Forskningsartikler

Abstarct

Objective: To evaluate and compare the predictive value of eight dementia risk scores for late-life cognitive function and cognitive decline; ANU-ADRI, CAIDE, CogDrisk, LIBRA, LIBRA2, UKBDRS(-APOE), and a Lancet commission-based risk score.

Methods: Using Norwegian Trøndelag Health Study (HUNT) data, we calculated risk scores from lifestyle and health data of 7221 dementia-free participants (mean age: 76.8 years, 54.1% female) collected in HUNT3 (2006–2008). Cognitive function was assessed using the Montreal Cognitive Assessment scale (MoCA) 11 years later in HUNT4 70+, and reassessed in 4716 participants 4 years thereafter. Associations between continuous risk scores or risk score tertiles, cognition and cognitive decline were examined using linear mixed-effects models. Logistic regression models were used to test associations between risk scores and a ≥ 3-point decline in MoCA scores.

Results: All risk scores were significantly associated with cognitive function and cognitive decline. Associations with cognitive function ranged from UKBDRS β per 1SD=-1.61(95%CI:-1.72,-1.51) to CAIDE (β=-0.74;95%CI:-0.82,-0.67), and with yearly cognitive decline from Lancet (β=-0.23;95%CI:-0.27,-0.18) to CAIDE (β=-0.04;95%CI:-0.07,-0.02). High-low risk group differences in cognitive function were largest for CogDrisk (β=-3.04;95%CI:-3.27,-2.81), LIBRA (β=-3.04;95%CI:-3.27,-2.80) and lowest for CAIDE (β=-1.65;95%CI:-1.86,-1.44). High-risk groups showed the steepest decline for UKBDRS-APOE (β=-0.43;95%CI:-0.52,-0.34), Lancet (β=-0.39;95%CI:-0.48,-0.30), and LIBRA (β=-0.38;95%CI:-0.47,-0.28). All scores predicted ≥3-point decline modestly: AUCs were highest for UKBDRS (AUC=0.61;95%CI:0.60,0.63), UKBDRS-APOE (0.61;95%CI:0.60,0.63), CogDrisk (0.60;95%CI:0.58,0.62), and Lancet (0.60;95%CI:0.58,0.61), but none outperformed a model including age and education alone (0.61;95%CI:0.60,0.63).

Conclusion: Risk scores captured meaningful gradients in cognition and decline but offered limited discriminatory accuracy beyond demographics, supporting their use for prevention-oriented risk profiling rather than prediction.

Josephine Stuebs, Geir Selbæk, Bjørn Heine Strand, Gill Livingston, Kaarin J. Anstey, Kay Deckers, Mika Kivimäki, Steinar Krokstad, Fiona E. Mathews & Ellen Melbye Langballe

Abstract

Objectives: We explored the relationship between the number of children and cognitive outcomes in later life in a large cohort of older females and males from Norway.

Design: Cross-sectional analysis using multinomial logistic regression.

Settings: The Norwegian HUNT4 70+ Study.

Participants: Males and females aged ≥70 years.

Measurments: The exposure was the number of biological children (none, one, two, three, or four or more). The primary outcome was categorized as dementia, mild cognitive impairment (MCI), or no cognitive impairment.

Results: Among 9263 participants (mean age 78 years; 54 % females), those without children had higher risk of dementia (relative risk ratio [RRR] 1.82, 95 % confidence interval [CI] 1.37 to 2.42) and MCI (RRR 1.31, 95 % CI 1.08 to 1.59) compared to those who had two children, adjusting for age and sex. Similar pattern was observed for those with one child, whereas those with three children did not have an increased MCI or dementia risk. Having four or more children was marginally associated with higher dementia risk (RRR 1.22, 95 % CI 1.00–1.49), but not with MCI risk. This association was attenuated after adjusting for education and marital status, whereas those without children and with one child had still higher risk. In sex-stratified analysis, having no children was associated with higher risk of dementia only in males.

Conclusions: The weak association with high parity, along with the increased dementia risk observed in males without children, contrasts with previous findings. Our results highlight the need for further investigation

K Wolfova, B H Strand, J Weiss, P Brennan Kearns, T Mekonnen, Y Stern 6, H-P Kohler, V F Skirbekk, S E Tom

Abstract

Background: Cardiovascular disease (CVD) risk factors are associated with the risk of cognitive decline and dementia. Composite CVD risk scores integrate multiple risk factors and may capture the cumulative burden of CVD risk relevant to cognitive outcomes. However, the long-term association between established CVD risk scores and subsequent dementia and mild cognitive impairment (MCI), and potential differences in these associations between males and females, remains insufficiently studied. This study examined the association between NORRISK 2, a CVD risk model estimating 10-year risk of fatal- and non-fatal CVD, and the presence of dementia and mild cognitive impairment (MCI) in males and females, after 22 years of follow-up.

Methods: Participants from The Trøndelag Health Study (HUNT), a longitudinal, population-based health study, were included. NORRISK 2 scores were based on data from HUNT2 (1995-1997). Cognitive status was assessed in the sub-study HUNT4 70+ (2017–2019) and categorized as cognitively unimpaired (CU), MCI, or dementia. We used multinomial logistic regression with NORRISK 2 as the predictor and cognitive status 22 years later as the main covariate.

Results: The study sample consisted of 6,971 participants (57.6% females, mean age at HUNT2 56.1 years). At HUNT4 70+, 14.0% of the participants had developed dementia, and 34.6% had developed MCI. Per one percent increase in NORRISK 2 score, the relative risk of developing dementia increased by 14% for males (relative risk ratio (RRR) = 1.14; 95% CI 1.12–1.17) and 28% for females (RRR = 1.28; 95% CI 1.25–1.31). The relative risk of developing MCI increased by 4% for men (RRR = 1.04; 95% CI 1.02–1.05) and 10% for women (RRR = 1.10; 95% CI 1.08–1.12).

Conclusion: A higher NORRISK 2 score was associated with an increased risk of dementia and MCI in both males and females, with the strongest associations observed in females.

Silje Kleven, Linda Ernstsen, Marte Kvello-Alme, Stian Lydersen, Geir Selbæk, Rannveig Sakshaug Eldholm