The association of vascular disorders with incident dementia in different age groups

Nienke Legdeur, Sven J. Van Der Lee, Marcel De Wilde, Johan Van Der Lei, Majon Muller, Andrea B. Maier, Pieter Jelle Visser

Research output: Contribution to JournalArticleAcademicpeer-review

Abstract

BACKGROUND: There is increasing evidence that dementia risk associated with vascular disorders is age dependent. Large population-based studies of incident dementia are necessary to further elucidate this effect. Therefore, the aim of the present study was to determine the association of vascular disorders with incident dementia in different age groups in a large primary care database.

METHODS: We included 442,428 individuals without dementia aged ≥ 65 years from the longitudinal primary care Integrated Primary Care Information (IPCI) database. We determined in 6 age groups (from 65-70 to ≥ 90 years) the risk of hypertension, diabetes mellitus, dyslipidemia, stroke, myocardial infarction, heart failure, and atrial fibrillation for all-cause dementia using incidence rate ratios, Cox regression, and Fine and Gray regression models.

RESULTS: The mean age at inclusion of the total study sample was 72.4 years, 45.7% of the participants were male, and median follow-up was 3.6 years. During 1.4 million person-years of follow-up, 13,511 individuals were diagnosed with dementia. The risk for dementia decreased with increasing age for all risk factors and was no longer significant in individuals aged ≥ 90 years. Adjusting for mortality as a competing risk did not change the results.

CONCLUSIONS: We conclude that vascular disorders are no longer a risk factor for dementia at high age. Possible explanations include selective survival of individuals who are less susceptible to the negative consequences of vascular disorders and differences in follow-up time between individuals with and without a vascular disorder. Future research should focus on the identification of other risk factors than vascular disorders, for example, genetic or inflammatory processes, that can potentially explain the strong age-related increase in dementia risk.

Original languageEnglish
Article number47
Pages (from-to)1-8
Number of pages8
JournalAlzheimer's Research & Therapy
Volume11
DOIs
Publication statusPublished - 17 May 2019

Fingerprint

Blood Vessels
Dementia
Age Groups
Primary Health Care
Databases
Inborn Genetic Diseases
Dyslipidemias
Atrial Fibrillation
Diabetes Mellitus
Heart Failure
Stroke
Myocardial Infarction
Hypertension
Survival
Mortality
Incidence
Population

Keywords

  • Aging
  • Cardiovascular risk factors
  • Dementia
  • Primary care
  • Vascular disease
  • Vascular disorders

Cite this

Legdeur, N., Van Der Lee, S. J., De Wilde, M., Van Der Lei, J., Muller, M., Maier, A. B., & Visser, P. J. (2019). The association of vascular disorders with incident dementia in different age groups. Alzheimer's Research & Therapy, 11, 1-8. [47]. https://doi.org/10.1186/s13195-019-0496-x
Legdeur, Nienke ; Van Der Lee, Sven J. ; De Wilde, Marcel ; Van Der Lei, Johan ; Muller, Majon ; Maier, Andrea B. ; Visser, Pieter Jelle. / The association of vascular disorders with incident dementia in different age groups. In: Alzheimer's Research & Therapy. 2019 ; Vol. 11. pp. 1-8.
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abstract = "BACKGROUND: There is increasing evidence that dementia risk associated with vascular disorders is age dependent. Large population-based studies of incident dementia are necessary to further elucidate this effect. Therefore, the aim of the present study was to determine the association of vascular disorders with incident dementia in different age groups in a large primary care database.METHODS: We included 442,428 individuals without dementia aged ≥ 65 years from the longitudinal primary care Integrated Primary Care Information (IPCI) database. We determined in 6 age groups (from 65-70 to ≥ 90 years) the risk of hypertension, diabetes mellitus, dyslipidemia, stroke, myocardial infarction, heart failure, and atrial fibrillation for all-cause dementia using incidence rate ratios, Cox regression, and Fine and Gray regression models.RESULTS: The mean age at inclusion of the total study sample was 72.4 years, 45.7{\%} of the participants were male, and median follow-up was 3.6 years. During 1.4 million person-years of follow-up, 13,511 individuals were diagnosed with dementia. The risk for dementia decreased with increasing age for all risk factors and was no longer significant in individuals aged ≥ 90 years. Adjusting for mortality as a competing risk did not change the results.CONCLUSIONS: We conclude that vascular disorders are no longer a risk factor for dementia at high age. Possible explanations include selective survival of individuals who are less susceptible to the negative consequences of vascular disorders and differences in follow-up time between individuals with and without a vascular disorder. Future research should focus on the identification of other risk factors than vascular disorders, for example, genetic or inflammatory processes, that can potentially explain the strong age-related increase in dementia risk.",
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Legdeur, N, Van Der Lee, SJ, De Wilde, M, Van Der Lei, J, Muller, M, Maier, AB & Visser, PJ 2019, 'The association of vascular disorders with incident dementia in different age groups' Alzheimer's Research & Therapy, vol. 11, 47, pp. 1-8. https://doi.org/10.1186/s13195-019-0496-x

