title: Risk factors across the life course and dementia in a Brazilian population: results from the Sao Paulo Ageing & Health Study (SPAH).
abstract: BACKGROUND
  Several mechanisms have been suggested to explain the association between adversities across life and dementia. This study aimed to investigate the association between indicators of socioeconomic disadvantages throughout the life-course and dementia among older adults in Sao Paulo, Brazil and to explore possible causal pathways.
  
  
  METHODS
  We used baseline data from the SPAH study which involved participants aged 65 years and older (n = 2005). The outcome of interest was prevalent dementia. Exposures included in the analyses were socioeconomic position (SEP) indicators in childhood (place of birth and literacy) and adulthood (occupation and income), anthropometric measurements as markers of intrauterine and childhood environment (head circumference and leg length), smoking, diabetes and hypertension. Logistic regression models were used to test the hypothesized pathways and to assess whether there was an association between cumulative adversities across the life course and prevalent dementia.
  
  
  RESULTS
  Indicators of socioeconomic disadvantage in early life were associated with increased prevalence of dementia. This association was partially mediated through adulthood SEP. Head circumference and leg length were also clearly associated with dementia but there was no evidence that this association was mediated by early life socioeconomic disadvantage. There was an association between cumulative unfavourable conditions across the life course and dementia.
  
  
  CONCLUSIONS
  Early life disadvantages seem to operate through biological mechanisms associated with passive brain reserve and opportunities in life representing active cognitive reserve. Prevention of dementia should start early in life and continue through life span as seen with many other chronic diseases.
authors.affiliation: Department of Psychiatry, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil. scazufca@usp.br
authors.forename: Marcia
authors.initials: M
authors.lastname: Scazufca
authors.forename: Paulo R
authors.initials: PR
authors.lastname: Menezes
authors.forename: Ricardo
authors.initials: R
authors.lastname: Araya
authors.forename: Vanessa D
authors.initials: VD
authors.lastname: Di Rienzo
authors.forename: Osvaldo P
authors.initials: OP
authors.lastname: Almeida
authors.forename: David
authors.initials: D
authors.lastname: Gunnell
authors.forename: Debbie A
authors.initials: DA
authors.lastname: Lawlor
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology; D001938:Brazil; D002508:Cephalometry; D015331:Cohort Studies; D003704:Dementia / Q000175:diagnosis / Q000209:etiology*; D003920:Diabetes Mellitus; D005260:Female; D015577:Geriatric Assessment; D006304:Health Status; D006801:Humans; D006973:Hypertension; D007866:Leg / Q000033:anatomy & histology; D016015:Logistic Models; D008297:Male; D009790:Occupations; D016017:Odds Ratio; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D017678:Sex Distribution; D012907:Smoking; D012959:Socioeconomic Factors