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Population attributable fractions of modifiable dementia risk factors in the Netherlands: a cross-sectional, time

Tessa L van Baal¹, Niels Janssen¹, Lukas A Duffner^1,2

¹Alzheimer Centre Limburg, Department of Psychiatry and Neuropsychology, Mental Health and Neuroscience Research Institute (MHeNs), Maastricht University, Maastricht, the Netherlands.

Eclinicalmedicine

|June 24, 2026

Abstract

Background:

Approximately 310,000 individuals in the Netherlands are currently living with dementia, and this number is projected to double by 2050. Examining the distribution of modifiable risk and protective factors is essential for developing effective dementia risk reduction strategies. This study aimed to estimate the population attributable fractions (PAFs) of seven common modifiable risk factors for dementia in the Netherlands.

Methods:

Nationally representative cross-sectional data from four waves of the Dutch Public Health Monitor surveys (2012-2022) were analysed, with sample sizes ranging from 302,422 to 409,278 respondents. Individuals were included in the analytical sample if data were available on all seven modifiable risk factors for dementia. PAFs were calculated using a life-course approach, categorising low educational attainment in earlylife (<45 years); obesity, physical inactivity, smoking, excessive alcohol consumption, and depression in mid-life (45-65 years); and social isolation in late-life (>65 years). PAFs were estimated overall and stratified by sex, household income, migration background, and region.

Findings:

Overall PAFs remained stable, with estimates of 30·9% [16·8-43·4] in 2012, 29·9% [16·4-42·1] in 2016, 29·7% [16·5-41·4] in 2020, and 31·1% [17·7-43·2] in 2022. The largest proportion of dementia cases was attributable to social isolation, followed by physical inactivity and depression. Stratified analyses showed comparable PAFs between females and males. In contrast, differences were observed across other subgroups. PAFs were higher among people with lower household income and among first-generation migrants. PAFs also showed regional variation.

Interpretation:

Despite shifts in individual modifiable risk factors, the overall potential for dementia risk reduction in the Netherlands remained stable over the past decade. At the same time, marked inequalities persisted across regions and structurally disadvantaged groups. Future work should prioritise the development of targeted, equity-focused dementia risk reduction strategies.

Funding:

The BIRD-NL consortium, funded by The Netherlands Organisation for Health Research and Development (ZonMw) as part of the National Dementia Strategy 2021-2030 of the Ministry of Health, Welfare and Sport.

Keywords:

Dementia Health equity Population attributable fractions Risk reduction The Netherlands

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