Midlife Health Research Articles

Exploring the relationships between adolescent alcohol misuse and later life health outcomes.

We sought to clarify the impact of adolescent alcohol misuse on adult physical health and subjective well-being. To do so, we investigated both the direct associations between adolescent alcohol misuse and early midlife physical health and life satisfaction and the indirect effects on these outcomes attributable to subsequent alcohol problems. The sample included 2733 twin pairs (32% monozygotic; 52% female) from the FinnTwin16 study. Adolescent alcohol misuse was a composite of frequency of drunkenness, frequency of alcohol use, and alcohol problems at ages 16, 17, and 18.5. The early midlife outcomes included somatic symptoms, self-rated health, and life satisfaction at age 34. The mediators examined as part of the indirect effect analyses included alcohol problems from the Rutgers Alcohol Problem Index at ages 24 and 34. Serial mediation and co-twin comparison models were applied and included covariates from adolescence and early midlife. There were weak direct associations between adolescent alcohol misuse and early midlife physical health and life satisfaction. However, there was stronger evidence for indirect effects, whereby young adult and early midlife alcohol problems serially mediated the relationship between adolescent alcohol misuse and early midlife somatic symptoms (β=0.03, 95% CI [0.03, 0.04]), self-rated health (β=-0.02, 95% CI [-0.03, -0.01]), and life satisfaction (β=-0.03, CI [-0.04, -0.02]). These serial mediation effects were robust in co-twin comparison analyses. These results provide evidence that alcohol problems are a primary driver linking adolescent alcohol misuse and poor health outcomes across the lifespan.

Is childhood oral health the 'canary in the coal mine' for poor adult general health? Findings from two New Zealand birth cohort studies.

This study aimed to investigate whether childhood dental caries was associated with self-reported general health in midlife. We used data on childhood oral health (caries experience) and adult self-reported general health from two New Zealand longitudinal birth cohorts, the Dunedin Multidisciplinary Health and Development Study (n=922 and n=931 at ages 5 and 45 years, respectively), and the Christchurch Health and Development Study (n=1048 and n=904 at ages 5 and 40 years, respectively). We used generalized estimating equations to examine associations between age-5 dental caries and self-rated general health and the number of self-reported physical health conditions at ages 45/40 (diagnosed by a doctor or health professional, n=14 conditions among both cohorts). Covariates included known risk factors for poor health (SES, IQ, perinatal complications), and personality style, which is known to affect subjective health ratings. Incidence rate ratios for 'Excellent' self-rated health were lower among those who had high experience of dental caries as children than those who had not in both, the Dunedin (IRR, 0.76; 95% CI, 0.50, 1.14) and Christchurch studies (IRR, 0.69; 95% CI, 0.47, 1.00). Childhood dental caries was not associated with the number of self-reported physical health conditions in midlife, in either cohort. Dunedin Study members who at age 5 were not caries-free or whose parents rated their own or their child's oral health as poor were less likely to report 'Excellent' self-rated general health at age 45 than those who were caries-free and whose parents did not give a 'poor' rating (IRR, 0.69; 95% CI, 0.49, 0.97). Five-year-olds with greater caries experience were more likely to have poorer self-rated general health by midlife. Beyond this longitudinal association, future research should examine whether childhood dental caries is associated with objective/biological markers of physical health and whether it may have utility as an early indicator for poor general health in adulthood.

Elevated blood pressure is associated with advanced brain aging in mid-life: A 30-year follow-up of The CARDIA Study.

