Public Health.

Area of Science:

• Neurology
• Public Health
• Gerontology

Background:

• Dementia affects nearly 900,000 individuals in the UK.
• Transitions between cognitive states (no cognitive impairment, mild cognitive impairment, dementia) and death are not well understood.
• The influence of demographic factors on these transitions requires further investigation.

Purpose of the Study:

• To investigate how sex, ethnicity, and socioeconomic status affect transitions between no cognitive impairment (NCI), mild cognitive impairment (MCI), dementia, and death.
• To analyze cognitive trajectories in a large UK population.

Main Methods:

• Analysis of electronic health records from the UK Clinical Practice Research Datalink (2000-2022).
• Inclusion of 668,554 adults diagnosed with dementia or MCI, followed for up to 10 years prior to diagnosis.
• Utilized a multistate Markov model to estimate transition hazard ratios and time probabilities.

Main Results:

• Women had lower risks for transitions from MCI to dementia, MCI to NCI, and dementia to death compared to men.
• Non-white populations exhibited higher risks for NCI to MCI and MCI to dementia transitions, but lower risks for dementia to death.
• Higher socioeconomic status was associated with increased transitions from MCI to dementia and MCI to NCI.

Conclusions:

• Sex, ethnicity, and socioeconomic status are significant determinants of cognitive trajectories in the UK.
• The study highlights substantial probabilities of reverse transitions (e.g., dementia to MCI), warranting further research.
• Findings underscore the need for personalized approaches to dementia care considering diverse demographic factors.