Modifiable Risk Factors In Midlife Research Articles

Abstract 46: Midlife and Late-Life Population Attributable Fractions of Dementia Risk Factors in the United States: A Cohort Study From the Dementia Risk Pooling Project

Introduction: Dementia cases in the US are projected to nearly double from 5.3 million in 2019 to 10.5 million by 2050. Research has suggested that 41% of US dementia cases may be prevented by eliminating several specific modifiable risk factors. Still, few studies examine risk factor variation between midlife and late-life. Previous studies have also been limited by sample diversity and size. The Dementia Risk Pooling Project (DRPP) is a consortium of longitudinal cohorts including several underrepresented racial/ethnic groups pooled at the individual level. Methods: We estimated individual and combined population attributable fractions (PAF) for seven modifiable risk factors in midlife (aged 45-64) and late-life (aged 65+), using data from six US cohorts in DRPP. We also used potential impact fractions (PIF) to estimate dementia cases that could be prevented due to risk factor reduction in midlife and late-life based upon the National Alzheimer’s Advisory Council goal of a 15% reduction in dementia risk factors by 2030. Results: In a sample of 41,432 unique participants (ppts), risk factor exposure was measured in midlife for 29,983 ppts (60% female, 77% white) and in late-life for 30,633 ppts (56% female, 70% white). During follow-up, 4,186 midlife ppts and 4,893 late-life ppts developed dementia. We found that eliminating midlife risk factors could prevent a greater proportion of dementia cases [PAF 41.3%, 27.9%-54.6%] compared to late-life risk factors [23.1%, 12.4%-33.7%]. Midlife physical inactivity [18.8%, 15.1%-22.4%] appeared to be the greatest contributor. Late-life hypertension and depression appeared to contribute to 9.8% [5.5%-13.9%] and 4.2% [3.5%-5.0%] of cases, respectively. Given the US prevalence of dementia in 2020, we estimate that a 15% reduction in physical inactivity alone could prevent 148,339 dementia cases. Conclusion: The importance of modifiable risk factors for dementia may vary with age. These estimates could inform the timing of public health interventions for dementia prevention.

Cross-sectional associations between neighborhood characteristics, cognition and dementia risk factor burden in middle-aged and older Australians

Dementia disproportionately affects individuals from disadvantaged backgrounds, including those living in areas of lower neighborhood-level socioeconomic status. It is important to understand whether there are specific neighborhood characteristics associated with dementia risk factors and cognition which may inform dementia risk reduction interventions. We sought to examine whether greenspace, walkability, and crime associated with the cumulative burden of modifiable dementia risk factors and cognition. This was a cross-sectional analysis of 2016–2020 data from the Healthy Brain Project, a population-based cohort of community-dwelling individuals across Australia. Participants were aged 40–70 and free of dementia. Measures included greenspace (greenspace % in the local area, and distance to greenspace, n = 2,181); and intersection density (n = 1,159), and crime (rate of recorded offences; n = 1,159). Outcomes included a modified Cardiovascular Risk Factors, Aging, and Incidence of Dementia (CAIDE) dementia risk score to index the burden of modifiable vascular dementia risk factors; and composite scores of both memory and attention, derived from the Cogstate Brief Battery. Linear regressions adjusted for age, sex, education, and personal socio-economic status, demonstrated distance to greenspace (b ± SE per 2-fold increase = 0.09 ± 0.03, p =.005) and crime rate (b ± SE per 2-fold increase = 0.07 ± 0.03, p =.018) were associated with higher modified CAIDE. Higher crime was associated with lower memory performance (b ± SE = -0.03 ± 0.01, p =.018). The association between distance to greenspace and modified CAIDE was only present in low-moderate socioeconomic status neighborhoods (p interaction = 0.004). Dementia prevention programs that address modifiable risk factors in midlife should consider the possible role of neighborhood characteristics.

Examination of potentially modifiable dementia risk factors across the adult life course: The Framingham Heart Study.

