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Joint impact of seven risk factors on incident dementia in elderly Japanese: the Ohsaki Cohort 2006 Study

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Abstract

Background

This cohort study estimated the population attributable fraction (PAF) of seven combined major risk factors for incident dementia.

Methods

We conducted a cohort study of 8563 community-dwelling individuals aged ≥ 65 years. In a baseline survey (2006), we collected data on major seven risk factors: diabetes mellitus, hypertension, obesity, physical inactivity, severe psychological distress, smoking, and low educational attainment. The total number of risk factors was applied as an exposure variable. Subjects were categorized into four groups according to the total number of risk factors they possessed (0, 1, 2, ≥ 3 risk factors). Data on incident dementia were retrieved from the public Long-term Care Insurance database. Hazard ratios (HRs) and 95% confidence interval (95% CI) were estimated using the Cox proportional regression model. We also calculated the PAF using HRs and the prevalences in our cohort data.

Results

The number of cases of incident dementia was 577 (6.7%). A dose–response relationship between the total number of risk factors and incident dementia was observed; in comparison with no risk factors (reference), the age- and sex-adjusted HRs (95% CIs) were 1.25 (0.92–1.70) for one risk factor, 1.59 (1.18–2.15) for two, and 2.21 (1.62–3.01) for three or more (P trend < 0.001). If subjects had adhered to none of the risk factors, the PAF would have been 32.2%. If subjects had improved toward one better category, the PAF would have been 23.0%.

Conclusion

Our findings suggest that reducing the combined number of risk factors would contribute significantly to reducing the incidence of dementia.

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References

  1. Prince MJ, Wimo A, Guerchet MM, Ali GC, Wu Y-T, Prina M (2015) World Alzheimer Report 2015—The global impact of dementia: an analysis of prevalence, incidence, cost and trends. Alzheimer’s Disease International, London

    Google Scholar 

  2. Cations M, Radisic G, Crotty M, Laver KE (2018) What does the general public understand about prevention and treatment of dementia? A systematic review of population-based surveys. PLoS One 13(4):e0196085. https://doi.org/10.1371/journal.pone.0196085

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Norton S, Matthews FE, Barnes DE, Yaffe K, Brayne C (2014) Potential for primary prevention of Alzheimer’s disease: an analysis of population-based data. Lancet Neurol 13:788–794. https://doi.org/10.1016/S1474-4422(14)70136-X

    Article  PubMed  Google Scholar 

  4. Barnes DE, Yaffe K (2011) The projected effect of risk factor reduction on Alzheimer’s disease prevalence. Lancet Neurol 10:819–828. https://doi.org/10.1016/S1474-4422(11)70072-2

    Article  PubMed  PubMed Central  Google Scholar 

  5. Ashby-Mitchell K, Burns R, Shaw J, Anstey KJ (2017) Proportion of dementia in Australia explained by common modifiable risk factors. Alzheimers Res Ther 9:11. https://doi.org/10.1186/s13195-017-0238-x

    Article  PubMed  PubMed Central  Google Scholar 

  6. Elwood P, Galante J, Pickering J, Palmer S, Bayer A, Ben-Shlomo Y, Longley M, Gallacher J (2013) Healthy lifestyles reduce the incidence of chronic diseases and dementia: evidence from the Caerphilly cohort study. PLoS One 8:e81877. https://doi.org/10.1371/journal.pone.0081877

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Gelber RP, Petrovitch H, Masaki KH, Abbott RD, Ross GW, Launer LJ, White LR (2012) Lifestyle and the risk of dementia in Japanese-American men. J Am Geriatr Soc 60:118–123. https://doi.org/10.1111/j.1532-5415.2011.03768.x

    Article  PubMed  Google Scholar 

  8. Samieri C, Perier M-C, Gaye B, Proust-Lima C, Helmer C, Dartigues J-F, Berr C, Tzourio C, Empana J-P (2018) Association of cardiovascular health level in older age with cognitive decline and incident dementia. JAMA 320:657–664. https://doi.org/10.1001/jama.2018.11499

    Article  PubMed  PubMed Central  Google Scholar 

  9. Kuriyama S, Nakaya N, Ohmori-Matsuda K, Shimazu T, Kikuchi N, Kakizaki M, Sone T, Sato F, Nagai M, Sugawara Y, Tomata Y, Akhter M, Higashiguchi M, Fukuchi N, Takahashi H, Hozawa A, Tsuji I (2010) The Ohsaki cohort 2006 study: design of study and profile of participants at baseline. J Epidemiol 20:253–258. https://doi.org/10.2188/jea.JE20090093