High blood pressure (BP) is a risk factor for late-life brain health; however, the association of elevated BP with brain health in mid-life is unclear. We identified 661 participants from the Coronary Artery Risk Development in Young Adults Study (age 18-30 at baseline) with 30 years of follow-up and brain magnetic resonance imaging at year 30. Cumulative exposure of BP was estimated by time-weighted averages (TWA). Ideal cardiovascular health was defined as systolic BP<120mm Hg, diastolic BP<80mm Hg. Brain age was calculated using previously validated high dimensional machine learning pattern analyses. Every 5mmHg increment in TWA systolic BP was associated with approximately 1-year greater brain age (95% confidence interval [CI]: 0.50-1.36) Participants with TWA systolic or diastolic BP over the recommended guidelines for ideal cardiovascular health, had on average 3-year greater brain age (95% CI: 1.00-4.67; 95% CI: 1.45-5.13, respectively). Elevated BP from early to mid adulthood, even below clinical cut-offs, is associated with advanced brain aging in mid-life.

0631 Actigraphy-based and self-reported sleep quality and cognitive function in midlife

Abstract Introduction Growing evidence suggests that sleep disturbance might be a risk factor for cognitive impairment in older adults. However, the association between device-based sleep duration, quality and cognitive function in midlife is poorly understood. Methods We examined 526 Black and White men and women who completed the sleep examination at baseline from 2003 to 2005 and had cognition evaluated 11 years later from the Coronary Artery Risk Development in Young Adults (CARDIA) study, Sleep duration and quality was assessed objectively using a wrist activity monitor and subjectively by Pittsburgh Sleep Quality Index (PSQI). We evaluated cognitive function using the Digit Symbol Substitution Test (DSST), Stroop test, Rey Auditory Verbal Learning Test (RAVLT), Montreal Cognitive Assessment (MoCA) and Letter Fluency and Category Fluency tests. Results This study included 305 (58%) women and 229 (44%) Black people, with a mean age of 40.1±3.6 years at baseline. After adjustment for age, sex, race, education, smoking, body mass index, depression, physical activity, hypertension and diabetes, actigraphy-measured sleep fragmentation index (calculated as the sum of the percentage of time spent moving and the percentage of immobile periods ≤ 1 minute) was significantly associated with all measures of cognition, except for fluency. Every standard deviation increase in sleep fragmentation index was associated with worse executive function [DSST (b=-1.80, 95%CI: -3.20, -0.41) and Stroop (b=-1.23, -0.25, -2.21)], worse verbal learning [RAVLT (b=-0.41, 95%CI: -0.66, -0.82)] and worse global cognition [MOCA (b=-0.41, 95%CI: -0.74, -0.16)]. Poorer sleep maintenance was associated with worse verbal learning (RAVLT) and global cognition (MOCA) of a similar magnitude. We did not find any association between objective sleep duration or subjective sleep quality and cognition. Conclusion Poorer actigraphy-measured sleep quality rather than sleep duration was associated with worse executive function, verbal learning and global cognition among middle-aged Black and White men and women. Sleep quality is important for cognitive health in midlife. Support (If Any)

The Life Course of Unemployment and Midlife Health.

Objectives: We estimate associations between unemployment trajectories from ages 27-49 and physical and mental health at age 50. Methods: Data are from the U.S. National Longitudinal Survey of Youth, 1979 (N=6434). Group-based trajectory models are used to identify unemployment trajectories. Generalized linear models with a modified Bolck, Croon, and Hagenaars (BCH) correction are used to regress health on unemployment trajectory groups. Results: We identified "Consistently Low (70%)," "Decreasing Mid-Career (18%)," and "Persistently High (12%)" unemployment trajectories. Experiencing Decreasing Mid-Career or Persistently High trajectories was associated with worse physical and mental health at age 50 than Consistently Low trajectories. Experiencing a Persistently High trajectory was associated with worse physical and mental health than a Decreasing Mid-Career trajectory. Discussion: Timing and likelihood of unemployment are associated with midlife health. Mid-Career unemployment is associated with worse physical and mental health at age 50, but not to the same degree as Persistently High unemployment.

NAMS 2021 Utian Translational Science SymposiumSeptember 2021, Washington, DCCharting the path to health in midlife and beyond: the biology and practice of wellness.

