Lessons From Mixed Dementia

Rockwood, Kenneth

doi:10.1017/s1041610297004407

Cited by 36 publications

(34 citation statements)

References 15 publications

(13 reference statements)

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“…97,98 In CSHA, a history of diabetes mellitus and smoking were not associated with an increased VaD risk as reported by other groups. 99 A basal metabolic index (wt in kgs/height in m 2 ) of <20 was associated with a near significant increased risk to VaD, extending an observation from other studies.…”

Section: Vascular Dementia Risk Factorssupporting

confidence: 62%

Diagnosis, Classification and Natural History of Degenerative Dementias

Feldman

2001

Can. J. Neurol. Sci.

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The release of the first approved medications for the treatment of Alzheimer’s disease in Canada has highlighted the renewed need and importance of diagnostic accuracy and understanding of the spectrum of the dementias. The epidemiological scope of the problem of dementia in Canada including risk factors, caregiving patterns and costs of care have been well-characterized through the Canadian Study of Health and Aging (CSHA 1991-1996) with some of the key findings reviewed here. Beyond Alzheimer’s disease the phenotypes and genotypes of the other degenerative dementias have been emerging with proposed operational diagnostic criteria that should facilitate their recognition in clinical practice. This paper reviews the clinical phenotypes of the most common causes of dementia with a proposed classification scheme and with discussion of their relevance from a differential treatment standpoint. This paper served as a background document for the working group of the Consensus Conference on Dementia (C3D) in February 1998 and has been revised subsequently for this publication.

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Section: Vascular Dementia Risk Factorssupporting

confidence: 62%

Diagnosis, Classification and Natural History of Degenerative Dementias

Feldman

2001

Can. J. Neurol. Sci.

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“…These factors seem chiefly to share either a broadly construed mechanistic riske.g., stress 7 -or the ability to induce the need for repair, with disease arising as a consequence of aberrant repair processes. 28 A broad view of how to approach dementia epidemiology seems particularly important, given that on a population basis, most dementia occurs in very late life, by which time many interacting medical and social problems commonly have accumulated. 12 Given that mixed dementia is often the most common form of dementia, 29 -31 it is essential that we consider approaches which can take a multiplicity of causes into account, and to relate these to mechanisms.…”

Section: Resultsmentioning

confidence: 99%

Nontraditional risk factors combine to predict Alzheimer disease and dementia

Song¹,

Mitnitski²,

Rockwood³

2011

Neurology

197

162

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Objective: To investigate whether dementia risk can be estimated using only health deficits not known to predict dementia. Methods:A frailty index consisting of 19 deficits not known to predict dementia (the nontraditional risk factors index [FI-NTRF]) was constructed for 7,239 cognitively healthy, communitydwelling older adults in the Canadian Study of Health and Aging. From baseline, their 5-year and 10-year risks for Alzheimer disease (AD), dementia of all types, and survival were estimated. Results:The FI-NTRF was closely correlated with age (r 2 Ͼ 0.96, p Ͻ 0.001). The incidence of AD and dementia increased exponentially with the FI-NTRF (r 2 Ͼ 0.75, p Ͻ 0.001 over 10 years).Adjusted for age, sex, education, and baseline cognition, the odds ratio of dementia increased by 3.2% (p ϭ 0.021) for each deficit (that was not known to predict dementia) accumulated, outperforming the individual cognitive risk factors. The FI-NTRF discriminated people with AD and allcause dementia from those who were cognitively healthy with an area under the receiver operating characteristic curve of 0.66 Ϯ 0.03. Conclusions:Comprehensive re-evaluation of a well-characterized cohort showed that ageassociated decline in health status, in addition to traditional risk factors, is a risk factor for AD and dementia. General health may be an important confounder to consider in dementia risk factor evaluation. If a diverse range of deficits is associated with dementia, then improving general health might reduce dementia risk. Age remains the single most potent risk factor for late-onset Alzheimer disease (AD). This is so even though many age-related health problems, such as heart disease, hypertension, stroke, and diabetes, are recognized as AD risk factors. 1,2 To this list, other problems common in older people might be added: high plasma cholesterol, morning cough, a sedentary lifestyle, pesticide exposure, dementia in a spouse, and feeling tired, lonely, or unwell have each also been reported to increase the risk of dementia. 3-8The diversity of risks for late-life dementia, and in particular AD, may itself be informative. Their broad range suggests that AD is more likely in people with a broadly constituted decline in health. Support for this hypothesis comes from studies that link frailty to dementia, 9 and more generally, to cognitive decline, 10 and from a recent review which found that dementia risk was best predicted by models that used multiple risk factors. 11If most known risk factors individually discriminate people at risk only poorly, 11 there may be merit in using an integrative approach to their evaluation. In studies of aging, the frailty From the

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“…So at a broad level, if what these risk factors have in common is the need for the body to mount responses, then in people with aberrant repair processes, or exhausted ones, various types of damage can accumulate [5]. This can be formulated precisely, by using the mathematics of queuing theory.…”

Section: Discussionmentioning

confidence: 99%

Age-related deficit accumulation and the risk of late-life dementia

Song¹,

Mitnitski²,

Rockwood³

2014

Alzheimers Res Ther

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Introduction: Many age-related health problems have been associated with dementia, leading to the hypothesis that late-life dementia may be determined less by specific risk factors, and more by the operation of multiple health deficits in the aggregate. Our study addressed (a) how the predictive value of dementia risk varies by the number of deficits considered and (b) how traditional (for example. vascular risks) and nontraditional risk factors (for example, foot problems, nasal congestion) compare in their predictive effects.

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Lessons From Mixed Dementia

Cited by 36 publications

References 15 publications

Diagnosis, Classification and Natural History of Degenerative Dementias

Diagnosis, Classification and Natural History of Degenerative Dementias

Nontraditional risk factors combine to predict Alzheimer disease and dementia

Age-related deficit accumulation and the risk of late-life dementia

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