Risk Factors For Incident Dementia Research Articles

SUBJECTIVE COGNITIVE DECLINE PHENOTYPES, SOCIAL ENGAGEMENT, AND CARDIOVASCULAR HEALTH

Abstract Epidemiological studies report subjective cognitive decline (SCD) as a risk factor for incident dementia. The co-occurrence of SCD, chronic conditions, and loneliness may contribute to functional limitations and decline. SCD etiologies are multifaceted, suggesting possible underlying phenotypes defined by clustering factors that characterize decline. Using pooled data (2015-2021) from the Behavioral Risk Factor Surveillance System (BRFSS) we investigated SCD phenotypes based on the six-item self-reported Cognitive Decline Module that measured challenges in daily life due to memory loss and confusion over the prior twelve months. We hypothesized that SCD phenotypes would be associated with socio-demographic, cardiovascular health and social engagement variables. Mixture modeling was used to determine unobserved SCD phenotypes (latent classes) based on item response patterns. Latent class membership was predicted from socio-demographic variables using multinomial logistic regression. The resulting classes predicted a six-item cardiovascular risk index (CVRI) and a measure of aloneness. SCD symptoms were reported by 65,217 (45-80+ years old). Mixture models produced four-latent SCD classes labeled as mild (43%), mild-moderate (23%), moderate (24%), and severe (10%). Mean CVRI scores were significant across classes (p < 0.001) and highest in the severe subgroup (n=6,491) which was more likely to be non-Hispanic Blacks, female, younger (45-64), low-income, non-homeowners, and report depression, and poor/fair health status. Class membership also significantly predicted aloneness. Studies are needed to examine how SCD phenotypes may be used in the design and development of interventions that are more precise to the cluster of modifiable risk factors which could, subsequently, prevent or delay dementia pathogenesis.

Handle with care: frailty complicates cognitive outcomes in older adults with delirium

AbstractBackgroundDelirium has been associated with long‐term cognitive impairment and dementia (1), and frailty is a known risk factor for incident dementia in older adults (2). However, it remains unclear whether delirium and frailty synergistically affect cognitive decline. We investigated whether frailty modifies the association between delirium and post‐discharge dementia in older adults.MethodsWe completed a cohort study including acutely ill older adults admitted to a tertiary university hospital (2010‐2016). Our inclusion criteria were: age ≥60 years; no preexisting cognitive decline; ≥12 months of follow‐up after discharge. Preexisting cognitive decline was identified using clinical history, CDR‐SB, and IQCODE‐16. Delirium was defined using the Short‐CAM. Frailty was defined using the FRAIL scale and the Frailty Index. Our primary outcome was the incidence of post‐discharge dementia, identified in follow‐up medical records. We investigated the association between delirium and post‐discharge dementia using competing‐risks regression models. We then completed interaction analyses exploring the effect of frailty on the association between delirium and post‐discharge dementia.ResultsWe included 309 participants (mean age = 78 years; female = 60%). We detected delirium in 66 (21%) hospitalizations and incident dementia in 59 (19%). Overall, 16% of the patients were classified by FRAIL as robust, 55% as prefrail, and 29% as frail. After multivariable analysis, we found that delirium was independently associated with incident dementia, but the association was significantly modified by frailty (p = 0.009) (Figure 1). The adjusted sub‐hazard ratio (SHR) in non‐frail participants was 1.14 (95%CI = 0.53‐2.44) and 3.80 (95%CI = 1.80‐8.05) in frail participants Tables 1‐2).ConclusionFrailty was a significant modifier of the association between delirium and post‐discharge dementia in this population. Research on frailty interventions should measure delirium incidence and long‐term cognitive decline to explore their potential impact on these outcomes.

