Association of Education Attainment, Smoking Status, and Alcohol Use Disorder with Dementia Risk in Older Adults: a Longitudinal Observational Study

Overview

Journal Alzheimers Res Ther

Date 2024 Sep 18

PMID 39294787

Authors

Huilin Tang

C Elizabeth Shaaban

Steven T DeKosky

Glenn E Smith

Xia Hu

Michael Jaffee

Ramzi G Salloum

Jiang Bian

Jingchuan Guo

Affiliations

Soon will be listed here.

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 overall cohort and subgroups identified through a decision tree model.

Results: Of 10,062 participants included, 929 developed all-cause dementia over a median 4.4-year follow-up. 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 APOE4 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.

References

Galasko D, Montine T . Biomarkers of oxidative damage and inflammation in Alzheimer's disease. Biomark Med. 2010; 4(1):27-36. PMC: 2850111. DOI: 10.2217/bmm.09.89. View

Sabia S, Fayosse A, Dumurgier J, Dugravot A, Akbaraly T, Britton A . Alcohol consumption and risk of dementia: 23 year follow-up of Whitehall II cohort study. BMJ. 2018; 362:k2927. PMC: 6066998. DOI: 10.1136/bmj.k2927. View

Wei J, Lohman M, Brown M, Hardin J, Xu H, Yang C . Physical activity initiated from midlife on risk of dementia and cognitive impairment: The Health and Retirement Study. J Am Geriatr Soc. 2024; 72(12):3668-3680. DOI: 10.1111/jgs.19109. View

Lee S, Buring J, Cook N, Grodstein F . The relation of education and income to cognitive function among professional women. Neuroepidemiology. 2005; 26(2):93-101. PMC: 1361359. DOI: 10.1159/000090254. View

Regier D, Farmer M, Rae D, Locke B, Keith S, Judd L . Comorbidity of mental disorders with alcohol and other drug abuse. Results from the Epidemiologic Catchment Area (ECA) Study. JAMA. 1990; 264(19):2511-8. View

Koch M, Fitzpatrick A, Rapp S, Nahin R, Williamson J, Lopez O . Alcohol Consumption and Risk of Dementia and Cognitive Decline Among Older Adults With or Without Mild Cognitive Impairment. JAMA Netw Open. 2019; 2(9):e1910319. PMC: 6777245. DOI: 10.1001/jamanetworkopen.2019.10319. View

Zhang M, Katzman R, Salmon D, Jin H, Cai G, Wang Z . The prevalence of dementia and Alzheimer's disease in Shanghai, China: impact of age, gender, and education. Ann Neurol. 1990; 27(4):428-37. DOI: 10.1002/ana.410270412. View

. 2022 Alzheimer's disease facts and figures. Alzheimers Dement. 2022; 18(4):700-789. DOI: 10.1002/alz.12638. View

Liampas I, Siokas V, Lyketsos C, Dardiotis E . Associations between neuropsychiatric symptoms and incident Alzheimer's dementia in men versus women. J Neurol. 2022; 270(4):2069-2083. PMC: 10025238. DOI: 10.1007/s00415-022-11541-w. View

10.

Li X, Shen C . Doubly Robust Estimation of Causal Effect: Upping the Odds of Getting the Right Answers. Circ Cardiovasc Qual Outcomes. 2020; 13(1):e006065. DOI: 10.1161/CIRCOUTCOMES.119.006065. View

11.

Cornelius M, Loretan C, Jamal A, Davis Lynn B, Mayer M, Alcantara I . Tobacco Product Use Among Adults - United States, 2021. MMWR Morb Mortal Wkly Rep. 2023; 72(18):475-483. PMC: 10168602. DOI: 10.15585/mmwr.mm7218a1. View

12.

Ott A, van Rossum C, Van Harskamp F, van de Mheen H, Hofman A, Breteler M . Education and the incidence of dementia in a large population-based study: the Rotterdam Study. Neurology. 1999; 52(3):663-6. DOI: 10.1212/wnl.52.3.663. View

13.

Ding D, Zhao Q, Wu W, Xiao Z, Liang X, Luo J . Prevalence and incidence of dementia in an older Chinese population over two decades: The role of education. Alzheimers Dement. 2020; 16(12):1650-1662. DOI: 10.1002/alz.12159. View

14.

Austin P . Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples. Stat Med. 2009; 28(25):3083-107. PMC: 3472075. DOI: 10.1002/sim.3697. View

15.

Alosh M, Huque M, Bretz F, DAgostino Sr R . Tutorial on statistical considerations on subgroup analysis in confirmatory clinical trials. Stat Med. 2016; 36(8):1334-1360. DOI: 10.1002/sim.7167. View

16.

van der Lee S, Wolters F, Ikram M, Hofman A, Ikram M, Amin N . The effect of APOE and other common genetic variants on the onset of Alzheimer's disease and dementia: a community-based cohort study. Lancet Neurol. 2018; 17(5):434-444. DOI: 10.1016/S1474-4422(18)30053-X. View

17.

Maccora J, Peters R, Anstey K . What does (low) education mean in terms of dementia risk? A systematic review and meta-analysis highlighting inconsistency in measuring and operationalising education. SSM Popul Health. 2020; 12:100654. PMC: 7721642. DOI: 10.1016/j.ssmph.2020.100654. View

18.

Otuyama L, Oliveira D, Locatelli D, Machado D, Noto A, Galduroz J . Tobacco smoking and risk for dementia: evidence from the 10/66 population-based longitudinal study. Aging Ment Health. 2019; 24(11):1796-1806. DOI: 10.1080/13607863.2019.1647140. View

19.

Zhang S, Xiao Y, Cheng Y, Ma Y, Liu J, Li C . Associations of sugar intake, high-sugar dietary pattern, and the risk of dementia: a prospective cohort study of 210,832 participants. BMC Med. 2024; 22(1):298. PMC: 11256505. DOI: 10.1186/s12916-024-03525-6. View

20.

Maiese K . Alcohol Use Disorder and Dementia: Critical Mechanisms for Cognitive Loss. Curr Neurovasc Res. 2021; 18(1):1-3. DOI: 10.2174/1567202618666210212153458. View