We examined for associations between potentially modifiable risk factors across the adult life course and incident dementia. Participants from the Framingham Heart Study were included (n=4015). Potential modifiable risk factors included education, alcohol intake, smoking, body mass index (BMI), physical activity, social network, diabetes, and hypertension. Cox models were used to examine associations between each factor and incident dementia, stratified by early adult life (33-44 years), midlife (45-65 years), and late life (66-80 years). Increased dementia risk was associated with diabetes (hazard ratio [HR]=1.62; 95% confidence interval [CI]=1.07-2.46) and physical inactivity (HR=1.57; 95% CI=1.12-2.20) in midlife, and with obesity (HR=1.76; 95% CI=1.08-2.87) in late life. Having multiple potential modifiable risk factors in midlife and late life was associated with greater risk. Potentially modifiable risk factors individually have limited impact on dementia risk in this population across the adult life course, although in combination they may have a synergistic effect. Diabetes and physical inactivity in midlife is associated with increased dementia risk. Obesity in late life is associated with increased dementia risk. Having more potentially modifiable risk factors in midlife and late life is associated with greater dementia risk.

High-normal blood pressure in midlife is a stronger predictor for development of hypertension in women than in men

Abstract Background Identification of modifiable risk factors in midlife may optimize prevention of hypertension. Sex differences in the multifactorial development of hypertension is not well understood. Purpose To explore the associations of health factors in midlife, with incident hypertension 26 years later, in women and men. Methods In the community-based Hordaland Health Study (HUSK) 1025 women and 703 men were examined at age 42 years (baseline) and re-examined after 6 and 26 years. Patients with hypertension at baseline were excluded. Attended blood pressure (BP) was measured in triplets. High-normal BP was identified as BP 130–139/85–89 mmHg. Incident hypertension was identified as BP ≥140/90 mmHg or patient reported use of antihypertensive drugs on the last study visit. The association of health factors at baseline and changes during midlife, with incident hypertension at follow-up were explored in sex specific multivariable logistic regression analyses. Models were adjusted for baseline body mass index (BMI), high-normal BP, heart rate, physical activity, daily smoking, education, serum cholesterol, and serum triglycerides. Results are presented as odds ratios (OR), 95% confidence intervals (CI) and p-values. Results At baseline, average BP was 119/73 mmHg in women and 126/76 mmHg in men (p<0.001). A high-normal BP was found in 26% of women and 47% of men (p<0.001). After 26 years of follow-up, 39% of women and 45% of men had developed hypertension (p<0.05). In multivariable logistic regression analyses, high-normal BP at baseline, was the strongest predictor of incident hypertension in both sexes, but significantly stronger in women (OR 4.8, 95% CI 3.4–6.9) than in men (OR 2.1, 95% CI 1.5–2.8), p<0.01 for sex interaction (Table 1). Increase in BMI from first to second study visit was significantly associated with incident hypertension in both sexes (both p<0.01). And an increase in serum triglycerides from first to second visit was significant only in women (p<0.05). Conclusions High-normal BP in midlife was a particularly strong risk factor for development of hypertension later in life and significantly stronger in women. An increase in BMI in midlife was associated with incident hypertension but did not differ between sexes. Awareness of sex differences in modifiable health factors in midlife enable improved prevention of hypertension. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): University of Bergen

Does clinical data capture modifiable midlife risk factors for Alzheimer’s disease?

AbstractBackgroundThe 2020 Lancet Dementia Commission Report highlighted 5 modifiable midlife risk factors for dementia across multiple datasets: hearing loss, traumatic brain injury (TBI), hypertension, alcohol use, and obesity. We tested associations of these risk factors with Alzheimer’s disease (AD) 10 or more years later within clinical care data from a large health system.MethodWe used University of Pittsburgh Medical Center electronic health record data including diagnoses, demographics, social history, and medications from inpatient, outpatient, and emergency visits. Cases were aged 50‐75 at the time of a first ICD‐9 or 10‐based diagnosis of AD between 2016‐2020. Controls were age‐matched to cases 4:1, selected with replacement; they were free from neurodevelopmental, neurodegenerative, or demyelinating disorders, and had a visit from 2016‐2020. Cases and controls had at least one visit 10+ years prior (“early visit”). Risk factors from the early visit were defined as follows: hearing loss and TBI were based on diagnoses; obesity and hypertension were based on diagnoses or 2 measures of body mass index ≥ 30 or systolic blood pressure (BP) ≥ 140 and diastolic BP ≥ 90, respectively; alcohol use was based on diagnoses or self‐reported use ≥ 21 drinks/week. We tested associations of risk factors with AD using logistic regression models; results are presented as unadjusted odds ratios [95% confidence intervals].ResultParticipants had a mean age of 67 in 2016‐2020; N=2382 cases (56% female, 80% white, 19% Black) and N=9528 controls (58% female, 88% white, 10% Black). All midlife risk factors were associated with significantly increased odds of AD. In order of largest to smallest effect size: TBI, 4.5 [4.1, 5.0]; alcohol use, 3.5 [3.0, 4.0]; hypertension 2.6 [2.4, 2.9]. hearing loss, 1.9 [1.7, 2.1]; and obesity, 1.2 [1.1, 1.4]. Narrower definitions of alcohol use and TBI only slightly altered their respective effect sizes.ConclusionIn agreement with the Lancet Report, we find that these modifiable factors in late‐early to midlife are associated with AD. Information about these risk factors is already captured in clinical electronic health records and should be used to guide dementia risk reduction beginning early in midlife.