Charting the Path to Health in Midlife and Beyond: The Biology and Practice of Wellness was a Translational Science Symposium held on Tuesday, September 21, 2021. Foundational psychosocial and behavioral approaches to promote healthy aging and strategies to disseminate this information were discussed. The following synopsis documents the conversation, describes the state of the science, and outlines a path forward for clinical practice. Wellness, in its broadest sense, prioritizes an orientation toward health, and an embrace of behaviors that will promote it. It involves a journey to improve and maintain physical and mental health and overall well-being to fully engage and live one's best life. It is more about recognizing and optimizing what one can do than what one cannot do and emphasizes the individual's agency over changing what they are able to change. Wellness is therefore not a passive state but rather an active goal to be sought continually. When viewed in this fashion, wellness is accessible to all. The conference addressed multiple aspects of wellness and embraced this philosophy throughout.

Life's Simple 7 at Midlife and Risk of Recurrent Cardiovascular Disease and Mortality after Stroke: The ARIC study

BackgroundStroke is a leading cause of morbidity and mortality among adults in the U.S. Ideal levels of the Life's Simple 7 (LS7) are associated with lower cardiovascular disease (CVD) and all-cause mortality. However, the association of LS7 with CVD, recurrent stroke, and all-cause mortality after incident stroke is unknown. MethodsWe used data from the ARIC study, a cohort of 13,508 adults from four US communities, 45–64 years old at baseline (1987–1989). Cardiovascular hospitalizations and mortality were ascertained in follow-up through December 31st, 2017. We defined cardiovascular health (CVH) based on AHA definitions for LS7 (range 0-14) and categorized CVH into four levels: LS7 0-3, 4-6, 7-9, and ≥10 (ideal LS7), according to prior studies. Outcomes included incident stroke, CVD, recurrent stroke, all-cause mortality, and a composite outcome including all the above. Adjusted hazard ratios (95% CI) were estimated with Cox proportional hazards regression models. ResultsMedian (25%-75%) follow-up for incident stroke was 28 (18.6-29.2) years. Participants with incident stroke were 55.7 (SD 5.6) years-old at baseline, 53% were women and 35% Black. Individuals with LS7 score ≥10 had 65% lower risk (HR: 0.35; 95% CI: 0.29-0.41) of incident stroke than those with LS7 4-6 (reference group). Of 1,218 participants with incident stroke, 41.2% (n=502) had composite CVD and 68.3% (n=832) died during a median (25%-75%) follow-up of 4.0 (0.76-9.95) years. Adjusted HR (95% CI) for stroke survivors with LS7≥10 at baseline were 0.74 (0.58-0.94) for the composite outcome, 0.38(0.17-0.85) for myocardial infarction, 0.60 (0.40-0.90) for heart failure, 0.63 (0.48-0.84) for all-cause mortality, and 0.65 (0.39-1.08) for recurrent stroke. ConclusionsGood and excellent midlife cardiovascular health are associated with lower risks of incident stroke and CVD after stroke. Clinicians should stress the importance of a healthy lifestyle for primary and secondary CVD prevention.

Educational attainment in young adulthood and self-rated health in midlife – Does allostatic load mediate the association?

This study aimed to examine the extent to which allostatic load (AL), measured in midlife, mediates the association between educational attainment in young adulthood and self-rated health (SRH) in midlife among women and men. The study used data from the Copenhagen Aging and Midlife Biobank (CAMB; n = 5467 participants, aged 48–62 years, 31.5% women). Educational attainment was assessed as years of education. SRH was assessed with one item: ‘In general, how would you say your health is?’ with response options from “excellent” to “poor”. AL mediated 31.7% and 19.7% of the association between educational attainment and SRH in women and men, respectively. We observed that higher educational attainment was associated with better SRH and lower AL in both women and men. Our study showed that AL partly mediates the association between educational attainment in young adulthood and SRH in adulthood among both men and women. This study indicates that educational attainment in young adulthood affects health throughout life. Such knowledge of a potential mediator may be important in breaking the social heritage.

