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01-12-2021 | Dementia | Research article

Frailty and the risk of dementia: is the association explained by shared environmental and genetic factors?

Authors: Ge Bai, Yunzhang Wang, Ralf Kuja-Halkola, Xia Li, Yasutake Tomata, Ida K. Karlsson, Nancy L. Pedersen, Sara Hägg, Juulia Jylhävä

Published in: BMC Medicine | Issue 1/2021

Abstract

Background

Frailty has been identified as a risk factor for cognitive impairment and dementia. However, it is not known whether familial factors, such as genetics and shared environmental factors, underlie this association. We analyzed the association between frailty and the risk of dementia in a large twin cohort and examined the role of familial factors in the association.

Methods

The Rockwood frailty index (FI) based on 44 health deficits was used to assess frailty. The population-level association between FI and the risk of all-cause dementia was analyzed in 41,550 participants of the Screening Across the Lifespan Twin (SALT) study (full sample, aged 41–97 years at baseline), using Cox and competing risk models. A subsample of 10,487 SALT participants aged 65 and older who received a cognitive assessment (cognitive sample) was used in a sensitivity analysis to assess the effect of baseline cognitive level on the FI-dementia association. To analyze the influence of familial effects on the FI-dementia association, a within-pair analysis was performed. The within-pair model was also used to assess whether the risk conferred by frailty varies by age at FI assessment.

Results

A total of 3183 individuals were diagnosed with dementia during the 19-year follow-up. A 10% increase in FI was associated with an increased risk of dementia (hazard ratio [HR] 1.17 (95% confidence interval [CI] 1.07, 1.18)) in the full sample adjusted for age, sex, education, and tobacco use. A significant association was likewise found in the cognitive sample, with an HR of 1.13 (95% CI 1.09, 1.20), adjusted for age, sex, and cognitive level at baseline. The associations were not attenuated when adjusted for APOE ɛ4 carrier status or considering the competing risk of death. After adjusting for familial effects, we found no evidence for statistically significant attenuation of the effect. The risk conferred by higher FI on dementia was constant after age 50 until very old age.

Conclusions

A higher level of frailty predicts the risk of dementia and the association appears independent of familial factors. Targeting frailty might thus contribute to preventing or delaying dementia.

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Title: Frailty and the risk of dementia: is the association explained by shared environmental and genetic factors?
Authors: Ge Bai
Yunzhang Wang
Ralf Kuja-Halkola
Xia Li
Yasutake Tomata
Ida K. Karlsson
Nancy L. Pedersen
Sara Hägg
Juulia Jylhävä
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Dementia
Dementia
Published in: BMC Medicine / Issue 1/2021
Electronic ISSN: 1741-7015
DOI: https://doi.org/10.1186/s12916-021-02104-3

ACC 2024 Congress

Springer Medicine

Frailty and the risk of dementia: is the association explained by shared environmental and genetic factors?

Abstract

Background

Methods

Results

Conclusions

ACC 2024 Congress

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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