The association of vascular disorders with incident dementia in different age groups. / Legdeur, Nienke; Van Der Lee, Sven J.; De Wilde, Marcel; Van Der Lei, Johan; Muller, Majon; Maier, Andrea B.; Visser, Pieter Jelle.

In: Alzheimer's Research & Therapy, Vol. 11, 47, 17.05.2019, p. 1-8.

Research output: Contribution to JournalArticleAcademicpeer-review

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T1 - The association of vascular disorders with incident dementia in different age groups

AU - Legdeur, Nienke

AU - Van Der Lee, Sven J.

AU - De Wilde, Marcel

AU - Van Der Lei, Johan

AU - Muller, Majon

AU - Maier, Andrea B.

AU - Visser, Pieter Jelle

PY - 2019/5/17

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N2 - BACKGROUND: There is increasing evidence that dementia risk associated with vascular disorders is age dependent. Large population-based studies of incident dementia are necessary to further elucidate this effect. Therefore, the aim of the present study was to determine the association of vascular disorders with incident dementia in different age groups in a large primary care database.METHODS: We included 442,428 individuals without dementia aged ≥ 65 years from the longitudinal primary care Integrated Primary Care Information (IPCI) database. We determined in 6 age groups (from 65-70 to ≥ 90 years) the risk of hypertension, diabetes mellitus, dyslipidemia, stroke, myocardial infarction, heart failure, and atrial fibrillation for all-cause dementia using incidence rate ratios, Cox regression, and Fine and Gray regression models.RESULTS: The mean age at inclusion of the total study sample was 72.4 years, 45.7% of the participants were male, and median follow-up was 3.6 years. During 1.4 million person-years of follow-up, 13,511 individuals were diagnosed with dementia. The risk for dementia decreased with increasing age for all risk factors and was no longer significant in individuals aged ≥ 90 years. Adjusting for mortality as a competing risk did not change the results.CONCLUSIONS: We conclude that vascular disorders are no longer a risk factor for dementia at high age. Possible explanations include selective survival of individuals who are less susceptible to the negative consequences of vascular disorders and differences in follow-up time between individuals with and without a vascular disorder. Future research should focus on the identification of other risk factors than vascular disorders, for example, genetic or inflammatory processes, that can potentially explain the strong age-related increase in dementia risk.

AB - BACKGROUND: There is increasing evidence that dementia risk associated with vascular disorders is age dependent. Large population-based studies of incident dementia are necessary to further elucidate this effect. Therefore, the aim of the present study was to determine the association of vascular disorders with incident dementia in different age groups in a large primary care database.METHODS: We included 442,428 individuals without dementia aged ≥ 65 years from the longitudinal primary care Integrated Primary Care Information (IPCI) database. We determined in 6 age groups (from 65-70 to ≥ 90 years) the risk of hypertension, diabetes mellitus, dyslipidemia, stroke, myocardial infarction, heart failure, and atrial fibrillation for all-cause dementia using incidence rate ratios, Cox regression, and Fine and Gray regression models.RESULTS: The mean age at inclusion of the total study sample was 72.4 years, 45.7% of the participants were male, and median follow-up was 3.6 years. During 1.4 million person-years of follow-up, 13,511 individuals were diagnosed with dementia. The risk for dementia decreased with increasing age for all risk factors and was no longer significant in individuals aged ≥ 90 years. Adjusting for mortality as a competing risk did not change the results.CONCLUSIONS: We conclude that vascular disorders are no longer a risk factor for dementia at high age. Possible explanations include selective survival of individuals who are less susceptible to the negative consequences of vascular disorders and differences in follow-up time between individuals with and without a vascular disorder. Future research should focus on the identification of other risk factors than vascular disorders, for example, genetic or inflammatory processes, that can potentially explain the strong age-related increase in dementia risk.

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