Abstract MP41: Associations Of Neighborhood Food And Physical Activity Environments In Young Adulthood With Cardiovascular Health (CVH) In Midlife: The Coronary Artery Risk Development In Young Adults (CARDIA) Study

Background: Adults who maintain high CVH profiles up to midlife have lower risk of several chronic diseases and better quality of life. However, the relationship between the access to different neighborhood resources in young adulthood and the maintenance of CVH into midlife remain understudied. Methods: We used data from 2,317 CARDIA participants. Measures of the neighborhood food and physical activity environment (Table) were linked to participant addresses collected at the baseline exam (1985-1986), when participants were 18-30 years old. CVH was measured at baseline and the year 30 follow-up exam. We examined associations of neighborhood food and physical activity environments with year 30 CVH scores (moderate vs. high and low vs. high) using multinomial logistic regression. Individual- and neighborhood-level covariates (Table) were adjusted for sequentially. Results: At baseline, 31% of participants had high and 5% had low CVH scores, respectively, whereas 11% had high and 34% had low CVH scores 30 years later. At year 30, compared to those with low CVH scores, participants with high CVH scores had better baseline neighborhood conditions (e.g., mean distance to nearest major park 4767m vs. 7043m, mean count of community and public physical activity facilities 50.70 vs. 43.57, mean percentage of food outlets that are supermarkets 0.75% vs. 0.44%) and were more likely to be female (70.99% vs. 59.21%) and White (86.64% vs. 39.14%). In adjusted models, participants who lived in neighborhoods with a higher percentage of supermarkets and more community and public physical activity facilities were less likely to have low CVH scores compared to high CVH scores (Table). Participants who lived in neighborhoods with a higher percentage of convenience stores and further from a major park were more likely to have low vs. high CVH scores. Conclusion: Improving access to physical activity and healthy food resources in young adulthood may have significant implications in longevity and quality of life in midlife.

Effects of weight misperception on the association between BMI and self-rated health in midlife and elderly Koreans

ObjectivesThis study aimed to find whether weight misperception affected the relationship between measured body mass index (BMI) and self-rated health (SRH) in middle-aged and senior Koreans. MethodsA cross-sectional study was conducted in 8397 men and 11,211 women aged 40–80 years from the 2014–2018 Korea National Health and Nutrition Examination Survey using gender and age group (40–59 years and 60–80 years) specific moderation analysis and ordinal regression analysis of complex sampling design. BMI and weight misperception were the predictor and moderator, respectively. Outcome measure was SRH graded on very good to very poor scale. ResultsIn the group with accurate body weight estimation, the odds ratio of poorer SRH was greater in underweight or obese men and women aged 40–59 years and women aged 60–80 years compared to normal weight. However, in men aged 60–80 years who accurately estimated their weight, the odds ratio was higher in the underweight group but not in obese group. In the group that overestimated body weight, the odds ratio increased as the BMI category increased. In the group underestimating body weight, the odds ratio decreased in overweight or obese group than in the normal weight group. ConclusionsWeight misperception in middle-aged and older Korean men and women altered the relationship between BMI category and poorer SRH. Individuals who accurately estimated themselves as underweight regardless of gender or age and those who correctly identified themselves as obese in their middle years were the most likely to have poorer SRH.

Associations Between Midlife Functional Limitations and Self-Reported Health and Cognitive Status: Results from the 1998-2016 Health and Retirement Study.

