Results of a new study suggest that there is a general association between high adiposity and an increased risk of dementia, particularly among the “younger” elderly. In addition to age, other patient factors can confound this association. "The few studies exploring the association between adiposity, measured by body mass index (BMI), and dementia in elderly persons were conflicting," Dr. Jose A. Luchsinger and colleagues from Columbia University College of Physicians and Surgeon in New York, write.
The researchers hypothesized that higher adiposity is associated with higher dementia risk, and that this relation is attenuated by age. Their study included 893 subjects with BMI data, 907 with waist circumference data, and 709 with a second weight measurement. At baseline, all subjects were free of dementia.
At 5-year follow-up, evaluations revealed 181 incident dementia cases, 112 Alzheimer’s disease cases, and 53 dementia cases associated with stroke. The mean patient age was 77.0 years.
Patients in the third BMI quartile had a lower dementia risk than those in the first BMI quartile, after adjusting for demographics and apolipoprotein E-epsilon-4 status. Patients in the third BMI quartile also had a lower Alzheimer’s disease risk. Those in the second BMI quartile had a lower risk of dementia associated with stroke.
"In persons younger than 76 years, the association between BMI quartiles and dementia resembled a U shape," Dr. Luchsinger’s team explains. "The second (HR, 0.4) and third (HR, 0.3) quartiles were related to lower risk, while the fourth (HR, 1.0) was similar to the reference," they note. "In older people (at least 76 years), dementia risk decreased with increasing BMI; this association was almost statistically significant (fourth quartile HR, 0.6; p = 0.07 for trend)."
For all of the subjects, an association was observed between those in the fourth BMI quartile of waist circumference and a higher risk of stroke-related dementia. Subjects younger than 76 who were in the fourth quartile of waist circumference had an increased risk of dementia (HR, 2.3; p = 0.03 for trend) and Alzheimer’s disease (HR, 5.1; p = 0.04 for trend).
Weight loss was associated with a higher risk of dementia and dementia associated with stroke. Weight gain was related to a higher risk of dementia associated with stroke only.
Arch Neurol 2007;64:392-398.
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