title: Predicting dementia risk in primary care: development and validation of the Dementia Risk Score using routinely collected data.
abstract: BACKGROUND
  Existing dementia risk scores require collection of additional data from patients, limiting their use in practice. Routinely collected healthcare data have the potential to assess dementia risk without the need to collect further information. Our objective was to develop and validate a 5-year dementia risk score derived from primary healthcare data.
  
  
  METHODS
  We used data from general practices in The Health Improvement Network (THIN) database from across the UK, randomly selecting 377 practices for a development cohort and identifying 930,395 patients aged 60-95 years without a recording of dementia, cognitive impairment or memory symptoms at baseline. We developed risk algorithm models for two age groups (60-79 and 80-95 years). An external validation was conducted by validating the model on a separate cohort of 264,224 patients from 95 randomly chosen THIN practices that did not contribute to the development cohort. Our main outcome was 5-year risk of first recorded dementia diagnosis. Potential predictors included sociodemographic, cardiovascular, lifestyle and mental health variables.
  
  
  RESULTS
  Dementia incidence was 1.88 (95% CI, 1.83-1.93) and 16.53 (95% CI, 16.15-16.92) per 1000 PYAR for those aged 60-79 (n = 6017) and 80-95 years (n = 7104), respectively. Predictors for those aged 60-79 included age, sex, social deprivation, smoking, BMI, heavy alcohol use, anti-hypertensive drugs, diabetes, stroke/TIA, atrial fibrillation, aspirin, depression. The discrimination and calibration of the risk algorithm were good for the 60-79 years model; D statistic 2.03 (95% CI, 1.95-2.11), C index 0.84 (95% CI, 0.81-0.87), and calibration slope 0.98 (95% CI, 0.93-1.02). The algorithm had a high negative predictive value, but lower positive predictive value at most risk thresholds. Discrimination and calibration were poor for the 80-95 years model.
  
  
  CONCLUSIONS
  Routinely collected data predicts 5-year risk of recorded diagnosis of dementia for those aged 60-79, but not those aged 80+. This algorithm can identify higher risk populations for dementia in primary care. The risk score has a high negative predictive value and may be most helpful in 'ruling out' those at very low risk from further testing or intensive preventative activities.
authors.affiliation: Research Department of Primary Care & Population Health, University College London, Rowland Hill St, London, NW3 2PF, UK. k.walters@ucl.ac.uk.
authors.forename: K
authors.initials: K
authors.lastname: Walters
authors.affiliation: Research Department of Primary Care & Population Health, University College London, Rowland Hill St, London, NW3 2PF, UK.
authors.forename: S
authors.initials: S
authors.lastname: Hardoon
authors.affiliation: Research Department of Primary Care & Population Health, University College London, Rowland Hill St, London, NW3 2PF, UK.
authors.forename: I
authors.initials: I
authors.lastname: Petersen
authors.affiliation: Research Department of Primary Care & Population Health, University College London, Rowland Hill St, London, NW3 2PF, UK.
authors.forename: S
authors.initials: S
authors.lastname: Iliffe
authors.affiliation: Department of Statistical Science, University College London, Gower Street, London, WC1E 6BT, UK.
authors.forename: R Z
authors.initials: RZ
authors.lastname: Omar
authors.affiliation: Research Department of Primary Care & Population Health, University College London, Rowland Hill St, London, NW3 2PF, UK.
authors.forename: I
authors.initials: I
authors.lastname: Nazareth
authors.affiliation: Research Department of Primary Care & Population Health, University College London, Rowland Hill St, London, NW3 2PF, UK.
authors.forename: G
authors.initials: G
authors.lastname: Rait
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D003704:Dementia / Q000175:diagnosis* / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000379:methods* / Q000706:statistics & numerical data; D011379:Prognosis; D012107:Research Design; D012307:Risk Factors