|Views50

Abstract

Introduction: Dementia cases in the US are projected to nearly double from 5.3 million in 2019 to 10.5 million by 2050. Research has suggested that 41% of US dementia cases may be prevented by eliminating several specific modifiable risk factors. Still, few studies examine risk factor variation between midlife and late-life. Previous studies have also been limited by sample diversity and size. The Dementia Risk Pooling Project (DRPP) is a consortium of longitudinal cohorts including several underrepresented racial/ethnic groups pooled at the individual level. Methods: We estimated individual and combined population attributable fractions (PAF) for seven modifiable risk factors in midlife (aged 45-64) and late-life (aged 65+), using data from six US cohorts in DRPP. We also used potential impact fractions (PIF) to estimate dementia cases that could be prevented due to risk factor reduction in midlife and late-life based upon the National Alzheimer’s Advisory Council goal of a 15% reduction in dementia risk factors by 2030. Results: In a sample of 41,432 unique participants (ppts), risk factor exposure was measured in midlife for 29,983 ppts (60% female, 77% white) and in late-life for 30,633 ppts (56% female, 70% white). During follow-up, 4,186 midlife ppts and 4,893 late-life ppts developed dementia. We found that eliminating midlife risk factors could prevent a greater proportion of dementia cases [PAF 41.3%, 27.9%-54.6%] compared to late-life risk factors [23.1%, 12.4%-33.7%]. Midlife physical inactivity [18.8%, 15.1%-22.4%] appeared to be the greatest contributor. Late-life hypertension and depression appeared to contribute to 9.8% [5.5%-13.9%] and 4.2% [3.5%-5.0%] of cases, respectively. Given the US prevalence of dementia in 2020, we estimate that a 15% reduction in physical inactivity alone could prevent 148,339 dementia cases. Conclusion: The importance of modifiable risk factors for dementia may vary with age. These estimates could inform the timing of public health interventions for dementia prevention.

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【要点】：该研究通过Dementia Risk Pooling Project (DRPP)项目，评估了美国中晚年可改变痴呆风险因素的人群归因分数，发现消除中年风险因素可能比晚年更有效地预防痴呆病例。

【方法】：研究使用DRPP中六个美国队列的数据，估计了七个可改变风险因素在中年和晚年的个体和组合人口归因分数（PAF），并根据国家阿尔茨海默病咨询委员会2030年减少痴呆风险因素15%的目标，使用潜在影响分数（PIF）估计了风险因素减少可能预防的痴呆病例。

【实验】：在41,432名独特参与者中，对29,983名（60%女性，77%白人）进行了中年风险因素暴露测量，对30,633名（56%女性，70%白人）进行了晚年风险因素暴露测量。随访期间，4,186名中年和4,893名晚年参与者发展为痴呆。结果显示，消除中年风险因素可以预防更大比例的痴呆病例（PAF 41.3%，范围27.9%-54.6%），相比之下晚年风险因素预防的比例较低（23.1%，范围12.4%-33.7%）。中年身体不活动（18.8%，范围15.1%-22.4%）似乎是最大的贡献因素。晚年高血压和抑郁分别似乎贡献了9.8%（范围5.5%-13.9%）和4.2%（范围3.5%-5.0%）的病例。考虑到2020年美国痴呆的流行情况，估计仅减少身体不活动15%就能预防148,339例痴呆病例。