Genome-wide analysis identifies novel loci influencing plasma apolipoprotein E concentration and Alzheimer’s disease risk

The APOE 2/3/4 polymorphism is the greatest genetic risk factor for Alzheimer’s disease (AD). This polymorphism is also associated with variation in plasma ApoE level; while APOE*4 lowers, APOE*2 increases ApoE level. Lower plasma ApoE level has also been suggested to be a risk factor for incident dementia. To our knowledge, no large genome-wide association study (GWAS) has been reported on plasma ApoE level. This study aimed to identify new genetic variants affecting plasma ApoE level as well as to test if baseline ApoE level is associated with cognitive function and incident dementia in a longitudinally followed cohort of the Ginkgo Evaluation of Memory (GEM) study. Baseline plasma ApoE concentration was measured in 3031 participants (95.4% European Americans (EAs)). GWAS analysis was performed on 2580 self-identified EAs where both genotype and plasma ApoE data were available. Lower ApoE concentration was associated with worse cognitive function, but not with incident dementia. As expected, the risk for AD increased from E2/2 through to E4/4 genotypes (P for trend = 4.8E-75). In addition to confirming the expected and opposite associations of APOE*2 (P = 4.73E-79) and APOE*4 (P = 8.73E-12) with ApoE level, GWAS analysis revealed nine additional independent signals in the APOE region, and together they explained about 22% of the variance in plasma ApoE level. We also identified seven new loci on chromosomes 1, 4, 5, 7, 11, 12 and 20 (P range = 5.49E-08 to 5.36E-10) that explained about 9% of the variance in ApoE level. Plasma ApoE level-associated independent variants, especially in the APOE region, were also associated with AD risk and amyloid deposition in the brain, indicating that genetically determined ApoE level variation may be a risk factor for developing AD. These results improve our understanding of the genetic determinants of plasma ApoE level and their potential value in affecting AD risk.

Risk factors of dementia in type 2 diabetes mellitus: The Hong Kong diabetes study

This population-based cohort study investigated the risk factors of incident dementia and vascular dementia in type 2 diabetic patients (≥45 years old) attending the Hong Kong Hospital Authority between 1st January and 31st December 2009.Of the 273,876 patients included,9994 showed incident dementia (median follow-up: 4245 days). Multivariable Cox regression identified older age (HR: 1.09 [95% CI: 1.08–1.10]) and antiplatelet use (HR: 1.36 [1.14–1.62]) as risk factors for incident dementia, and older age (HR: 1.07 [1.06–1.08]), ischemic stroke (HR: 1.47 [1.09–1.98]), fasting blood glucose (HR: 1.10 [1.01–1.20]), antiplatelets (HR: 1.92 [1.51–2.44]), and calcium channel blocker (HR: 1.28 [1.04–1.57]) use as risk factors of incident vascular dementia.

Cross-sectional associations between short and mid-term blood pressure variability, cognition, and vascular stiffness in older adults

High blood pressure variability (BPV), particularly in older age, appears to be an independent risk factor for incident dementia. The current study aimed to investigate the association between different BPV measures (short- and mid-term BPV including circadian patterns) and cognitive functioning as well as vascular stiffness measures to better understand the role that BPV plays in cognitive impairment. 70 older adults (60-80-year-olds) without dementia completed a cognitive test battery and had their blood pressure (BP) assessed via a 24-hour ambulatory BP monitor (divided into sleep and wake for short-term BPV) and 4-day morning and evening home-based BP monitor (for day-to-day BPV). Arterial stiffness was evaluated via pulse wave analysis and pulse wave velocity (PWV) and cerebrovascular pulsatility was assessed via transcranial doppler sonography of the middle cerebral arteries. High systolic as well as diastolic short- and mid-term BPV were associated with poorer cognitive functioning, independent of the mean BP. Higher short-term BPV was associated with poorer attention and psychomotor speed, whilst day-to-day BPV was negatively linked with executive functioning. Circadian BP patterns (dipping and morning BP surge) showed no significant relationships with cognition after adjusting for covariates. Higher systolic short-term BPV was associated with higher arterial stiffness (PWV) and higher diastolic day-to-day BPV was linked with lower arterial stiffness. No significant associations between BPV measures and cerebrovascular pulsatility were present. High BPV, independently of the mean BP, is associated with lower cognitive performance and increased arterial stiffness in older adults without clinically-relevant cognitive impairment. This highlights the role of systolic and diastolic BPV as a potential early clinical marker for cognitive impairment.