The identification of established modifiable mid-life risk factors for cardiovascular disease which contribute to cognitive decline: Korean Longitudinal Study of Aging (KLoSA)

IntroductionWe explored how different chronic diseases, risk factors, and protective factors highly associated with cardiovascular diseases (CVD) are associated with dementia or Mild Cognitive Impairment (MCI) in Korean elders, with a focus on those that manifest in mid-life.MethodsA CVD-free cohort (n = 4289) from the Korean Longitudinal Study of Aging was selected to perform Cox mixed-effects proportional hazard regressions. Eighteen control variables with strong associations to CVD were chosen as explanatory variables, and Mini-Mental State Examination (MMSE) score cut-off for dementia and MCI were used as outcome variables.ResultsThe statistically significant (P < 0.05) adverse factors that contribute in developing dementia were age (aHR 1.07, 1.05–1.09), Centre for Epidemiological Studies Depression Scale (CESD-10) (aHR 1.17, 1.12–1.23), diagnosis with cerebrovascular disease (aHR 3.73, 1.81–7.66), living with diabetes (aHR 2.30, 1.22–4.35), and living with high blood pressure (HBP) (aHR 2.05, 1.09–3.87). In contrast, the statistically significant protective factors against developing dementia were current alcohol consumption (aHR 0.67, 0.46–0.99), higher educational attainment (aHR 0.36, 0.26–0.56), and regular exercise (aHR 0.37, 0.26–0.51). The factors with a statistically significant adverse association with progression to MCI were age (aHR 1.02, 1.01–1.03) and CESD-10 (aHR 1.17, 1.14–1.19). In contrast, the statistically significant protective factors against developing MCI were BMI (aHR 0.96, 0.94–0.98), higher educational attainment (aHR 0.33, 0.26–0.43), and regular exercise (aHR 0.83, 0.74–0.92).ConclusionIn lieu of the protective factor of MCI and dementia, implementing regular exercise routine well before mid-life and cognitive decline is significant, with adjustments made for those suffering from health conditions, so they can continue exercising despite their morbidity. Further attention in diabetes care and management is needed for patients who already show decline in cognitive ability as it is likely that their MCI impacts their ability to manage their existing chronic conditions, which may adversely affect their cognitive ability furthermore.

The CAIDE Dementia Risk Score and the Honolulu-Asia Aging Study

Introduction: The CAIDE (Cardiovascular Risk Factors, Aging, and Incidence of Dementia) dementia risk score is based on demographic, genetic, and modifiable risk factors in midlife and has been shown to be predictive of later-life dementia. Objective: To test the predictive capacity of the CAIDE dementia risk score among a cohort of Japanese-American men. Methods: Midlife measures were obtained from a sample of 3,582 Japanese-American men in the Honolulu Heart Program (1965–1968, average age = 53.1 years). A follow-up exam in 1991 (average age = 77.8 years) assessed cognitive impairment using the Cognitive Abilities Screening Instrument (CASI). Severe cognitive impairment was defined as a CASI score <60. Results: In this cohort, the CAIDE dementia risk score demonstrates significant association with later-life severe cognitive impairment (OR = 1.477, 95% CI: 1.39–1.58). However, the area under the receiver-operating characteristic curve c-statistics suggests poor predictive ability (c = 0.645, 95% CI: 0.62–0.67). Using a score cut-point of 10, the accuracy is acceptable (0.82), but the sensitivity is low (0.50). Conclusion: While the CAIDE dementia risk score at midlife is associated with later development of cognitive impairment in Japanese-American men, its predictive capacity in this population is weak.

Lifestyle predictors of successful aging: A 20-year prospective HUNT study.

