| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
From the Departments of Psychiatry (D.E.B., K.Y.), Medicine (K.E.C.), Neurology (K.Y.), and Epidemiology & Biostatistics (K.Y.), University of California, San Francisco, and San Francisco Veterans Affairs Medical Center; Kaiser Division of Research (D.E.B., K.E.C., R.A.W., K.Y.), Oakland, CA; and Departments of Epidemiology (L.H.K.) and Neurology and Psychiatry (O.L.L.), University of Pittsburgh, PA.
Address correspondence and reprint requests to Dr. Deborah E. Barnes, University of California, San Francisco, 4150 Clement Street, 151R, San Francisco, CA 94121 Deborah.Barnes{at}ucsf.edu
Objective: To develop a late-life dementia risk index that can accurately stratify older adults into those with a low, moderate, or high risk of developing dementia within 6 years.
Methods: Subjects were 3,375 participants in the Cardiovascular Health Cognition Study without evidence of dementia at baseline. We used logistic regression to identify those factors most predictive of developing incident dementia within 6 years and developed a point system based on the logistic regression coefficients.
Results: Subjects had a mean age of 76 years at baseline; 59% were women and 15% were African American. Fourteen percent (n = 480) developed dementia within 6 years. The final late-life dementia risk index included older age (1–2 points), poor cognitive test performance (2–4 points), body mass index <18.5 (2 points), 
1 apolipoprotein E 
4 alleles (1 point), cerebral MRI findings of white matter disease (1 point) or ventricular enlargement (1 point), internal carotid artery thickening on ultrasound (1 point), history of bypass surgery (1 point), slow physical performance (1 point), and lack of alcohol consumption (1 point) (c statistic, 0.81; 95% confidence interval, 0.79–0.83). Four percent of subjects with low scores developed dementia over 6 years compared with 23% of subjects with moderate scores and 56% of subjects with high scores.
Conclusions: The late-life dementia risk index accurately stratified older adults into those with low, moderate, and high risk of developing dementia. This tool could be used in clinical or research settings to target prevention and intervention strategies toward high-risk individuals.
Abbreviations: 3MS = Modified Mini-Mental State Examination; AD = Alzheimer disease; ADL = activities of daily living; BMI = body mass index; CABG = coronary artery bypass graft; CART = Classification And Regression Tree; CES-D = Center for Epidemiologic Studies–Depression Scale; CHF = congestive heart failure; CHS = Cardiovascular Health Study; CI = confidence interval; DSST = Digit Symbol Substitution Test; IADL = instrumental activities of daily living; MCI = mild cognitive impairment; MI = myocardial infarction; NPV = negative predictive value; PAD = peripheral artery disease; PPV = positive predictive value; ROC = receiver operating characteristic; UES = upper extremity strength.
Supplemental data at www.neurology.org
Editorial, page 168
e-Pub ahead of print on May 13, 2009, at www.neurology.org.
Support information is provided at the end of the article.
Disclosure: The authors report no disclosures.
Disclaimer: The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of the NIH.
Received October 20, 2008. Accepted in final form February 2, 2009.
Related Article
Neurology 2009 73: 168-169.
This article has been cited by other articles:
|
|
 |
|
  M. Kivipelto and A. Solomon Preventive neurology: On the way from knowledge to action Neurology, July 21, 2009; 73(3): 168 - 169. [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
