Tags

Type your tag names separated by a space and hit enter

Risk factors in late adolescence for young-onset dementia in men: a nationwide cohort study.

Abstract

IMPORTANCE

Young-onset dementia (YOD), that is, dementia diagnosed before 65 years of age, has been related to genetic mutations in affected families. The identification of other risk factors could improve the understanding of this heterogeneous group of syndromes.

OBJECTIVE

To evaluate risk factors in late adolescence for the development of YOD later in life.

DESIGN

We identified the study cohort from the Swedish Military Service Conscription Register from January 1, 1969, through December 31, 1979. Potential risk factors, such as cognitive function and different physical characteristics, were assessed at conscription. We collected other risk factors, including dementia in parents, through national register linkage.

PARTICIPANTS

All Swedish men conscripted for mandatory military service (n=488,484) with a mean age of 18 years.

SETTING

Predominantly Swedish men born from January 1, 1950, through December 31, 1960.

EXPOSURE

Potential risk factors for dementia based on those found in previous studies, data available, and quality of register data.

MAIN OUTCOMES AND MEASURE

All forms of YOD.

RESULTS

During a median follow-up of 37 years, 487 men were diagnosed as having YOD at a median age of 54 years. In multivariate Cox regression analysis, significant risk factors (all P< .05) for YOD included alcohol intoxication (hazard ratio, 4.82 [95% CI, 3.83-6.05]); population-attributable risk, 0.28), stroke (2.96 [2.02-4.35]; 0.04), use of antipsychotics (2.75 [2.09-3.60]; 0.12), depression (1.89 [1.53-2.34]; 0.28), father's dementia (1.65 [1.22-2.24]; 0.04), drug intoxication other than alcohol (1.54 [1.06-2.24]; 0.03), low cognitive function at conscription (1.26 per 1-SD decrease [1.14-1.40]; 0.29), low height at conscription (1.16 per 1-SD decrease [1.04-1.29]; 0.16), and high systolic blood pressure at conscription (0.90 per 1-SD decrease [0.82-0.99]; 0.06). The population-attributable risk associated with all 9 risk factors was 68%. Men with at least 2 of these risk factors and in the lowest third of overall cognitive function were found to have a 20-fold increased risk of YOD during follow-up (hazard ratio, 20.38 [95% CI, 13.64-30.44]).

CONCLUSIONS AND RELEVANCE

In this nationwide cohort, 9 independent risk factors were identified that accounted for most cases of YOD in men. These risk factors were multiplicative, most were potentially modifiable, and most could be traced to adolescence, suggesting excellent opportunities for early prevention.

Links

  • Publisher Full Text
  • Authors+Show Affiliations

    ,

    Department of Community Medicine and Rehabilitation, Section of Geriatric Medicine, Umeå University, Umeå, Sweden.

    , , ,

    Source

    JAMA internal medicine 173:17 2013 Sep 23 pg 1612-8

    MeSH

    Adolescent
    Adult
    Age of Onset
    Aged
    Dementia
    Disease Progression
    Follow-Up Studies
    Forecasting
    Humans
    Incidence
    Male
    Middle Aged
    Population Surveillance
    Retrospective Studies
    Risk Assessment
    Risk Factors
    Sweden
    Young Adult

    Pub Type(s)

    Comparative Study
    Journal Article
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    23939347

    Citation

    Nordström, Peter, et al. "Risk Factors in Late Adolescence for Young-onset Dementia in Men: a Nationwide Cohort Study." JAMA Internal Medicine, vol. 173, no. 17, 2013, pp. 1612-8.
    Nordström P, Nordström A, Eriksson M, et al. Risk factors in late adolescence for young-onset dementia in men: a nationwide cohort study. JAMA Intern Med. 2013;173(17):1612-8.
    Nordström, P., Nordström, A., Eriksson, M., Wahlund, L. O., & Gustafson, Y. (2013). Risk factors in late adolescence for young-onset dementia in men: a nationwide cohort study. JAMA Internal Medicine, 173(17), pp. 1612-8. doi:10.1001/jamainternmed.2013.9079.
    Nordström P, et al. Risk Factors in Late Adolescence for Young-onset Dementia in Men: a Nationwide Cohort Study. JAMA Intern Med. 2013 Sep 23;173(17):1612-8. PubMed PMID: 23939347.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Risk factors in late adolescence for young-onset dementia in men: a nationwide cohort study. AU - Nordström,Peter, AU - Nordström,Anna, AU - Eriksson,Marie, AU - Wahlund,Lars-Olof, AU - Gustafson,Yngve, PY - 2013/8/14/entrez PY - 2013/8/14/pubmed PY - 2013/11/20/medline SP - 1612 EP - 8 JF - JAMA internal medicine JO - JAMA Intern Med VL - 173 IS - 17 N2 - IMPORTANCE: Young-onset dementia (YOD), that is, dementia diagnosed before 65 years of age, has been related to genetic mutations in affected families. The identification of other risk factors could improve the understanding of this heterogeneous group of syndromes. OBJECTIVE: To evaluate risk factors in late adolescence for the development of YOD later in life. DESIGN: We identified the study cohort from the Swedish Military Service Conscription Register from January 1, 1969, through December 31, 1979. Potential risk factors, such as cognitive function and different physical characteristics, were assessed at conscription. We collected other risk factors, including dementia in parents, through national register linkage. PARTICIPANTS: All Swedish men conscripted for mandatory military service (n=488,484) with a mean age of 18 years. SETTING: Predominantly Swedish men born from January 1, 1950, through December 31, 1960. EXPOSURE: Potential risk factors for dementia based on those found in previous studies, data available, and quality of register data. MAIN OUTCOMES AND MEASURE: All forms of YOD. RESULTS: During a median follow-up of 37 years, 487 men were diagnosed as having YOD at a median age of 54 years. In multivariate Cox regression analysis, significant risk factors (all P< .05) for YOD included alcohol intoxication (hazard ratio, 4.82 [95% CI, 3.83-6.05]); population-attributable risk, 0.28), stroke (2.96 [2.02-4.35]; 0.04), use of antipsychotics (2.75 [2.09-3.60]; 0.12), depression (1.89 [1.53-2.34]; 0.28), father's dementia (1.65 [1.22-2.24]; 0.04), drug intoxication other than alcohol (1.54 [1.06-2.24]; 0.03), low cognitive function at conscription (1.26 per 1-SD decrease [1.14-1.40]; 0.29), low height at conscription (1.16 per 1-SD decrease [1.04-1.29]; 0.16), and high systolic blood pressure at conscription (0.90 per 1-SD decrease [0.82-0.99]; 0.06). The population-attributable risk associated with all 9 risk factors was 68%. Men with at least 2 of these risk factors and in the lowest third of overall cognitive function were found to have a 20-fold increased risk of YOD during follow-up (hazard ratio, 20.38 [95% CI, 13.64-30.44]). CONCLUSIONS AND RELEVANCE: In this nationwide cohort, 9 independent risk factors were identified that accounted for most cases of YOD in men. These risk factors were multiplicative, most were potentially modifiable, and most could be traced to adolescence, suggesting excellent opportunities for early prevention. SN - 2168-6114 UR - https://www.unboundmedicine.com/medline/citation/23939347/Risk_factors_in_late_adolescence_for_young_onset_dementia_in_men:_a_nationwide_cohort_study_ L2 - https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/10.1001/jamainternmed.2013.9079 DB - PRIME DP - Unbound Medicine ER -