Modifiable risk factors for incident dementia and cognitive impairment: An umbrella review of evidence

BackgroundDementia and cognitive impairment can be attributed to genetic and modifiable factors. Considerable evidence emerged in modifiable factors and urgently requires standardized evaluation. We conducted an umbrella review to evaluate the strength and validity of the existing evidence. MethodsWe searched PubMed, Embase, CINAHL and Cochrane Database of Systematic Reviews to identify relevant systematic reviews and meta-analyses of prospective studies regarding the associations of dementia and cognitive impairment with modifiable factors. For each association, we analyzed the summary effect size, 95 % confidence interval, 95 % prediction interval, heterogeneity, small study effect and excess significance bias. Mendelian randomization studies were descriptively reviewed further exploring the causality of the associations. ResultsIn total, 12,015 articles were identified, of which 118 eligible studies yielded 243 unique associations. Convincing evidence was found for associations of dementia and cognitive impairment with early-life education, midlife to late-life plasma glucose, BMI, atrial fibrillation, benzodiazepine use, and gait speed. Suggestive to highly suggestive evidence was found for that of midlife to late-life blood pressure, homocysteine, cerebrovascular diseases, hearing impairment, respiratory illness, anemia, smoking, alcohol consumption, diet, sleep, physical activity and social engagement. Among convincing evidence, Mendelian randomization studies verified causal relationships of education and plasma glucose with Alzheimer's disease. LimitationsLow quality of the studies included. ConclusionsModifiable risk factors identified in this study, especially those with high-level evidence, should be considered in dementia prevention. Our results support a valuable rationale for future experimental designs to establish further evidence for the associations in larger populations.

Risk Factors for Dementia in Patients With Incident Rheumatoid Arthritis: A Population-Based Cohort Study.

Growing evidence suggests that patients with rheumatoid arthritis (RA) have increased risk for dementia. We assessed risk factors for incident dementia in an inception cohort of patients with RA. This retrospective population-based cohort study included residents of 8 counties in Minnesota who were ≥ 50 years of age when they met 1987 American College of Rheumatology criteria for incident RA between 1980 and 2014 and were followed until death/migration or December 31, 2019. Patients with dementia before RA incidence were excluded. Incident dementia was defined as 2 relevant International Classification of Diseases, 9th or 10th revision codes at least 30 days apart. Data on sociodemographics, disease characteristics, cardiovascular/cerebrovascular disease (CVD) risk factors, and comorbidities were abstracted from medical records. The study included 886 patients with RA (mean age 65.1 yrs, 65.2% female). During the follow-up period (median 8.5 yrs), 103 patients developed dementia. After adjusting for age, sex, and calendar year of RA incidence, older age at RA incidence (HR 1.14 per 1 year increase, 95% CI 1.12-1.17), rheumatoid nodules (HR 1.76, 95% CI 1.05-2.95), hypertension (HR 1.84, 95% CI 1.19-2.85), presence of large joint swelling (HR 2.03, 95% CI 1.14-3.60), any CVD (HR 2.25, 95% CI 1.38-3.66), particularly ischemic stroke (HR 3.16, 95% CI 1.84-5.43) and heart failure (HR 1.82, 95% CI 1.10-3.00), anxiety (HR 1.86, 95% CI 1.16-2.97), and depression (HR 2.63, 95% CI 1.76-3.93) were associated with increased risk of dementia. After adjusting for CVD risk factors and any CVD, all covariates listed above were still significantly associated with risk of dementia. Apart from age, hypertension, depression, and anxiety, all of which are universally recognized risk factors for dementia, clinically active RA and presence of CVD were associated with an elevated risk of dementia incidence among patients with RA.

PO-669-06 BRAIN METABOLISM IN PATIENTS WITH ATRIAL FIBRILLATION: INSIGHTS FROM A PILOT FDG-PET STUDY

Atrial Fibrillation (AF) is an independent risk factor for incident dementia. Overt stroke, microembolism and microbleeds are among the main mechanisms linking this arrhythmia and cognitive dysfunction. Cerebral hypoperfusion related to beat-to-beat blood flow variation during AF can also explain the occurrence of dementia or mild cognitive impairment, as rhythm control strategies were shown to reduce its incidence. However, data regarding brain metabolism patterns in patients with AF are still scarce.

