Age and Ageing Advance Access originally published online on June 24, 2009
Age and Ageing 2009 38(5):521-527; doi:10.1093/ageing/afp094
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Sociodemographic and lifestyle risk factors for incident dementia and cognitive decline in the HYVET*
1 Care of the Elderly, Faculty of Medicine, Exhibition Road, Imperial College London, W12 0NN, UK
2 Clinic of Rheumatology, University Hospital, 15A Vassil Aprilov Blvd, 4002 Plovdiv, Bulgaria
3 Multiprofile Hospital for Active Treatment 8, Georgi Kochev blvd, 5800 Pleven, Bulgaria
4 Department of Cardiology, Shandong Academy of Medical Science, Jing Shi Road, Jinan, 250062 China
5 Department of Medicine for the Elderly, Brighton General Hospital, Elm Grove, Brighton BN2 3EW, UK
6 The Royal College of Physicians and Surgeons of Glasgow, 232-242 St. Vincent Street, Glasgow G2 5RJ, UK
7 Directeur de l’unite INSERM U 606, Bone and Joints, Hospital Lariboisiere-Paris, France
8 Department of Epidemiology & Population Heath, London School of Hygiene and Tropical Medicine, Keppel Street London, WC1E 7HT, UK
Address correspondence to: R. Peters. Tel: (+44) 20 83833959; Fax: (+44) 20 83833378. Email: r.peters@imperial.ac.uk
Introduction: previous studies have suggested that smoking, living alone and having a high body mass index may increase risk of developing dementia whereas a normal body mass index, having received education and moderate alcohol consumption may decrease risk. Dementia risk also increases with age and is thought to be higher in hypertensives.
Method: we used data collected in the Hypertension in the Very Elderly Trial (HYVET), and cognitive function was assessed using the Mini-Mental State Examination (MMSE) at baseline and annually. Participants with a fall in MMSE to <24 or with a fall of 3 points in any 1 year were investigated further. The association of baseline sociodemographic, medical and lifestyle factors with incident dementia or decline in MMSE scores was assessed by regression models.
Results: incident dementia occurred in 263 of 3,336 participants over a mean follow-up of 2 years. In multivariate analyses, being underweight, BMI < 18.5 (HR 1.90, 95% CI 1.06–3.39) or obese, BMI >30 (HR 1.84, 95% CI 1.24–2.72), increased risk of incident dementia as did piracetam use (HR 2.72, 95% CI 1.60–4.63). Receiving formal education was associated with a reduced risk (HR 0.59, 95% CI 0.45–0.78). There was no association with smoking, alcohol and gender. Similar results were found when examining mean annual change in the MMSE score.
Discussion: our results for BMI and education agree with those from other studies. The increased risk associated with piracetam may reflect awareness of memory problems before any diagnosis of dementia has been made. Trial participants may be healthier than the general population and further studies in the general population are required.
Keywords: dementia, cognitive decline, sociodemographic, predictor, elderly
* The co-ordinating centre for the trial was part of the Care of the Elderly department in the Faculty of Medicine Imperial College London UK
Received 24 October 2008; accepted in revised form 24 March 2009.