II-2.

Introduction Longitudinal studies examining the effect of endogenous estrogens on dementia risk are needed to understand why women have higher dementia incidence than men after age 85. Methods A population‐based sample of women with natural menopause (N = 1364) from Gothenburg, Sweden, was followed from 1968‐2012. Information on endogenous estrogens (age at menarche and menopause, number of pregnancies, and months of breastfeeding) was obtained from interviews in 1968‐1992. Dementia was diagnosed according to established criteria based on information from neuropsychiatric examinations and close informant interviews. Results We found that longer reproductive period was associated with increased risk of dementia (hazard ratio [HR] per year 1.06, 95% confidence interval [CI] 1.03‐1.20) and Alzheimer's disease (AD) (1.06, 1.02‐1.11), particularly for those with dementia (1.10, 1.04‐1.17) and AD (1.15, 1.06‐1.26) onset after age 85. Discussion These results may explain why women have higher dementia incidence compared to men after age 85, the age with the highest number of dementia cases.

The occurrence of mental disorders is likely to be underestimated in studies with this design and with substantial dropout rates. However, the study participants can most likely be a base for generalising risk indicators for, or social consequences of,mental disorder, to the general population.

ObjectiveTo investigate whether cognitive and physical activities in midlife are associated with reduced risk of dementia and dementia subtypes in women followed for 44 years.MethodsA population-based sample of 800 women aged 38–54 years (mean age 47 years) was followed from 1968 to 2012. Cognitive (artistic, intellectual, manual, religious, and club) and physical activity were assessed at baseline. During follow-up, dementia (n = 194), Alzheimer disease (n = 102), vascular dementia (n = 27), mixed dementia (n = 41), and dementia with cerebrovascular disease (n = 81) were diagnosed according to established criteria based on information from neuropsychiatric examinations, informant interviews, hospital records, and registry data. Cox regression models were used with adjustment for age, education, socioeconomic status, hypertension, body mass index, cigarette smoking, diabetes mellitus, angina pectoris, stress, and major depression.ResultsWe found that cognitive activity in midlife was associated with a reduced risk of total dementia (hazard ratio [HR] 0.66; 95% confidence interval [CI] 0.49–0.89) and Alzheimer disease (HR 0.54; 95% CI 0.36–0.82) during follow-up. Physical activity in midlife was associated with a reduced risk of mixed dementia (HR 0.43; 95% CI 0.22–0.86) and dementia with cerebrovascular disease (HR 0.47; 95% CI 0.28–0.78). The results were similar after excluding those who developed dementia before 1990 (n = 21), except that physical activity was then also associated with reduced risk of total dementia (HR 0.67; 95% CI 0.46–0.99).ConclusionOur findings suggests that midlife cognitive and physical activities are independently associated with reduced risk of dementia and dementia subtypes. The results indicate that these midlife activities may have a role in preserving cognitive health in old age.

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A population study of women in Gothenburg, Sweden, is presented. The women were representative of the total female population in Gothenburg in the age strata 38, 46, 50, 54 and 60 years. Altogether 1 462 women participated in the examination, the participation rate being 90.1%. Social data of participants and non‐participants are given. The performance of the examination is described and research projects are outlined. It is concluded that the selection of a strictly representative sample, together with careful uniformity of performance and high participation rate, will make it possible to draw valid conclusions about the total population of middle‐aged women in Gothenburg.

Our study suggests that midlife neuroticism is associated with increased risk of AD dementia, and that distress mediates this association. The results have clinical implications because a group of women at risk of AD dementia is identified.

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