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Combining modifiable risk factors and risk of dementia: a systematic review and meta-analysis
Open accessAbstract
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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“Increasing evidence also points to air pollution as an emerging risk factor for dementia, heart and cardiovascular disease and lung cancer.1,14”
From Common risk factors for major noncommunicable disease, a systematic overview of reviews and commentary: the implied potential for targeted risk reduction (2019) · cites this paper as [14]
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“Evidence is increasing for air pollution to be risk factor for cognitive decline, Alzheimer’s disease and other cognitive disorders, as stated in several literature reviews (Block and Calderón-Garcidueñas, 2009; Block et al., 2012; Clifford et al., 2016; Kilian and Kitazawa, 2018; Peters et al., 2019; Power et al., 20…”
Metadata
- 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
- Venue
- BMJ Open
- Publisher
- BMJ
- Published
- 2019-01
- Volume
- 9
- Issue
- 1
- Pages
- e022846
- ISSN
- 2044-6055 (ISSN-L)
- 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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