Cumulative health deficits, APOE genotype, and risk for later-life mild cognitive impairment and dementia
| Autor: | David D. Ward, Kenneth Rockwood, Lindsay M. K. Wallace |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Apolipoprotein E
0303 health sciences medicine.medical_specialty business.industry Risk effect Frailty Index Cognition medicine.disease 03 medical and health sciences Psychiatry and Mental health 0302 clinical medicine Internal medicine Genotype Medicine Dementia Surgery Neurology (clinical) Risk factor business Cognitive impairment 030217 neurology & neurosurgery 030304 developmental biology |
| Zdroj: | Journal of Neurology, Neurosurgery & Psychiatry. 92:136-142 |
| ISSN: | 1468-330X 0022-3050 |
| DOI: | 10.1136/jnnp-2020-324081 |
| Popis: | ObjectiveTo determine whether health-deficit accumulation is associated with the risks of mild cognitive impairment (MCI) and dementia independently of APOE genotype.MethodsA frailty index was calculated using the deficit-accumulation approach in participants aged 50 years and older from the National Alzheimer’s Coordinating Center. Cognitive status was determined by clinical evaluation. Using multistate transition models, we assessed the extent to which an increasing degree of frailty affected the probabilities of transitioning between not cognitively impaired (NCI), MCI, and dementia.ResultsParticipants (n=14 490) had a mean age of 72.2 years (SD=8.9 years; range=50–103 years). Among those NCI at baseline (n=9773), each 0.1 increment increase in the frailty index was associated with a higher risk of developing MCI and a higher risk of progressing to dementia. Among those with MCI at baseline (n=4717), higher frailty was associated with a higher risk of progressing to dementia, a lower probability of being reclassified as NCI, and a higher likelihood of returning to MCI in those that were reclassified as NCI. These risk effects were present and similar in both carriers and non-carriers of the APOE ε4 allele.ConclusionAmong older Americans, health-deficit accumulation affects the likelihood of progressive cognitive impairment and the likelihood of cognitive improvement independently of a strong genetic risk factor for dementia. Frailty represents an important risk factor for cognitive dysfunction and a marker of potential prognostic value. |
| Databáze: | OpenAIRE |
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