title: Predicting dementia in primary care patients with a cardiovascular health metric: a prospective population-based study.
abstract: BACKGROUND
  Improving cardiovascular health possibly decreases the risk of dementia. Primary care practices offer a suitable setting for monitoring and controlling cardiovascular risk factors in the older population. The purpose of the study is to examine the association of a cardiovascular health metric including six behaviors and blood parameters with the risk of dementia in primary care patients.
  
  
  METHODS
  Participants (N = 3547) were insurants aged ≥55 of the largest German statutory health insurance company, who were enrolled in a six-year prospective population-based study. Smoking, physical activity, body mass index, blood pressure, total cholesterol, and fasting glucose were assessed by general practitioners at routine examinations. Using recommended cut-offs for each factor, the patients' cardiovascular health was classified as ideal, moderate, or poor. Behaviors and blood parameters sub-scores, as well as a total score, were calculated. Dementia diagnoses were retrieved from health insurance claims data. Results are presented as hazard ratios (HRs) and 95% confidence intervals (95% CIs).
  
  
  RESULTS
  Over the course of the study 296 new cases of dementia occurred. Adjusted for age, sex, and education, current smoking (HR = 1.77, 95% CI 1.09-2.85), moderate (1.38, 1.05-1.81) or poor (1.81, 1.32-2.47) levels of physical activity, and poor fasting glucose levels (1.43, 1.02-2.02) were associated with an increased risk of dementia. Body mass index, blood pressure, and cholesterol were not associated with dementia. Separate summary scores for behaviors and blood values, as well as a total score showed no association with dementia. Sensitivity analyses with differently defined endpoints led to similar results.
  
  
  CONCLUSIONS
  Due to complex relationships of body-mass index and blood pressure with dementia individual components cancelled each other out and rendered the sum-scores meaningless for the prediction of dementia.
authors.affiliation: Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Strasse 22, D-81675, Munich, Germany. johannes.hessler@tum.de.
authors.forename: Johannes Baltasar
authors.initials: JB
authors.lastname: Hessler
authors.affiliation: INVADE Study Group, Karl-Böhm-Strasse 32, D-85598, Baldham, Germany.
authors.forename: Karl-Heinz
authors.initials: KH
authors.lastname: Ander
authors.affiliation: Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Strasse 22, D-81675, Munich, Germany.
authors.forename: Monika
authors.initials: M
authors.lastname: Brönner
authors.affiliation: Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Strasse 22, D-81675, Munich, Germany.|Department of Neurology, kbo-Inn-Salzach-Klinikum, Gabersee 7, D-83512, Wasserburg am Inn, Germany.
authors.forename: Thorleif
authors.initials: T
authors.lastname: Etgen
authors.affiliation: Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Strasse 22, D-81675, Munich, Germany.
authors.forename: Hans
authors.initials: H
authors.lastname: Förstl
authors.affiliation: Department of Neurology, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Strasse 22, D-81675, Munich, Germany.
authors.forename: Holger
authors.initials: H
authors.lastname: Poppert
authors.affiliation: Department of Neurology, Benedictus Krankenhaus Tutzing, Bahnhofstrasse 5, D-82327, Tutzing, Germany.
authors.forename: Dirk
authors.initials: D
authors.lastname: Sander
authors.affiliation: Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Strasse 22, D-81675, Munich, Germany.
authors.forename: Horst
authors.initials: H
authors.lastname: Bickel
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000032:analysis; D001794:Blood Pressure / Q000502:physiology; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D002784:Cholesterol / Q000097:blood; D015331:Cohort Studies; D003704:Dementia / Q000453:epidemiology*; D004522:Educational Status; D015444:Exercise; D005215:Fasting; D005260:Female; D005544:Forecasting; D015438:Health Behavior; D006801:Humans; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D011320:Primary Health Care / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology
chemical_list: D001786:Blood Glucose; D002784:Cholesterol
keywords: Cardiovascular disease; Dementia prevention; Life’s simple 7; Modifiable risk factors