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Examining multimorbidity contributors to dementia over time
Matthias Klee1, Sheila Markwardt2, Miriam R Elman2
1Department of Social Sciences, University of Luxembourg, Esch-sur-Alzette, Luxembourg.
Alzheimer'S & Dementia : the Journal of the Alzheimer'S Association
|February 23, 2025
Summary
Multimorbidity significantly increases dementia risk, with eight chronic conditions accounting for over 70% of cases. Targeting cardiovascular health may be key to reducing dementia incidence.
Area of Science:
- Gerontology
- Epidemiology
- Neurology
Background:
- Multimorbidity is a known risk factor for dementia.
- Previous studies did not fully capture the combined impact of conditions on dementia incidence, particularly regarding timing and additive effects.
Purpose of the Study:
- To estimate the joint contribution of specific chronic conditions to dementia incidence.
- To model additive contributions and temporal proximity in the sequential onset of conditions.
Main Methods:
- Analysis of 9944 participants (ages 68-99) from the Health and Retirement Study and Medicare beneficiaries (1998-2016).
- Utilized validated claims algorithms to encode Alzheimer's disease and related dementias (ADRD) and chronic conditions.
- Employed the longitudinal extension of the average attributable fraction (LE-AAF) to estimate condition contributions.
Main Results:
- Eight chronic conditions (hypertension, myocardial infarction, atrial fibrillation, diabetes, heart failure, ischemic heart disease, stroke, arthritis) accounted for 71.8% of incident ADRD cases.
- Hypertension was identified as the largest single contributor to dementia risk.
- Confidence intervals were narrowest for conditions within the cardiovascular pathway to dementia.
Conclusions:
- Multimorbidity plays a critical role in the incidence of dementia.
- Interventions targeting cardiovascular conditions may offer the most effective strategy for lowering dementia risk.
- The LE-AAF method explicitly accounts for longitudinal comorbidity patterns.
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