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Medientyp:
E-Artikel
Titel:
Estimating the potential for dementia prevention through modifiable risk factors elimination in the real-world setting: a population-based study
Beschreibung:
<jats:title>Abstract</jats:title><jats:sec>
<jats:title>Background</jats:title>
<jats:p>Preventing dementia onset is one of the global public health priorities: around 35% of dementia cases could be attributable to modifiable risk factors. These estimates relied on secondary data and did not consider the concurrent effect of non-modifiable factors and death.</jats:p>
<jats:p>Here, we aimed to estimate the potential reduction of dementia incidence due to modifiable risk factors elimination, controlling for non-modifiable risk factors and for the competing risk of death.</jats:p>
</jats:sec><jats:sec>
<jats:title>Methods</jats:title>
<jats:p>Participants from the InveCe.Ab population-based prospective cohort (Abbiategrasso, Italy) without a baseline dementia diagnosis and attending at least one follow-up visit were included (<jats:italic>N</jats:italic> = 1100). Participants underwent multidimensional assessment at baseline and after 2, 4, and 8 years, from November 2009 to January 2019.</jats:p>
<jats:p>Modifiable risk factors were low education, obesity, hypertension, diabetes, depression, smoking, physical inactivity, hearing loss, loneliness, heart disease, stroke, head injury, and delirium. Non-modifiable risk factors were age, sex, and APOE ε4 genotype. The primary endpoint was dementia diagnosis within the follow-up period (DSM-IV criteria). We performed competing risk regression models to obtain sub-hazard ratio (SHR) for each exposure, with death as competing risk. The exposures associated with dementia were included in a multivariable model to estimate their independent influence on dementia and the corresponding population attributable fraction (PAF).</jats:p>
</jats:sec><jats:sec>
<jats:title>Results</jats:title>
<jats:p>Within the study period (mean follow-up, 82.3 months), 111 participants developed dementia (10.1%). In the multivariable model, APOE ε4 (SHR = 1.89, 95% CI 1.22–2.92, <jats:italic>p</jats:italic> = 0.005), diabetes (SHR = 1.56, 95% CI 1.00–2.39, <jats:italic>p</jats:italic> = 0.043), heart disease (SHR = 1.56, 95% CI 1.03–2.36, <jats:italic>p</jats:italic> = 0.037), stroke (SHR = 2.31, 95% CI 1.35–3.95, <jats:italic>p</jats:italic> = 0.002), and delirium (SHR = 8.70, 95% CI 3.26–23.24, <jats:italic>p</jats:italic> < 0.001) were independently associated with increased dementia risk. In the present cohort, around 40% of dementia cases could be attributable to preventable comorbid diseases.</jats:p>
</jats:sec><jats:sec>
<jats:title>Conclusions</jats:title>
<jats:p>APOE ε4, diabetes, heart disease, stroke, and delirium independently increased the risk of late-life dementia, controlling for the competing risk of death. Preventive intervention addressed to these clinical populations could be an effective approach to reduce dementia incidence. Further studies on different population-based cohort are needed to obtain more generalizable findings of the potential of dementia prevention in the real-world setting.</jats:p>
</jats:sec><jats:sec>
<jats:title>Trial registration</jats:title>
<jats:p>ClinicalTrials.gov, <jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:href="https://clinicaltrials.gov/ct2/show/NCT01345110">NCT01345110</jats:ext-link>.</jats:p>
</jats:sec>