BackgroundLifestyle factors predicting successful aging as a unified concept or as separate components of successful aging are important for understanding healthy aging, interventions and preventions. The main objective was to investigate the effect of midlife predictors on subsequent successful aging 20 years later.Materials and methodsData were from a population-based health survey, the Nord-Trøndelag Health Study (HUNT), with an average follow-up of 22.6 years. Individuals free of major disease at baseline in 1984–86 with complete datasets for the successful aging components in HUNT3 in 2006–08, were included (n = 4497; mean age at baseline 52.7, range 45–59, years). Successful aging was defined either as a unified category or as three components: being free of nine specified diseases and depression, having no physical or cognitive impairment, and being actively engaged with life. The midlife predictors (smoking, physical activity, alcohol consumption, obesity and social support) were analysed both as separate predictors and combined into a lifestyle index controlling for sociodemographic variables, using multivariable regression analysis.ResultsSuccessful aging as a unified concept was related to all the lifestyle factors in the unadjusted analyses, and all except alcohol consumption in the adjusted analyses. The individual components of successful aging were differently associated with the lifestyle factors; engagement with life was less associated with the lifestyle factors. Non- smoking and good social support were the most powerful predictors for successful aging as a unified concept. When the lifestyle factors were summed into a lifestyle index, there was a trend for more positive lifestyle to be related to higher odds for successful aging.ConclusionsLifestyle factors predicted an overall measure of SA, as well as the individual components, more than 20 years later. Modifiable risk factors in midlife, exemplified by social support, may be used for interventions to promote overall health and specific aspects of health in aging.

Seize the Day for a Day With No Seizures: Modifiable Midlife Risk Factors Identified.

Association Between Midlife Risk Factors and Late-Onset Epilepsy: Results From the Atherosclerosis Risk in Communities Study Johnson EL, Krauss GL, Lee AK, Schneider ALC, Dearborn JL, Kucharska-Newton AM, Huang J, Alonso A, Gottesman RF. JAMA Neurol. 2018 Jul 23 [Epub ahead of print]. doi:10.1001/jamaneurol.2018.1935Importance: The incidence of epilepsy is higher in older age than at any other period of life. Stroke, dementia, and hypertension are associated with late-onset epilepsy; however, the role of other vascular and lifestyle factors remains unclear. Objective: To identify midlife vascular and lifestyle risk factors for late-onset epilepsy. Design, Setting, and Participants: The Atherosclerosis Risk in Communities (ARIC) study is a prospective cohort study of 15 792 participants followed up since 1987 to 1989 with in-person visits, telephone calls, and surveillance of hospitalizations (10 974 invited without completing enrollment). The ARIC is a multicenter study with participants selected from 4 US communities. This study included 10 420 black or white participants from ARIC with at least 2 years of Medicare fee-for-service coverage and without missing baseline data. Data were analyzed between April 2017 and May 2018. Exposures: Demographic, vascular, lifestyle, and other possible epilepsy risk factors measured at baseline (age 45-64 years) were evaluated in multivariable survival models including demographics, vascular risk factors, and lifestyle risk factors. Main Outcomes and Measures: Time to development of late-onset epilepsy (2 or more International Classification of Diseases, Ninth Revision codes for epilepsy or seizures starting at 60 years or older in any claim [hospitalization or outpatient Medicare through 2013]), with first code for seizures after at least 2 years without code for seizures. Results: Of the 10 420 total participants (5878 [56.4%] women and 2794 [26.8%] black participants; median age 55 years at first visit), 596 participants developed late-onset epilepsy (3.33 per 1000 person-years). The incidence was higher in black than in white participants (4.71; 95% confidence interval [CI], 4.12-5.40 vs 2.88; 95% CI, 2.60-3.18 per 1000 person-years). In multivariable analysis, baseline hypertension (hazard ratio [HR], 1.30; 95% CI, 1.09-1.55), diabetes (HR, 1.45; 95% CI, 1.17-1.80), smoking (HR, 1.09; 95% CI, 1.01-1.17), apolipoprotein E ε4 (APOE ε4) genotype (1 allele HR, 1.22; 95% CI, 1.02-1.45; 2 alleles HR, 1.95; 95% CI, 1.35-2.81), incident stroke (HR, 3.38; 95% CI, 2.78-4.10), and dementia (HR, 2.56; 95% CI, 2.11-3.12) were associated with an increased risk of late-onset epilepsy, while higher levels of physical activity (HR, 0.90; 95% CI, 0.83-0.98) and moderate alcohol intake (HR, 0.72; 95% CI, 0.57-0.90) were associated with a lower risk. Results were similar after censoring individuals with stroke or dementia. Conclusions and Relevance: Potentially modifiable risk factors in midlife and the APOE ε4 genotype were positively associated with risk of developing late-onset epilepsy. Although stroke and dementia were both associated with late-onset epilepsy, vascular and lifestyle risk factors were significant even in the absence of stroke or dementia.

