Congratulations to Drs. Steven Trent DeKosky and Michael Jaffee on the publication of “Association of education attainment, smoking status, and alcohol use disorder with dementia risk in older adults: a longitudinal observational study,” which was published in the September issue of Alzheimer’s Research & Therapy.
Abstract
Background
Previous research on the risk of dementia associated with education attainment, smoking status, and alcohol use disorder (AUD) has yielded inconsistent results, indicating potential heterogeneous treatment effects (HTEs) of these factors on dementia risk. Thus, this study aimed to identify the important variables that may contribute to HTEs of these factors in older adults.
Methods
Using 2005-2021 data from the National Alzheimer’s Coordinating Center (NACC), we included older adults (≥65 years) with normal cognition at the first visit. The exposure of interest included college education or above, current smoking, and AUD and the outcome was all cause dementia. We applied doubly robust learning to estimate risk differences (RD) and 95% confidence intervals (CI) between exposed and unexposed groups in the overal cohort and subgroups identified though a decision tree model.
Results
Of 10,062 participants included, 929 developed all-cause dementia over a median 4.4 year followup. College education or above was associated with a lower risk of all-cause dementia in the overall population (RD, -1.5%; 95%CI, -2.8 to -0.3), especially among the subpopulations without hypertension, regardless of the AP0E4 status. Current smoking was not related to increased dementia risk overall (2.8%; -1.5 to 7.2) but was significantly associated with increased dementia risk among men with (21.1%, 3.1 to 39.1) and without (8.4%, 0.9 to 15.8) cerebrovascular disease. AUD was not related to increased dementia risk overall (2.0%; -7.7% to 11.7) but was significantly associated with increased dementia risk among men with neuropsychiatric disorders (31.5%; 7.4 to 55.7).
Conclusions
Our studies identified important factors contributing to HTEs of education, smoking and AUD on risk of all-cause dementia, suggesting an individualized approach is needed to address dementia disparities.