Fast track — ArticlesRisk score for the prediction of dementia risk in 20 years among middle aged people: a longitudinal, population-based study
Introduction
The occurrence of dementia is rising substantially worldwide.1, 2, 3 No curative treatment is available and extensive efforts for the prevention of dementia are needed. Identification of individuals at increased risk of dementia would allow more efficient targeting of available preventive measures than currently possible.
Risk scores have been developed to predict the risk of cardiovascular events, diabetes, and mortality.4, 5, 6, 7, 8, 9, 10, 11 Risk scores have generally included only a few known risk factors that are easily measurable to calculate the subsequent risk of an event or disease within a given time frame. Although the absolute risk of an event might differ across populations, risk ranking by use of risk scores is consistent.12, 13, 14, 15 The main use of risk scores is for targeting of preventive measures to those most at risk of the disease.16 Another important benefit is that they can be used to distribute easily understandable information about risk factors to the general population.
Dementia shares many risk factors with cardiovascular diseases, including hypertension, hypercholesterolaemia, obesity, and diabetes.17, 18, 19, 20, 21, 22 Risk scores have not yet been developed to predict the risk of dementia. The aim of this study was to develop a model for a simple technique to predict the late risk of dementia on the basis of risk factor profiles present in middle age using data from the population-based Cardiovascular Risk Factors, Aging, and Dementia (CAIDE) study.23
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Participants
The participants of the CAIDE study were derived from four separate and independent population-based random samples examined within the framework of the North Karelia Project and the FINMONICA study in 1972, 1977, 1982, or 1987.24, 25, 26 Participation rates of these surveys ranged from 82% to 90%. Those individuals still alive who were aged 65–79 years at the end of 1997 and who were living in two geographically defined areas in or close to the towns of Kuopio and Joensuu in eastern Finland
Results
Of the 1409 participants of the CAIDE study, 875 (62%) were women and 534 (38%) were men. They were aged from 39 years to 64 years at the midlife examination with a mean age of 50·4 (SD 6·0) years, and from 65 years to 80 years at the late-life examination with a mean age of 71·3 (4·0) years. Mean follow-up was 20·9 years (4·9). 4% of participants were diagnosed with dementia. Participants with dementia were older, less educated, and more commonly had vascular risk factors present at midlife
Discussion
Several modifiable and non-modifiable risk factors for dementia are known today. Our study shows that the dementia risk score created with the risk factors present at midlife predicts the future risk of dementia well. However, the dementia risk score needs to be further validated in another population. Eventually more variables could be added to the dementia risk score to improve its predictivity.
The AUCs for both the models used in our analyses were similar. The AUC values were between 0·70
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