Association Between Midlife Risk Factors and Late-Onset Epilepsy

The incidence of epilepsy is higher in older age than at any other period of life. Stroke, dementia, and hypertension are associated with late-onset epilepsy; however, the role of other vascular and lifestyle factors remains unclear. To identify midlife vascular and lifestyle risk factors for late-onset epilepsy. The Atherosclerosis Risk in Communities (ARIC) study is a prospective cohort study of 15 792 participants followed up since 1987 to 1989 with in-person visits, telephone calls, and surveillance of hospitalizations (10 974 invited without completing enrollment). The ARIC is a multicenter study with participants selected from 4 US communities. This study included 10 420 black or white participants from ARIC with at least 2 years of Medicare fee-for-service coverage and without missing baseline data. Data were analyzed betweeen April 2017 and May 2018. Demographic, vascular, lifestyle, and other possible epilepsy risk factors measured at baseline (age 45-64 years) were evaluated in multivariable survival models including demographics, vascular risk factors, and lifestyle risk factors. Time to development of late-onset epilepsy (2 or more International Classification of Diseases, Ninth Revision codes for epilepsy or seizures starting at 60 years or older in any claim [hospitalization or outpatient Medicare through 2013]), with first code for seizures after at least 2 years without code for seizures. Of the 10 420 total participants (5878 women [56.4%] and 2794 black participants [26.8%]; median age 55 years at first visit), 596 participants developed late-onset epilepsy (3.33 per 1000 person-years). The incidence was higher in black than in white participants (4.71; 95% CI, 4.12-5.40 vs 2.88; 95% CI, 2.60-3.18 per 1000 person-years). In multivariable analysis, baseline hypertension (hazard ratio [HR], 1.30; 95% CI, 1.09-1.55), diabetes (HR, 1.45; 95% CI, 1.17-1.80), smoking (HR, 1.09; 95% CI, 1.01-1.17), apolipoprotein E ε4 genotype (1 allele HR, 1.22; 95% CI, 1.02-1.45; 2 alleles HR, 1.95; 95% CI, 1.35-2.81), and incident stroke (HR, 3.38; 95% CI, 2.78-4.10) and dementia (HR, 2.56; 95% CI, 2.11-3.12) were associated with an increased risk of late-onset epilepsy, while higher levels of physical activity (HR, 0.90; 95% CI, 0.83-0.98) and moderate alcohol intake (HR, 0.72; 95% CI, 0.57-0.90) were associated with a lower risk. Results were similar after censoring individuals with stroke or dementia. Potentially modifiable risk factors in midlife and the APOE ε4 genotype were positively associated with risk of developing late-onset epilepsy. Although stroke and dementia were both associated with late-onset epilepsy, vascular and lifestyle risk factors were significant even in the absence of stroke or dementia.

Approaches for preventive psychiatry in the geriatric population

In the last couple of decades, researchers have focused on finding strategies for the prevention of cognitive decline in the geriatric age group. Equivocal evidence is available from high-quality randomized controlled studies regarding causative role of modifiable midlife risk factors in cognitive decline and dementia. Among the cardiovascular risk factors, hypertension, hyperlipidemia, obesity, high saturated fat intake, and cigarette smoking have been found to be present in more than 50% of the cases of dementia and cognitive decline. Adopting healthy lifestyle changes with diet, regular moderate levels of physical activity, and abstinence from substance use have been found to have consistent evidence in the prevention of cognitive decline among other ambiguous findings across cultures. Studies assessing preventive and beneficial role of pharmacological treatment strategies such as preemptive use of disease modifying drugs, cerebroactive drugs, and nutritional supplements have been inconclusive. Psychological intervention strategies have shown some promising results. This review attempts to understand some of the perplexing issues in the prevention of cognitive decline in old age.

Modifiable midlife risk factors, independent aging, and survival in older men: report on long-term follow-up of the Uppsala Longitudinal Study of Adult Men cohort.