Life-course approaches to identify and help improve modifiable risk factors, particularly in midlife, may mitigate cognitive aging. We examined how midlife self-rated physical functioning and health may predict cognitive health in older age. We used data from the Health and Retirement Study (1998-2016; unweighted-N = 4,685). We used survey multinomial logistic regression and latent growth curve models to examine how midlife (age 50-64 years) activities of daily living (ADL), physical function, and self-reported health affect cognitive trajectories and cognitive impairment not dementia (CIND) and dementia status 18 years later. Then, we tested for sex and racial/ethnic modifications. After covariates-adjustment, worse instrumental ADL (IADL) functioning, mobility, and self-reported health were associated with both CIND and dementia. Hispanics were more likely to meet criteria for dementia than non-Hispanic Whites given increasing IADL impairment. Midlife health, activities limitations, and difficulties with mobility are predictive of dementia in later life. Hispanics may be more susceptible to dementia in the presence of midlife IADLs. Assessing midlife physical function and general health with brief questionnaires may be useful for predicting cognitive impairment and dementia in later life.

Pathways from childhood socioemotional characteristics and cognitive skills to midlife health behaviours

Objective This longitudinal study investigated the pathways from childhood socioemotional characteristics and cognitive skills to health behaviours in midlife. Methods: Participants in the Jyväskylä Longitudinal Study of Personality and Social Development (JYLS) were followed from age 8 (n = 369) to age 50 (n = 271). Outcomes included physical activity, smoking, alcohol consumption and body mass index (BMI) assessed at ages 36, 42 and 50. Predictors were socioemotional characteristics (behavioural activity, negative emotionality, and well-controlled behaviour) and parents’ occupational status collected at age 8, cognitive skills (school success at age 14 and the highest education at age 27) and adulthood personality traits (extraversion, neuroticism and conscientiousness). Longitudinal path modelling was used for analyses. Results: Well-controlled behaviour and extraversion predicted physical activity in women. Behavioural activity predicted alcohol consumption in women and smoking in men. Negative emotionality was not directly connected to health behaviours. Adulthood neuroticism was associated with smoking in men and with alcohol-related problems in both men and women. There were some indirect paths from childhood socioemotional characteristics to midlife health behaviours through cognitive skills. None of the study variables predicted midlife BMI. Conclusions: Childhood socioemotional characteristics have some predictive value on midlife health behaviours, both directly and through cognitive skills. Supplemental data for this article is available online at https://doi.org/10.1080/08870446.2022.2041639 .

Race, sex, and mid-life changes in brain health: Cardia MRI substudy.

To examine longitudinal race and sex differences in mid-life brain health and to evaluate whether cardiovascular health (CVH) or apolipoprotein E (APOE) ε4 explain differences. The study included 478 Black and White participants (mean age: 50 years). Total (TBV), gray (GMV), white (WMV), and white matter hyperintensity (WMH) volumes and GM-cerebral blood flow (CBF) were acquired with 3T-magnetic resonance imaging at baseline and 5-year follow-up. Analyses were based on general linear models. There were race x sex interactions for GMV (P-interaction=.004) and CBF (P-interaction=.01) such that men showed more decline than women, and this was most evident in Blacks. Blacks compared to Whites had a significantly greater increase in WMH (P=.002). All sex-race differences in change were marginally attenuated by CVH and APOE ε4. Race-sex differences in brain health emerge by mid-life. Identifying new environmental factors beyond CVH is needed to develop early interventions to maintain brain health.

Childbearing Biographies and Midlife Women's Health.

We introduce a "childbearing biography" approach to show how multiple childbearing characteristics cluster in ways significant for midlife health. We analyze the National Longitudinal Survey of Youth 1979 (NLSY79; N = 3992) using mixed-mode Latent Class Analysis with eight childbearing variables (e.g., age at first birth, parity, birth spacing, and mistimed births) to identify how childbearing biographies are associated with midlife health, adjusting for key covariates-including socioeconomic status (SES) and relationship history. We identify six childbearing biographies: (1) early compressed, (2) staggered, (3) extended high parity, (4) later, (5) married planned, and (6) childfree. Childbearing biographies are strongly associated with physical health but not mental health, with differences primarily explained by SES. Different childbearing biographies are related to physical health inequalities above what is demonstrated by the typical use of one or two childbearing measures, providing a new perspective into the growing health gap among aging midlife women.

