Risk factors for incidence of dementia in primary care practice: a retrospective cohort study in older adults

Abstract

Background The dementias are long-term, chronic conditions caused by progressive neurological degeneration. Current literature suggests that cardiovascular disease risk factors may contribute to the onset of dementia; however, evidence of these associations is inconsistent. Objectives This study aimed to examine the impact of risk factors on dementia onset in older adults diagnosed and managed in Canadian primary care settings. Methods A retrospective cohort study was employed utilizing electronic medical records data in the Canadian Primary Care Sentinel Surveillance Network (CPCSSN). Patients aged 65+ years with no dementia diagnosis at baseline who were followed from 2009 to 2017 with a run-in year to exclude existing undiagnosed dementia cases. Multivariate Cox proportional hazard models were used to estimate risk. Results Age was associated with an increased incidence risk of dementia in both examined age groups: 65–79 years (13%) and 80+ years (5%). History of depression increased dementia risk by 38% and 34% in the age groups. There were significant associations with lower social deprivation area quintile, smoking history, osteoarthritis, and diabetes mellitus in patients aged 65–79 years but not in those aged 80+ years. Sex, hypertension, obesity, dyslipidemia, and the use of antihypertensive medications and statins were not associated with risk of incident dementia diagnosis. Conclusions The association between chronic health conditions and dementia onset is complicated. Primary care electronic medical record data might be useful for research in this topic, though follow-up time is still relatively short to observe a clear causal relationship. Future studies with more complete data may provide evidence for dementia preventive strategies within primary care practice.

Assessing Risk Factors for Cognitive Decline Using Electronic Health Records: A Scoping Review

“…30 Conversely, another study determined that both malignant melanoma and non-melanoma skin cancers were associated with a decreased ADRD risk, suggesting a protective effect. 60 Kidney disease, 21, 51 hip fracture, 46 and osteoarthritis 54 were also identified as risk factors for ADRD.…”

“…Both smoking 54 and alcohol use– as determined by overall consumption and alcohol-induced loss of consciousness 56 – were identified as risk factors for ADRD. Conversely, a healthy lifestyle, characterized by no current smoking, moderate alcohol consumption, regular physical activity, healthy diet, adequate sleep duration, less sedentary behavior, and frequent social contact, exhibited a protective effect against ADRD in patients with type II diabetes.…”

“…88, 89 However, the third study found no significant correlation. 23 Neighborhood disadvantage 54, 90 and low occupational position 23 were associated with higher risk of ADRD.…”

“…ICD codes were the most prevalent, featuring in 81.3% (n=65) of the studies, followed by Read codes in 11.3% (n=9). In addition to these coding systems, several other methods were used to define the outcomes, including prescriptions for dementia medications, 18,45,47,54 cognitive function tests, 27,53,57 referencing the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition), 50,58,59 conducting screening interviews, 43,57 and neuroimaging. 27…”

Prevalence of Dementia among Patients Hospitalized with Type 2 Diabetes Mellitus in Spain, 2011–2020: Sex-Related Disparities and Impact of the COVID-19 Pandemic

“…Another cohort study of 245,483 participants showed that older adults with multiple comorbid conditions had a higher risk of dementia [ 26 ]. Other factors reported as being relevant include aging, polypharmacy, and a heavier treatment burden, all of which might affect the brain and cause neural injuries [ 27 , 28 ].…”