The association of vascular disorders with incident dementia in different age groups

Abstract

Background: There is increasing evidence that dementia risk associated with vascular disorders is age dependent. Large population-based studies of incident dementia are necessary to further elucidate this effect. Therefore, the aim of the present study was to determine the association of vascular disorders with incident dementia in different age groups in a large primary care database.

Methods: We included 442,428 individuals without dementia aged ≥ 65 years from the longitudinal primary care Integrated Primary Care Information (IPCI) database. We determined in 6 age groups (from 65-70 to ≥ 90 years) the risk of hypertension, diabetes mellitus, dyslipidemia, stroke, myocardial infarction, heart failure, and atrial fibrillation for all-cause dementia using incidence rate ratios, Cox regression, and Fine and Gray regression models.

Results: The mean age at inclusion of the total study sample was 72.4 years, 45.7% of the participants were male, and median follow-up was 3.6 years. During 1.4 million person-years of follow-up, 13,511 individuals were diagnosed with dementia. The risk for dementia decreased with increasing age for all risk factors and was no longer significant in individuals aged ≥ 90 years. Adjusting for mortality as a competing risk did not change the results.

Conclusions: We conclude that vascular disorders are no longer a risk factor for dementia at high age. Possible explanations include selective survival of individuals who are less susceptible to the negative consequences of vascular disorders and differences in follow-up time between individuals with and without a vascular disorder. Future research should focus on the identification of other risk factors than vascular disorders, for example, genetic or inflammatory processes, that can potentially explain the strong age-related increase in dementia risk.

Keywords: Aging; Cardiovascular risk factors; Dementia; Primary care; Vascular disease; Vascular disorders.

Fig. 1

Association of risk factor with incident dementia per 5 year age groups (except for individuals ≥ 90, in which no upper age limit was used). IRR, incidence rate ratio; PY, person-years; CI, confidence interval; *p < 0.05

Fig. 2

Risk of incident dementia in the presence of a risk factor per 5-year age group (except for individuals ≥ 90, in which no upper age limit was used). Hazard ratio from model 1 (HR1) determined with Cox regression analyses adjusted for age at study entry and sex; hazard ratio from model 2 (HR2) determined with competing risk analyses adjusted for age at study entry and sex; the HR on the y-axis is graphed on a log scale. CI, confidence interval; *HRs changed significantly (p < 0.0071) between age groups, determined with trend analysis including the interaction of age group with risk factor