Prenatal alcohol exposure and mental health at midlife: A preliminary report on two longitudinal cohorts.

Although the effects of prenatal alcohol exposure (PAE) have been studied extensively, there is relatively little information available on adult mental health functioning among exposed individuals. The current study compares the self-reported midlife mental health status of individuals who were prenatally exposed to alcohol and diagnosed in childhood with the effects of this exposure with that of unexposed individuals. Participants (N=292) were recruited from two longitudinal cohorts in Atlanta and Seattle and asked to complete an Adult Health Questionnaire that surveyed their current health and mental health status. The questionnaire was completed either in-person or remotely and included questions about current symptoms of depression and anxiety and mental health disorder diagnoses. The analysis compared a Nonexposed Contrast group to those in two exposure groups: (1) Alcohol Exposed with Fetal Alcohol Effect but not meeting criteria for Fetal Alcohol Syndrome (FAS) and (2) Alcohol Affected and meeting criteria for FAS. Both alcohol-exposed groups reported higher levels of current depressive symptoms and a higher prevalence of diagnoses of depression, anxiety, bipolar disorder, and/or attention deficit/hyperactivity disorder. No differences were noted for psychotic disorders. PAE was also associated with greater environmental stressors, including higher levels of adverse childhood events and lower current socioeconomic status. Path analyses suggested that PAE was indirectly related to mood disorders with its effects being mediated by other environmental factors. PAE is associated with greater rates of mental health disorders in middle adulthood. These outcomes appear to result from multiple stressors that affect individuals made vulnerable by their early alcohol exposure. Clinical outcomes could be improved by prevention efforts directed at preventing prenatal alcohol use and reducing environmental stressors later in life, and by the early identification of PAE and its effects.

Personality traits at age 16 and risk of metabolic syndrome at age 46

ObjectiveTo examine whether five-factor model personality traits at age 16 are associated with risk of metabolic syndrome 30 years later at age 46 and whether adolescent personality mediates the association between childhood social class and midlife metabolic health. MethodsParticipants were from the British Cohort Study 1970, a birth cohort study of participants all born in the same week in 1970. Personality was assessed by participants' mothers (n = 3819) and participants' themselves (n = 2697) at age 16. The five components of the metabolic syndrome were measured at the age 46 assessment: elevated blood pressure, glucose, triglycerides, waist circumference and lower HDL cholesterol. ResultsMother-rated neuroticism and mother-rated conscientiousness at age 16 were associated with risk of metabolic syndrome at age 46 (OR = 1.19, 95% CI = 1.04, 1.36 and OR = 0.70, 95% CI = 0.62, 0.78, respectively). Self-reported neuroticism was also associated with metabolic syndrome risk (OR = 1.43, 95% CI = 1.08, 1.91). Mother-rated conscientiousness at age 16 accounted for 10% of the association between childhood social class and metabolic health at age 46. None of the other traits were significant mediators. ConclusionConsistent with lifespan models of personality and health, age 16 personality traits were associated with metabolic health measured 30 years later. Personality traits may also function as a mechanism through which early-life socioeconomic status contributes to midlife health.

The Health of Mothers of Adult Children with Serious Conditions.

This study examined the association between parenting adult children with serious conditions and mothers' midlife health in the United States. The literature about the link between the parenting status of having an adult child with a serious condition and maternal wellbeing can be advanced by systematic analysis of the cumulative role that this parenting status can play in maternal health over the life course as opposed to at any one point. Propensity score reweighting models of data from the National Longitudinal Study of Youth 1979 and its linked child and young adult data estimated disparities in midlife health among mothers of adult children with serious conditions (disabilities, developmental disorders, chronic diseases) and mothers of typically developing children, including examining variation by how long mothers had been in this parenting role and moderation by maternal education and marital status. Mothers of young adult children with serious conditions had poorer physical (but not mental) health at midlife than other mothers, especially when more years had elapsed since the child was diagnosed with or developed the condition. These patterns did not differ by maternal education and marital status. The dynamics of epidemiological risk and protection among parents of children with serious conditions were temporally situated in the maternal life course but were consistent across different segments of the maternal population.

