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. 2024 Apr 25;16(1):92.
doi: 10.1186/s13195-024-01436-5.

Effects of risk factors on the development and mortality of early- and late-onset dementia: an 11-year longitudinal nationwide population-based cohort study in South Korea

Min Young Chun #  1   2   3 , Wonjeong Chae #  4 , Sang Won Seo  1   5   6   7 , Hyemin Jang  1   8 , Jihwan Yun  1   9 , Duk L Na  1 , Dongwoo Kang  10 , Jungkuk Lee  10 , Dustin B Hammers  11 , Liana G Apostolova  11   12   13 , Sung-In Jang #  14 , Hee Jin Kim #  15   16   17   18   19
Affiliations

Effects of risk factors on the development and mortality of early- and late-onset dementia: an 11-year longitudinal nationwide population-based cohort study in South Korea

Min Young Chun et al. Alzheimers Res Ther. .

Abstract

Background: Early-onset dementia (EOD, onset age < 65) and late-onset dementia (LOD, onset age ≥ 65) exhibit distinct features. Understanding the risk factors for dementia development and mortality in EOD and LOD respectively is crucial for personalized care. While risk factors are known for LOD development and mortality, their impact on EOD remains unclear. We aimed to investigate how hypertension, diabetes mellitus, hyperlipidemia, atrial fibrillation, and osteoporosis influence the development and mortality of EOD and LOD, respectively.

Methods: Using the Korean National Health Insurance Service (NHIS) database, we collected 546,709 dementia-free individuals and followed up for 11 years. In the two study groups, the Younger group (< 65 years old) and the Older group (≥ 65 years old), we applied Cox proportional hazard models to assess risk factors for development of EOD and LOD, respectively. Then, we assessed risk factors for mortality among EOD and LOD.

Results: Diabetes mellitus and osteoporosis increased the risk of EOD and LOD development. Hypertension increased the risk of EOD, while atrial fibrillation increased the risk of LOD. Conversely, hyperlipidemia exhibited a protective effect against LOD development. Additionally, diabetes mellitus increased mortality in EOD and LOD. Hypertension and atrial fibrillation increased mortality in LOD, while hyperlipidemia decreased mortality in EOD and LOD.

Conclusions: Risk factors influencing dementia development and mortality differed in EOD and LOD. Targeted public health interventions addressing age-related risk factors may reduce dementia incidence and mortality.

Keywords: Dementia; Development; Mortality; Onset age; Population study; Risk factor.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart of the study population. †Among the 418,861 individuals who did not develop EOD until age 65, 114,288 individuals reached 65 years of age during the study window. After excluding individuals with missing data for demographic/socioeconomic (n = 2,188) and deceased/censored/diagnosed with dementia within 30 days after entry to the older group (n = 106), 111,994 individuals were transitioned from the Younger group to the Older group
Fig. 2
Fig. 2
Hazard ratios of each risk factor for development of early-onset dementia and late-onset dementia among the Younger and Older groups, respectively. The hazard ratios are expressed as boxes and the 95% confidence intervals are expressed as limit lines. The multivariate Cox proportional hazard models included age, sex, risk factor of interest (hypertension, diabetes, atrial fibrillation, hyperlipidemia, and osteoporosis), other risk factors in Charlson comorbidity index, socioeconomic status, and residential area as independent variables. Abbreviations: HR, hazard ratios; CI, confidence intervals
Fig. 3
Fig. 3
Hazard ratios of each risk factor for all-cause mortality among early-onset dementia and late-onset dementia groups. The hazard ratios are expressed as boxes and the 95% confidence intervals are expressed as limit lines. Abbreviations: HR, hazard ratios; CI, confidence intervals. The multivariate Cox proportional hazard models included age, sex, risk factor of interest (hypertension, diabetes, atrial fibrillation, hyperlipidemia, and osteoporosis), other risk factors in Charlson comorbidity index, socioeconomic status, and residential area as independent variables
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