Evaluation of Risk Factors for Dementia Incidence Based on Previous Questionnaire Results of Specific Health Checkups in Japan

The prevalence of dementia is rapidly increasing worldwide, and its treatment and prevention are a health concern. The prevention of dementia requires the identification of risk factors through longitudinal studies of lifestyle. In this study, we aimed to identify the risk factors for the development of dementia in Japan and to clarify their primary care strategies. We analyzed the relationship between the cognitive ability level determined by the survey of long-term care certification and the past questionnaire results of a specific health examination in Japan 10 years ago. To analyze the risk factors for developing dementia, multivariate analysis was used, which showed that residents who gained more than 10 kg since reaching 20 years of age had a significantly lower risk of developing dementia. Regarding the “start of lifestyle modifications” question, those who answered “already started” had a significantly lower risk than those who answered “no plan to improve”. Conversely, residents receiving insulin injections or oral hypoglycemic agents were at a significantly higher risk of developing dementia based on the results of the questionnaire of the health checkups surveyed 10 years prior.

Hearing Loss and Incident Dementia: Claims Data From the New York SPARCS Database.

Age-related hearing loss (HL) may be a risk factor for incident dementia. The objective was to use population-based claims data from the New York Statewide Planning and Research Cooperative System (SPARCS) to establish if HL is associated with incident dementia. Retrospective cohort study. Comprehensive all-payer data reporting system (2007-2017). Two hundred six thousand eight hundred one subjects more than 60 years (56,523 with HL, random sample of 150,278 without HL). None. The main outcome was incident dementia, measured by initial dementia diagnosis (ICD-9/ICD-10 code) associated with a patient visit/insurance claim. The main exposure was HL, measured by at least two separate HL diagnoses associated with claims before dementia diagnosis. Cox proportional-hazards models were used to examine the relationship of baseline HL with incident dementia, adjusting for age, sex, cardiovascular disease, cerebrovascular disease, diabetes, and smoking. Dementia incidence rates per 1,000 person-years were 10.16 (95% confidence interval [CI] = 9.81-10.51; subjects with HL) and 5.43 (5.28-5.57; subjects without HL). Fewer (2-10) HL claims (n = 56,523), compared with no (0) HL claims, was associated with 1.10 (95% CI = 1.05-1.15, p < 0.001) times the hazard of incident dementia, adjusting for covariates. Greater (>10) HL claims (n = 3,414), compared with no (0) HL claims, was associated with 1.63 (95% CI = 1.42, 1.86, p < 0.001) times the hazard of incident dementia, adjusting for covariates. HL diagnosis was associated with increased risk of incident dementia based on a comprehensive all-payer data reporting system. Individuals with a more established diagnosis of HL (more HL claims) demonstrated an increased hazard ratio.

Depression, cognitive reserve markers, and dementia risk in the general population

Objectives We investigated depression, cognitive reserve, and their interaction as risk factors for incident dementia among community-dwelling older adults. Methods In total, 2099 participants, aged ≥65 years with no dementia during baseline assessment, who completed the follow-up two years later were included from the Cognitive Function and Ageing Study Wales. Baseline depression and dementia and dementia at follow-up were evaluated using the Geriatric Mental State Examination and the Automated Geriatric Examination for Computer Assisted Taxonomy. Cognitive reserve was measured by combining overall education, mid-life occupational complexity, and later-life social and cognitive activities. Risk of dementia in relation to depression and cognitive reserve was estimated using penalized maximum likelihood logistic regression. Interactions between cognitive reserve and depression were assessed using both multiplicative and additive scales. Results Baseline depression and low cognitive reserve significantly increased the risk of subsequent dementia at follow-up. No multiplicative interaction between cognitive reserve and depression existed. We observed an additive interaction between case-level depression and cognitive reserve. A significant association between depression and dementia was only found among people with low cognitive-reserve levels. Conclusions Greater cognitive reserve attenuated the depression-associated risk of developing dementia. This suggests the need to emphasize prodromal dementia detection among older adults with lower cognitive reserve and depression.

