Patterns of modifiable lifestyle, behavioural and health-related risk factors and their associations with incident dementia in UK Biobank

Abstract

INTRODUCTIONIndividual lifestyle, behavioural and health-related factors are associated with the risk of developing dementia. However, the co-occurrence of these factors, which are likely to form distinct patterns, in relation to dementia risk has been understudied. METHODSThe sample included 151,832 UK Biobank participants aged 60-69 years. Latent class analysis was used to identify patterns among participants with two or more of the following risk factors: high alcohol consumption, high body weight, depression, diabetes, poor diet, hypertension, physical inactivity, visual impairment, hearing impairment, sleep disturbance, smoking, social isolation, traumatic brain injury, and vitamin D deficiency. Multivariate Cox proportional hazards models were used to determine the associations between identified risk factor patterns and incident dementia ascertained through hospital and death records. RESULTSOver a median follow-up of 13 years, 5,304 participants developed dementia. Six risk factor classes were identified. Compared to participants with zero or one risk factor, all classes were associated with dementia risk: multiple risk factors (hazard ratio [HR] 2.38, 95% confidence interval [CI] 2.11-2.68), hearing loss and unhealthy lifestyle (HR=1.37, 95% CI 1.22-1.55), sleep and psychosocial factors (HR=1.34, 95% CI 1.20-1.49), poor cardiometabolic health (HR=1.32, 95% CI 1.19-1.46), heavy drinking and unhealthy lifestyle (HR=1.20, 95% CI 1.07-1.35), and vitamin D deficiency, sedentary and psychosocial factors (HR=1.18, 95% CI 1.03-1.35). DISCUSSIONWe identified risk factor patterns that were differentially associated with dementia risk. These findings suggest that accounting for the co-occurrence of risk factors might be an effective approach for risk stratification and developing effective dementia prevention strategies. HighlightsO_LIThere is limited research on identifying clusters of lifestyle, behavioural, and health-related factors linked to dementia risk. C_LIO_LISix distinct classes of modifiable dementia risk factor patterns were identified in UK Biobank participants. C_LIO_LIAll classes were associated with higher dementia risk, strongest for those with multiple coexisting risk factors. C_LIO_LIThe findings support the importance of multi-domain approaches to dementia prevention. C_LI