To examine relationships between modifiable midlife factors, aging, and physical and cognitive function (independent aging) and survival in very old age. Prospective cohort. Uppsala Longitudinal Study of Adult Men, Uppsala, Sweden. Swedish men investigated in 1970-74 (aged 48.6-51.1) and followed up for four decades (N=2,293). Conventional cardiovascular risk factors, body mass index (BMI), and dietary biomarkers were measured, and a questionnaire was used to gather information on lifestyle variables at age 50. Four hundred seventy-two men were reinvestigated in 2008-09 (aged 84.8-88.9). Independent aging was defined as survival to age 85, Mini-Mental State Examination score of 25 or greater, not living in an institution, independent in personal care and hygiene, able to walk outdoors without personal help, and no diagnosis of dementia. The National Swedish Death Registry provided survival data. Thirty-eight percent of the cohort survived to age 85. Seventy-four percent of the participants in 2008-09 were aging independently. In univariable analyses, high leisure-time physical activity predicted survival but not independent aging. Low work-time physical activity was associated more strongly with independent aging (odds ratio (OR)=1.84, 95% confidence interval (CI)=1.18-2.88) than with survival (OR=1.27, 95% CI=1.05-1.52). In multivariable analyses, midlife BMI was negatively associated (OR=0.80/SD, 95% CI=0.65-0.99/SD), and never or former smoking was positively associated (OR=1.66, 95% CI=1.07-2.59), with independent aging. As expected, conventional cardiovascular and lifestyle risk factors were associated with mortality. A normal midlife BMI and not smoking were associated with independent aging close to four decades later, indicating that normal weight at midlife has the potential not only to increase survival, but also to preserve independence with aging.

Predicting the risk of physical disability in old age using modifiable mid-life risk factors

BackgroundWe aimed to investigate the relationship between potentially modifiable risk factors in middle age and disability after 13 years using the Framingham Offspring Study (FOS). We further aimed to develop...

EPA-0212 - Identification of comorbidity as a preventive strategy for dementia

Introduction Dementia has a multifactorial etiology including social, environmental, behavioral and neurobiological factors. The validity and status of currentlydocumented dementia risk factors are often uncertain, based on few studies, or inconsistent. We combined quantitative and qualitative information to summarize and weight the most important dementia risk factors. Objectives Identifying the major modifiable midlife risk factors for dementia is crucial to develop effective preventive strategies and improve healthy late life cognitive functioning. Aims The present study is part of the FP-7 funded In-MINDD (Innovative Midlife Intervention for Dementia Deterrence) project, which aims to identify the most important modifiable risk factors for dementia. Methods Dementia risk factors named by international dementia experts in a Delphi study were synthesized with information from a systematic literature review. The literature research conducted in PubMed used a search strategy modified from Plassman et al. (2010). This yielded 3,127 abstracts, of which 327 were included for further scrutiny based on title and abstract. The results were pooled with those from previous reviews to arrive at the final risk inventory. Results The risk factors named by experts were among the best-documented risk factors based on previous literature and our systematic review. These include depression, hypertension, physical inactivity, diabetes, obesity, hyperlipidemia, and smoking. We also identified new candidate risk factors that need further validation: coronary heart disease, renal dysfunction, stroke, and inflammation. Conclusions This study provides strong support for somatic and lifestyle factors in the etiology of dementia and flags several important targets for prevention in midlife.

The Women's Healthy Ageing Project: Fertile ground for investigation of healthy participants ‘at risk’ for dementia

Alzheimer's disease neuropathology (amyloid, tauopathies) and brain atrophy are present decades prior to manifestation of clinical symptoms. With the failure of treatment trials it is becoming clearer that the window for prevention and therapeutic intervention is before significant neuronal loss and clinical deterioration of cognition has occurred. Early identification of those at risk of disease and optimizing their management to prevent disease in later life are crucial to delaying disease onset and improving people's quality of life. The Women's Healthy Aging Project (WHAP) is a longitudinal study of over 400 Australian-born women, epidemiologically randomly sampled in 1990. The WHAP aims to identify modifiable mid-life risk factors for the development of late-life cognitive decline, improve the understanding of the pathogenesis of dementia, and target early disease identification utilizing clinical, biomarker and health risk profiles. These aims are fortified by the ability to leverage the considerable database on health, lifestyle and socio-demographics collected prospectively from 1990 to date. This is the first study with a comprehensive neuropsychological battery, over a decade of cognitive follow-up, with all participants being offered amyloid imaging from 2012, and prospective longitudinal data including clinical and physical measures and bio-bank samples from over 20 years prior.

Modifiable Risk Factors in Midlife and the Age of Onset of Diabetes Mellitus: A 34‐Year Follow‐Up Study

Modifiable Risk Factors in Midlife and the Age of Onset of Diabetes Mellitus: A 34‐Year Follow‐Up Study