Meat consumption and risk of incident dementia: cohort study of 493,888 UK Biobank participants

ABSTRACTBackgroundWorldwide, the prevalence of dementia is increasing and diet as a modifiable factor could play a role. Meat consumption has been cross-sectionally associated with dementia risk, but specific amounts and types related to risk of incident dementia remain poorly understood.ObjectiveWe aimed to investigate associations between meat consumption and risk of incident dementia in the UK Biobank cohort.MethodsMeat consumption was estimated using a short dietary questionnaire at recruitment and repeated 24-h dietary assessments. Incident all-cause dementia comprising Alzheimer disease (AD) and vascular dementia (VD) was identified by electronic linkages to hospital and mortality records. HRs for each meat type in relation to each dementia outcome were estimated in Cox proportional hazard models. Interactions between meat consumption and the apolipoprotein E (APOE) ε4 allele were additionally explored.ResultsAmong 493,888 participants included, 2896 incident cases of all-cause dementia, 1006 cases of AD, and 490 cases of VD were identified, with mean ± SD follow-up of 8 ± 1.1 y. Each additional 25 g/day intake of processed meat was associated with increased risks of incident all-cause dementia (HR: 1.44; 95% CI: 1.24, 1.67; P-trend < 0.001) and AD (HR: 1.52; 95% CI: 1.18, 1.96; P-trend = 0.001). In contrast, a 50-g/d increment in unprocessed red meat intake was associated with reduced risks of all-cause dementia (HR: 0.81; 95% CI: 0.69, 0.95; P-trend = 0.011) and AD (HR: 0.70; 95% CI: 0.53, 0.92; P-trend = 0.009). The linear trend was not significant for unprocessed poultry and total meat. Regarding incident VD, there were no statistically significant linear trends identified, although for processed meat, higher consumption categories were associated with increased risks. The APOE ε4 allele increased dementia risk by 3 to 6 times but did not modify the associations with diet significantly.ConclusionThese findings highlight processed-meat consumption as a potential risk factor for incident dementia, independent of the APOE ε4 allele.

Does older subjective age predict poorer cognitive function and higher risk of dementia in middle-aged and older adults?

As a biopsychosocial marker of aging, subjective age (i.e., the age individuals feel regardless of their actual age) was related to many health issues in the elderly. The purpose of this study is to investigate whether subjective age is associated with subsequent cognition and dementia risk in middle-aged and older adults. Samples were drawn from the English Longitudinal Study of Ageing (ELSA). Participants reported their subjective ages at the baseline (2004/2005), and their cognitive functions were measured after 10 years (2014/2015). Newly diagnosed dementias were recorded between 2006/2007 to 2014/2015. Overall, 6,475 adults aged 50 years or older were included in the current analyses. The relationship between subjective age reported at baseline and cognition assessed ten years later was modeled using multiple linear regression models. Compared to participants who reported a younger subjective age, those who reported an older subjective age were more likely to have poorer cognition after ten years (β = -0.705, P = .002 for memory, β = -1.567, P = .001 for executive function). A Cox proportional hazard regression model suggested that older subjective age was an independent risk factor for incident dementia (HR = 1.737, 95% CI =1.060-2.848). Other than chronological age, subjective age could also be considered as an important predictor for the development of cognitive dysfunction.

