Cited by 255Dementia and Cognitive Impairment ResearchMenopause: Health Impacts and TreatmentsCardiovascular Health and Risk Factors

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Combining modifiable risk factors and risk of dementia: a systematic review and meta-analysis

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Peters, Ruth, Booth, Andrew, Rockwood, Kenneth, Peters, Jean, D’Este, Catherine, Anstey, Kaarin J·2019·BMJ Open

DOI 10.1136/bmjopen-2018-022846PMC PMC6352772

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Abstract

Objective: To systematically review the literature relating to the impact of multiple co-occurring modifiable risk factors for cognitive decline and dementia. Design: A systematic review and meta-analysis of the literature relating to the impact of co-occurring key risk factors for incident cognitive decline and dementia. All abstracts and full text were screened independently by two reviewers and each article assessed for bias using a standard checklist. A fixed effects meta-analysis was undertaken. Data sources: Databases Medline, Embase and PsycINFO were searched from 1999 to 2017. Eligibility criteria: For inclusion articles were required to report longitudinal data from participants free of cognitive decline at baseline, with formal assessment of cognitive function or dementia during follow-up, and an aim to examine the impact of additive or clustered comorbid risk factor burden in with two or more core modifiable risk factors. Results: Seventy-nine full-text articles were examined. Twenty-two articles (18 studies) were included reporting data on >40 000 participants. Included studies consistently reported an increased risk associated with greater numbers of intraindividual risk factors or unhealthy behaviours and the opposite for healthy or protective behaviours. A meta-analysis of studies with dementia outcomes resulted in a pooled relative risk for dementia of 1.20 (95% CI 1.04 to 1.39) for one risk factor, 1.65 (95% CI 1.40 to 1.94) for two and 2.21 (95% CI 1.78 to 2.73) for three or more, relative to no risk factors. Limitations include dependence on published results and variations in study outcome, cognitive assessment, length of follow-up and definition of risk factor exposure. Conclusions: The strength of the reported associations, the consistency across studies and the suggestion of a dose response supports a need to keep modifiable risk factor exposure to a minimum and to avoid exposure to additional modifiable risks. Further research is needed to establish whether particular combinations of risk factors confer greater risk than others. PROSPERO registration number: 42016052914.

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Background
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“7,8 Therefore, this study used the AL index to quantify the cumulative physiological burden imposed by stressors over time.”
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“It was reported that, compared with no risk factors, the relative risk for dementia was 1 · 20 for one risk factor, 1 · 65 for two and 2 · 21 for three or more risk factors (61) .”
Background
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Self-citation
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Cognitive Impairment and Its Associated Determinants Among the Elderly Population of Telangana, India: An Analytical Prevalence Study
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“Dementia-related risk is also higher in smokers compared to that of never-smokers, with cessation of smoking for more than three years reducing the risk level to that of never-smokers [8-11].”
Background
A Multimodal Risk Network Predicts Executive Function Trajectories in Non-demented Aging
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“…review on combining multiple co-occurring modi ﬁ able risk factors and risk of dementia noted that “ one risk factor is associated with a 20% increase in the risk of incident dementia, two risk factors with a 65% increased risk and three or more with a doubling risk ” (Peters et al., 2019, p. 19).”
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Establishing a Digitally Enabled Healthcare Framework for Enhanced Prevention, Risk Identification, and Relief for Dementia and Frailty
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“12 There are numerous models developed for dementia risk assessment, given that each risk factor contributes differently to overall risk, the CAIDE (Cardiovascular Risk Factors, Ageing, and Incidence of Dementia) score was developed, incorporating multiple non-modifiable (age, sex, education) and…”
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Background
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Influential
Associations of Modifiable Behavioral Risk Factor Combinations at 65 to 74 Years Old With Cognitive Health Span for 20 Years
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“A recent meta-analysis (15) found that, compared with individuals with no risk factors, dementia risk increased by 20% in people with one risk factor, 65% in people with two risk factors, and 100% in people with three or more risk factors.”
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“…become increasingly susceptible to a host of potential medical complications (e.g., cardiovascular diseases, diabetes, and cerebrovascular insult) which may accelerate cognitive aging (Izzo et al., 2018; Lloyd-Jones et al., 2006; Lu et al., 2009; Peters et al., 2019; Yaffe et al., 2020).”
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Authors: Peters, R., Booth, A., Rockwood, K., Peters, J., D’Este, C., & Anstey, K. J.
Affiliations: UNSW Sydney (AU)
University of Sheffield (GB)
Dalhousie University (CA)
Australian National University (AU)
Corresponding author: Peters, Ruth
ORCID: Peters, Ruth
Booth, Andrew
Rockwood, Kenneth
D’Este, Catherine
Anstey, Kaarin J
Venue: BMJ Open
Publisher: BMJ
Published: 2019-01
Volume: 9
Issue: 1
Pages: e022846
ISSN: 2044-6055 (ISSN-L)
DOI: 10.1136/bmjopen-2018-022846
PMC: PMC6352772
OpenAlex: W2912629063
Cited by: 255
References: 135
Citations by year: 2026: 32 · 2025: 42 · 2024: 37 · 2023: 32 · 2022: 36 · 2021: 42 · 2020: 30 · 2019: 4
FWCI: 4.73
Type: journal article
Language: en
Open access: gold
doi.org
Licence: cc-by-nc
Locations: BMJ Open (publishedVersion, cc-by-nc)
Europe PMC (PubMed Central) (publishedVersion, other-oa)
PubMed Central (publishedVersion, cc-by-nc)
PubMed (publishedVersion)
White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
UNSWorks (UNSW Sydney) (submittedVersion, cc-by-nc-nd)
ANU Open Research (Australian National University) (submittedVersion, cc-by-nc)
Spiral (Imperial College London) (submittedVersion, cc-by-nc)
NOVA (University of Newcastle Australia) (submittedVersion, cc-by-nc)
Funders: Dalhousie Medical Research Foundation
Dalhousie University
Canadian Institutes of Health Research
Topics: Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Menopause: Health Impacts and Treatments
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
Keywords: dementia risk, cognitive decline, modifiable risk factors, comorbidities, risk factor burden, protective behavior, unhealthy behaviours, dose-response relationship
MeSH terms: Dementia, Humans, Risk Factors, Incidence, Cognitive Dysfunction

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Combining modifiable risk factors and risk of dementia: a systematic review and meta-analysis

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