    Article  PubMed  PubMed Central  Google Scholar 

  10. Yong V, Saito Y (2012) How accurate are self-reported height, weight, and BMI among community-dwelling elderly Japanese?: Evidence from a national population-based study. Geriatr Gerontol Int 12:247–256. https://doi.org/10.1111/j.1447-0594.2011.00759.x

    Article  PubMed  Google Scholar 

  11. Tsubono Y, Tsuji I, Fujita K, Nakaya N, Hozawa A, Ohkubo T, Kuwahara A, Watanabe Y, Ogawa K, Nishino Y, Hisamichi S (2002) Validation of walking questionnaire for population-based prospective studies in Japan: comparison with pedometer. J Epidemiol 12:305–309

    Article  PubMed  Google Scholar 

  12. Kessler RC, Andrews G, Colpe LJ, Hiripi E, Mroczek DK, Normand SL, Walters EE, Zaslavsky AM (2002) Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychol Med 32:959–976

    Article  CAS  PubMed  Google Scholar 

  13. Kessler RC, Green JG, Gruber MJ, Sampson NA, Bromet E, Cuitan M, Furukawa TA, Gureje O, Hinkov H, Hu C-Y, Lara C, Lee S, Mneimneh Z, Myer L, Oakley-Browne M, Posada-Villa J, Sagar R, Viana MC, Zaslavsky AM (2010) Screening for serious mental illness in the general population with the K6 screening scale: results from the WHO World Mental Health (WMH) survey initiative. Int J Methods Psychiatr Res 19:4–22. https://doi.org/10.1002/mpr.310

    Article  PubMed  PubMed Central  Google Scholar 

  14. Kessler RC, Barker PR, Colpe LJ, Epstein JF, Gfroerer JC, Hiripi E, Howes MJ, Normand SL, Manderscheid RW, Walters EE, Zaslavsky AM (2003) Screening for serious mental illness in the general population. Arch Gen Psychiatry 60:184–189

    Article  PubMed  Google Scholar 

  15. Tomata Y, Hozawa A, Ohmori-Matsuda K, Nagai M, Sugawara Y, Nitta A, Kuriyama S, Tsuji I (2011) Validation of the Kihon Checklist for predicting the risk of 1-year incident long-term care insurance certification: the Ohsaki Cohort 2006 Study. Jpn J public Heal 58:3–13

    Google Scholar 

  16. Meguro K (2012) The validity of the Basic Checklist in the old–old population: the Kurihara Project. Jpn J Geriatr Psychiatry 23:725–730

    Google Scholar 

  17. Ikeda A, Yamagishi K, Tanigawa T, Cui R, Yao M, Noda H, Umesawa M, Chei C, Yokota K, Shiina Y, Harada M, Murata K, Asada T, Shimamoto T, Iso H (2008) Cigarette smoking and risk of disabling dementia in a Japanese Rural community: a nested case–control study. Cerebrovasc Dis 25:324–331. https://doi.org/10.1159/000118377

    Article  PubMed  Google Scholar 

  18. Ministry of Health, Labour and Welfare (2016) Long-term care insurance system of Japan, health and welfare services for the elderly. https://www.mhlw.go.jp/english/policy/care-welfare/care-welfare-elderly/. Accessed Nov 2016

  19. Imahashi K, Kawagoe M, Eto F, Haga N (2007) Clinical status and dependency of the elderly requiring long-term care in Japan. Tohoku J Exp Med 212:229–238

    Article  PubMed  Google Scholar 

  20. Moriyama Y, Tamiya N, Kamimura A, Sandoval F, Luptak M (2014) doctors’ opinion papers in long-term care need certification in Japan: comparison between clinic and advanced treatment hospital settings. Public Policy Adm Res 4:31–37

    Google Scholar 

  21. Nemoto Y, Saito T, Kanamori S, Tsuji T, Shirai K, Kikuchi H, Maruo K, Arao T, Kondo K (2017) An additive effect of leading role in the organization between social participation and dementia onset among Japanese older adults: the AGES cohort study. BMC Geriatr 17:297. https://doi.org/10.1186/s12877-017-0688-9