Frailty as a risk factor for incident dementia and cognitive decline: Data from the longitudinal InveCe.Ab study

AbstractBackgroundFrailty is a frequent and potentially reversible age‐related syndrome. Current evidence supports the associations between Frailty, cognitive impairment and dementia. The aim of the study is to estimate the predictive role of Frailty syndrome in incident dementia and cognitive impairment, as well as the modulation of genetic‐psycho‐social factors, such as APOEɛ4 polymorphism and loneliness in a non‐demented Italian cohort of elderly individuals.MethodData are from a cohort of 1,321 persons aged 70‐74 years old, living in Abbiategrasso (Milan, Itay): the InveCe.Ab study (Guaita et al. 2013; clinical trials.gov NCT01345110). The sample took place in 2009 with follow‐ups in 2012 and 2014. Frailty was measured by Frailty Index (FI). The FI was then separated into Frail (FI&gt;0.25), pre‐Frail (FI = 0.08‐0.25) and non‐Frail (FI &lt; 0.08) groups. Dementia was defined using the DSM‐IV‐TR. Global cognition was assessed by the Mini Mental State Examination (MMSE), Comorbidity by Cumulative Illness Rating Scale (CIRS).ResultFrailty was associated with cumulative incidence of dementia (p&lt;0.001), MMSE score at baseline (p&lt;0.001), difference in MMSE score between 2009 and 2014 (p 0.005), CIRS (p&lt;0.001).After four follow‐up years, 4.6% developed Dementia. In the longitudinal regression models adjusted for age, gender, level of education and loneliness, APOEɛ4 carrier status, Frailty was associated with incident dementia (OR=7.75,95% CI 3.26‐18.41), with higher risk of dementia for frail men compared to women (OR=13.79, 95% CI 4.11–46.21; OR= 4.63, 95% CI 1.32‐16.26, respectively). In linear regression models, adjusted for the same variables, Frailty also showed a significant association with the decrease of MMSE score in follow‐up only in males (male: β ‐0.131,95% CI ‐7.16 – ‐0.15; females: β‐0.085, 95% CI ‐5.60 – 0.19). Other covariates, such as loneliness, were independently associated with the outcomes. However, the interaction term for loneliness and frailty was not significant in predicting incident dementia.Conclusionin our large population sample, Frailty is associated with cognitive impairment and cognitive decline. These results suggest that Frailty syndrome, especially if accompanied by other genetic‐psycho‐social characteristics such as loneliness, could be considered by clinicians as a red flag for early detection of cognitive disorders.

Risk Factors for Dementia Incidence Based on Previous Results of the Specific Health Checkups in Japan.

Dementia is a common disease in elderly people, with its prevalence expanding rapidly worldwide. Longitudinal and cohort studies on lifestyle and health conditions are needed to identify the risk of dementia. This study aimed to identify the risk factors for dementia incidence in Japan and to clarify the strategy for its primary care. In this study, an analysis was performed to investigate the association between the cognitive faculty level of the long-term care certification survey and the previous results of the specific health checkups in Japan. To investigate the risk factor for dementia incidence, a multivariable logistic regression analysis was performed, which showed a significant odds ratio for the incidence of dementia for two items, including abdominal circumference and insulin injections or oral hypoglycemic medications. The findings of our study suggested that a lower abdominal circumference had a higher risk for dementia incidence, and individuals who received insulin injections or oral hypoglycemic medications had a higher risk for dementia incidence based on the results of the health checkups conducted 10 years previously. Further, longer duration study with a larger sample is needed to identify the items from the specific health checkups that are associated with the risk of dementia.

Risk Factors for Incident Dementia Among Older Cubans.

Introduction: Little is known about risk factors of dementia in Latin American countries. We aimed to identify socio–demographic, health and lifestyle risk factors of incident dementia in Cuban older adults.Methods: Data were from 1,846 participants in the Cuban cohort of the 10/66 Dementia Research Group. Participants completed questionnaires, health examinations, and cognitive tests at baseline (2003–2006) and 4.5 years later (2007–2010). Associations between risk factors (baseline) and incident dementia (follow-up) were examined using logistic regression.Results: Just over 9% of participants developed dementia. Overall, older age and low physical activity were associated with incident dementia. In those 65–74 years of age, depression, stroke and low physical activity were associated with incident dementia. In those ≥75 years of age, low physical activity, never eating fish, and smoking were associated with incident dementia.Conclusions: Modifiable lifestyle factors play an important role in developing dementia in Cuban older adults. This knowledge opens up opportunities for preventive strategies.

Female reproductive factors and the risk of dementia: a nationwide cohort study.

