Risk factors for dementia in the cardiovascular health cognition study.
BACKGROUND
The Cardiovascular Health Cognition Study has evaluated the determinants of dementia among 3,608 participants that had a magnetic resonance imaging (MRI) of the brain in 1991 and were followed to 1998-1999.


METHODS
There were 480 incident dementia cases, 330 (69%) were classified as Alzheimer's disease (AD).


RESULTS
In univariate analysis, low scores on the Modified Mini-Mental State Examination (3MSE) and on the Digit Symbol Substitution Test as well as declines in scores over time prior to the development of dementia were significant predictors of dementia. A high ventricular grade on the MRI (atrophy) as well as high white matter grade, a number of brain infarcts on the MRI were all determinants of dementia. Apolipoprotein E epsilon4 (Apo(E-4)) was also a powerful predictor of dementia. In a multivariate Cox proportional hazards model controlling for race, gender and grade, the hazard ratios for age (1.1), 3MSE score (0.9), ventricular size (1.4), white matter grade (1.8), presence of large infarcts >3 mm (1.3) and Apo(E-4) (2.1) were significant predictors of dementia. The combination of an Apo(E-4) genotype, 3MSE score <90, > or =5 ventricular grade, > or =3 white matter grade at the time of the MRI were associated with a 17-fold increased risk (95% CI: 8.6-34.9) of dementia as compared to individuals with none of the above attributes.


CONCLUSIONS
Measures of cognition, Apo(E-4) and MRI of the brain are strong predictors of both dementia and of AD.
Kuller
Lewis H
LH
Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pa 15261, USA. kuller@pitt.edu
Lopez
Oscar L
OL
Newman
Anne
A
Beauchamp
Norman J
NJ
Burke
Greg
G
Dulberg
Corinne
C
Fitzpatrick
Annette
A
Fried
Linda
L
Haan
Mary N
MN
D000368:Aged; D000369:Aged, 80 and over; D001057:Apolipoproteins E / Q000235:genetics; D002318:Cardiovascular Diseases / Q000150:complications* / Q000235:genetics / Q000473:pathology; D003072:Cognition Disorders / Q000209:etiology* / Q000235:genetics / Q000473:pathology; D003704:Dementia / Q000209:etiology* / Q000235:genetics / Q000473:pathology; D005260:Female; D005838:Genotype; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D016017:Odds Ratio; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012307:Risk Factors
D001057:Apolipoproteins E