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Can Dementia Be Predicted 20 Years in Advance?

Researchers aimed to develop a simple method to predict risk for late-life dementia in middle-aged people.

To develop a model for predicting middle-aged people’s risk for dementia in older age, researchers tracked 1409 participants in the Cardiovascular Risk Factors, Aging, and Dementia (CAIDE) study who were recruited in the 1970s and 1980s. CAIDE participants came from four separate population samples. They completed a baseline questionnaire about health, medical history, and health behaviors. During a mean follow-up of 21 years, dementia was diagnosed via a 3-step cognitive assessment. The authors used logistic-regression analysis to determine the dementia risk score (range, 0–15).

Sixty-one participants (4%) were diagnosed with dementia during follow-up. Dementia was predicted by higher baseline age ( 47 years), low education (<10 years), hypertension, hypercholesterolemia, and obesity. Risk for dementia by predictor score was:

• 0 to 5, 1%;
  
• 6 to 7, 1.9%;
  
• 8 to 9, 4.2%;
  
• 10 to 11, 7.4%; and
  
• 12 to 15, 16.4%.
  

With a cut-off of 9 points or more, the sensitivity was 0.77, specificity 0.63, and negative predictive value 0.98. The authors conclude that this dementia risk score highlights the role of vascular factors in dementia and that this novel approach can aid in the prediction of later-life dementia risk.

Comment: Many clinicians emphasize reductions of stroke and coronary heart disease risks as the main benefits of cardiovascular risk-factor control. This study points out the possibility of predicting later-life dementia risk based on a patient’s midlife vascular risk-factor profile. Whether this predictor equation, derived from observational epidemiologic data, would translate to prevention of later-life dementia if modifiable vascular risk factors were controlled is uncertain. Validation of the predictor equation is needed, as are long-term clinical trials to determine whether control of modifiable vascular risk factors earlier in life can improve later-life cognitive outcome.

— Philip B. Gorelick, MD, MPH

Dr. Gorelick is John S. Garvin Professor and Head, Department of Neurology and Rehabilitation, University of Illinois College of Medicine at Chicago.

Published in Journal Watch Neurology October 31, 2006

Citation(s):

Kivipelto M et al. Risk score for the prediction of dementia risk in 20 years among middle aged people: A longitudinal, population-based study. Lancet Neurol 2006 Sep; 5:735-41.

• Medline abstract (Free)

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