The aim was to investigate whether female reproductive factors are associated with dementia. In all, 4696633 post-menopausal women without dementia were identified using the Korean National Health Insurance System database. Data on reproductive factors were collected using a self-administered questionnaire. Dementia was determined using dementia diagnosis codes and anti-dementia drug prescription. Cox proportional hazards regression was conducted to assess the hazard ratio (HR) for dementia according to reproductive factors. During a median follow-up of 5.74years, there were 212227 new cases of all-cause dementia (4.5%), 162901 cases of Alzheimer's disease (3.5%) and 24029 cases of vascular dementia (0.5%). The HR of dementia was 1.15 [95% confidence interval (CI) 1.03-1.16] for menarcheal age ≥17years compared with menarcheal age 13-14years, 0.79 (0.77-0.81) for menopausal age ≥55years compared with menopausal age <40years, and 0.81 (0.79-0.82) for fertility duration ≥40years compared with fertility duration <30years. Whilst being of parity one (HR 0.89, 95% CI 0.85-0.94) and breastfeeding <6months (HR 0.92, 95% CI 0.88-0.95) was associated with lower risk of dementia, being of parity two or more (HR 1.04, 95% CI 0.99-1.05) and breastfeeding ≥12months (HR 1.14, 95% CI 1.01-1.07) was associated with a higher risk of dementia than women without parity or breastfeeding history. Use of hormone replacement therapy and oral contraceptives independently reduced the dementia risk by 15% and 10%, respectively. Female reproductive factors are independent risk factors for dementia incidence, with higher risk associated with shorter lifetime endogenous estrogen exposure.

Using clinical registries, administrative data and electronic medical records to improve medication safety and effectiveness in dementia.

Clinical registries, routinely collected administrative data and electronic medical records (EMRs) provide new opportunities to investigate medication safety and effectiveness. This review outlines the strengths and limitations of these data, and highlights recent research related to safe and effective medication use in dementia. Clinical registries, administrative data and EMRs facilitate observational research among people often excluded from randomized controlled trials (RCTs). Larger sample sizes and longer follow-up times permit research into less common adverse events not apparent in RCTs. The validity of diagnoses recorded in administrative data and EMRs remains variable, although positive predictive values are typically high and sensitivity is low. Dispensing records are a rich source of data for estimating medication exposure. Recent research has investigated medications and prescribing patterns as risk factors for incident dementia, strategies to alleviate behavioural symptoms and the management of comorbidity. Common study protocols and common data models are examples of distributed network approaches increasingly used to conduct large and generalizable multi-database studies across different countries. Greater availability of electronic health data provides important opportunities to address evidence-practice gaps in relation to medication use and safety in people with dementia.

P.471 Reduced thickness of frontal cortex is a risk factor for incident dementia with psychosis in patients with mild cognitive impairment

P.471 Reduced thickness of frontal cortex is a risk factor for incident dementia with psychosis in patients with mild cognitive impairment

Postoperative delirium after hip surgery is a potential risk factor for incident dementia: A systematic review and meta-analysis of prospective studies

BackgroundAlthough a few trials have explored the relationship between postoperative delirium (POD) and incident dementia in patients with hip surgery, the numbers of participants in each study are relatively small. Thus, we performed a meta-analysis to examine whether POD after hip surgery is a risk factor for incident dementia. MethodsSix prospective cohort studies investigating the development of incident dementia in patients with POD after hip surgery were retrieved from PubMed, Embase, and the Cochrane Library. We performed a pairwise meta-analysis using fixed- and random- effect models. ResultsPOD significantly increased the risk of incident dementia and cognitive decline (overall odds ratio [ORs] = 8.957; 95 % confidence interval [CI], 5.444–14.737; P < 0.001 in fixed-effects model; overall ORs = 8.962; 95 % CI, 5.344–15.029; P < 0.001 in random-effects model). A publication bias was not evident in this study. ConclusionsOur meta-analysis revealed that POD after hip surgery is a risk factor for incident dementia. Early identification of cognitive function should be needed after surgery and appropriate prevention and treatment for dementia will be required, especially in cases with POD.