Trends in Health in Midlife and Late Life.

Gains in life expectancy have recently slowed and mortality inequalities have increased. This paper examines whether trends in health observed at ages 55 to 89 mirror those trends in mortality, which may serve as an early indicator for the future evolution of mortality. We found that many health outcomes have worsened from 1992 to 2016, especially at ages below 70, and that differentials in health between low and high education groups have increased among the more recent cohorts. Overall the findings cast a pessimistic light on the future evolution of mortality rates and mortality inequalities.

Midlife financial strain and later-life health and wellbeing of husbands and wives: Linking and moderating roles of couple intimacy trajectories.

This study investigates (a) heterogeneous trajectories of couple intimacy over the mid-later years (average ages of 40-65) and (b) how these intimacy classes are differentially associated with spouses' midlife financial strain as well as their later-life health and wellbeing outcomes. The sample was comprised of white couples in long-term marriages from the rural Mid-west who experienced the economic downturn of the farm crisis in late 1980s. Couple-level measures of emotional intimacy and sexual intimacy were created by summing husbands' and wives' reports. Using growth mixture modeling with a sample of 304 couples, conjoint intimacy classes were identified from trajectories of couple emotional intimacy and sexual intimacy. Three qualitatively different latent intimacy classes of couples were identified: Consistently High, Moderate and Increasing, and Chronically Low. Intimacy classes were differentially associated with midlife financial strain and later-life health and wellbeing. Spouses with consistently high and moderate and increasing intimacy in their mid-later years averaged lower financial strain in early midlife and better health and wellbeing outcomes in later years (>67years) compared to those with consistently low intimacy after controlling for lagged health measures. The identification of couple intimacy trajectory groups provides a potentially useful prognostic tool for counseling efforts that can promote and develop resiliency factors to aid in the redirection of adverse couple intimacy trajectories.

Blood pressure screening in midlife aids in prediction of dementia later in life.

BackgroundThere is substantial evidence that midlife hypertension is a risk factor for late life dementia. Our aim was to investigate if even high blood pressure at a single timepoint in midlife can predict an increased risk for all-cause dementia, Alzheimer’s disease (AD), or vascular dementia (VaD) later in life.MethodsThe community-based study population comprised 30,102 dementia-free individuals from the Westmannia Cardiovascular Risk Factors Study. The participants were aged 40 or 50 years when the health examination took place in 1990–2000. Diagnose registers from both hospitals and primary healthcare centers were used to identify individuals who after inclusion to the study developed dementia. The association between midlife high blood pressure (defined as systolic blood pressure >140 and/or diastolic blood pressure >90 mmHg) at a single timepoint and dementia was adjusted for age, gender, body mass index (BMI), fasting blood glucose, education, smoking, and physical activity level. Multivariate binary cox regression analyses were used.ResultsAfter a mean follow-up time of 24 years resulting in 662,244 person/years, 761 (2.5%) individuals had been diagnosed with dementia. Midlife high blood pressure at a single timepoint predicted all-cause dementia (hazard ratio [HR]: 1.22, 95% confidence interval [CI]: 1.02–1.45) and VaD (HR: 2.10, 95% CI: 1.47–3.00) but not AD (HR: 1.06, 95% CI: 0.81–1.38).ConclusionThis study suggests that even midlife high blood pressure at a single timepoint predicts all-cause dementia and more than doubles the risk for VaD later in life independently of established confounders. Even though there was no such association with AD, this strengthens the importance of midlife health examinations in order to identify individuals with hypertension and initiate treatment.