title: The potential for prevention of dementia across two decades: the prospective, population-based Rotterdam Study.
abstract: BACKGROUND
  Cardiovascular factors and low education are important risk factors of dementia. We provide contemporary estimates of the proportion of dementia cases that could be prevented if modifiable risk factors were eliminated, i.e., population attributable risk (PAR). Furthermore, we studied whether the PAR has changed across the last two decades.
  
  
  METHODS
  We included 7,003 participants of the original cohort (starting in 1990) and 2,953 participants of the extended cohort (starting in 2000) of the Rotterdam Study. Both cohorts were followed for dementia until ten years after baseline. We calculated the PAR of overweight, hypertension, diabetes mellitus, cholesterol, smoking, and education. Additionally, we assessed the PAR of stroke, coronary heart disease, heart failure, and atrial fibrillation. We calculated the PAR for each risk factor separately and the combined PAR taking into account the interaction of risk factors.
  
  
  RESULTS
  During 57,996 person-years, 624 participants of the original cohort developed dementia, and during 26,177 person-years, 145 participants of the extended cohort developed dementia. The combined PAR in the original cohort was 0.23 (95 % CI, 0.05-0.62). The PAR in the extended cohort was slightly higher at 0.30 (95 % CI, 0.06-0.76). The combined PAR including cardiovascular diseases was 0.25 (95 % CI, 0.07-0.62) in the original cohort and 0.33 (95 % CI, 0.07-0.77) in the extended cohort.
  
  
  CONCLUSIONS
  A substantial part of dementia cases could be prevented if modifiable risk factors would be eliminated. Although prevention and treatment options of cardiovascular risk factors and diseases have improved, the preventive potential for dementia has not declined over the last two decades.
authors.affiliation: Department of Epidemiology, Erasmus University Medical Center, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands. r.f.a.g.debruijn@erasmusmc.nl.|Department of Neurology, Erasmus University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands. r.f.a.g.debruijn@erasmusmc.nl.
authors.forename: Renée F A G
authors.initials: RF
authors.lastname: de Bruijn
authors.affiliation: Department of Epidemiology, Erasmus University Medical Center, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands. m.bos@erasmusmc.nl.
authors.forename: Michiel J
authors.initials: MJ
authors.lastname: Bos
authors.affiliation: Department of Epidemiology, Erasmus University Medical Center, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands. m.portegies@erasmusmc.nl.|Department of Neurology, Erasmus University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands. m.portegies@erasmusmc.nl.
authors.forename: Marileen L P
authors.initials: ML
authors.lastname: Portegies
authors.affiliation: Department of Epidemiology, Erasmus University Medical Center, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands. a.hofman@erasmusmc.nl.
authors.forename: Albert
authors.initials: A
authors.lastname: Hofman
authors.affiliation: Department of Epidemiology, Erasmus University Medical Center, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands. o.franco@erasmusmc.nl.
authors.forename: Oscar H
authors.initials: OH
authors.lastname: Franco
authors.affiliation: Department of Neurology, Erasmus University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands. p.j.koudstaal@erasmusmc.nl.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Koudstaal
authors.affiliation: Department of Epidemiology, Erasmus University Medical Center, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands. m.a.ikram@erasmusmc.nl.|Department of Neurology, Erasmus University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands. m.a.ikram@erasmusmc.nl.|Department of Radiology, Erasmus University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands. m.a.ikram@erasmusmc.nl.
authors.forename: M Arfan
authors.initials: MA
authors.lastname: Ikram
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000517:prevention & control; D015984:Causality; D003704:Dementia / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control; D003920:Diabetes Mellitus / Q000453:epidemiology*; D015987:Effect Modifier, Epidemiologic; D005260:Female; D006266:Health Education / Q000379:methods / Q000458:organization & administration; D006801:Humans; D006937:Hypercholesterolemia / Q000453:epidemiology*; D006973:Hypertension / Q000453:epidemiology*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D050177:Overweight / Q000453:epidemiology; D011315:Preventive Medicine / Q000379:methods; D011446:Prospective Studies; D012307:Risk Factors; D040242:Risk Reduction Behavior; D012907:Smoking / Q000453:epidemiology*