    Article  PubMed  PubMed Central  Google Scholar 

  22. Meguro K, Tanaka N, KasaiI M, Nakamura K, Ishikawa H, Nakatsuka M, Satoh M, Ouchi Y (2012) Prevalence of dementia and dementing diseases in the old-old population in Japan: the Kurihara Project. Implications for Long-Term Care Insurance data. Psychogeriatrics 12:226–234. https://doi.org/10.1111/j.1479-8301.2012.00406.x

    Article  PubMed  Google Scholar 

  23. Yamamoto T, Kondo K, Hirai H, Nakade M, Aida J, Hirata Y (2012) Association between self-reported dental health status and onset of dementia. Psychosom Med 74:241–248. https://doi.org/10.1097/PSY.0b013e318246dffb

    Article  PubMed  Google Scholar 

  24. Tomata Y, Sugiyama K, Kaiho Y, Sugawara Y, Hozawa A, Tsuji I (2017) Predictive ability of a simple subjective memory complaints scale for incident dementia: Evaluation of Japan’s national checklist, the “Kihon Checklist”. Geriatr Gerontol Int 17:1300–1305. https://doi.org/10.1111/ggi.12864

    Article  PubMed  Google Scholar 

  25. Levin ML (1953) The occurrence of lung cancer in man. Acta Unio Int Contra Cancrum 9:531–541

    CAS  PubMed  Google Scholar 

  26. Miettinen OS (1974) Proportion of disease caused or prevented by a given exposure, trait or intervention. Am J Epidemiol 99:325–332. https://doi.org/10.1093/OXFORDJOURNALS.AJE.A121617

    Article  CAS  PubMed  Google Scholar 

  27. Hales CM, Carroll MD, Fryar CD, Ogden CL (2017) Prevalence of obesity among adults and youth: United States, 2015–2016. NCHS Data Brief. https://www.cdc.gov/nchs/data/databriefs/db288.pdf

  28. Grimes DA, Schulz KF (2002) Bias and causal associations in observational research. Lancet 359:248–252. https://doi.org/10.1016/S0140-6736(02)07451-2

    Article  PubMed  Google Scholar 

  29. Noda H, Yamagishi K, Ikeda A, Asada T, Iso H (2018) Identification of dementia using standard clinical assessments by primary care physicians in Japan. Geriatr Gerontol Int 18:738–744. https://doi.org/10.1111/ggi.13243

    Article  PubMed  Google Scholar 

  30. Hisano S (2009) The relationship between revised Hasegawa Dementia Scale (HDS-R), Mini-Mental State Examination (MMSE) and Bed-fast Scale, Dementia scale. Jpn J Geriatr Psychiatry 20:883–891

    Google Scholar 

  31. Kim MY, Goldberg JD (2001) The effects of outcome misclassification and measurement error on the design and analysis of therapeutic equivalence trials. Stat Med 20:2065–2078. https://doi.org/10.1002/sim.847

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

The authors thank Yoshiko Nakata, Mami Takahashi, Miyuki Takeuchi, and Yuko Miyoshi for their technical assistance.

Funding

This work was supported by a Grant-in-Aid for Young Scientists (B; 17K15844) from the Japan Society for the Promotion of Science.

Author information

Authors and Affiliations

  1. Division of Epidemiology, Department of Health Informatics and Public Health, Tohoku University School of Public Health, Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan

    Yumika Kotaki, Yasutake Tomata, Fumiya Tanji, Shu Zhang, Yumi Sugawara & Ichiro Tsuji

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  1. Yumika Kotaki
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  2. Yasutake Tomata
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  3. Fumiya Tanji
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Contributions

YK, YT and IT designed research. YT and IT conducted research. YK, FT, YT and SZ analyzed data. YK wrote the paper. YT, FT, YS, SZ and IT gave the constructive suggestions. YK had primary responsibility for final content. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Yasutake Tomata.

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Conflicts of interest

The authors declare that they have no conflict of interest.

Ethical standards

The study protocol was reviewed and approved by the Ethics Committee of Tohoku University Graduate School of Medicine (Sendai, Japan) (Approval number: 2006-206, 2013-1-289). The study has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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Kotaki, Y., Tomata, Y., Tanji, F. et al. Joint impact of seven risk factors on incident dementia in elderly Japanese: the Ohsaki Cohort 2006 Study. J Neurol 266, 1222–1229 (2019). https://doi.org/10.1007/s00415-019-09252-w

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  • DOI: https://doi.org/10.1007/s00415-019-09252-w

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