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

Nienke LegdeurEmail author View ORCID ID profile,
Sven J. van der LeeView ORCID ID profile,
Marcel de Wilde,
Johan van der LeiView ORCID ID profile,
Majon Muller,
Andrea B. MaierView ORCID ID profile and
Pieter Jelle VisserView ORCID ID profile

Alzheimer's Research & Therapy201911:47

https://doi.org/10.1186/s13195-019-0496-x

Received: 12 December 2018
Accepted: 22 April 2019
Published: 17 May 2019

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.