Modifiable psychosocial risk factors and delayed onset of dementia in older populations: analysis of two prospective US cohorts

Objective Preventing Alzheimer's dementia (AD) fundamentally equates to delaying onset. Thus, we quantified associations of modifiable, psychosocial risk factors to years of delayed onset of dementia. Design Two prospective cohorts (n=2860) with negative and positive psychosocial factors measured at baseline (depressive symptoms, neuroticism, cognitive activity). Setting and participants Religious Orders Study of older priests, nuns and brothers across the USA, initiated in 1994; Rush Memory and Aging Project, of older persons in Chicago area, initiated in 1997. Outcome measure We conducted annual neurological and neuropsychological assessments to identify AD (n=785 incident cases). We compared age at diagnosis of AD across psychosocial risk factor groups, controlling for confounders, using accelerated failure time models. Results We found strong relations of three or more depressive symptoms with age at AD diagnosis; estimated mean age at diagnosis was 86.9 years with significant symptoms versus 92.1 years with no symptoms (p=0.001). In addition, neuroticism was inversely related to age at AD diagnosis; estimated mean age at diagnosis was 88.8 years for the highest neuroticism tertile and 93.1 years in the lowest tertile (p<0.001). Participants with higher cognitive activity (such as reading books) had later AD diagnosis; estimated mean age at diagnosis was 89.2 years for the lowest cognitive activity group and 92.6 years for the highest activity group (p<0.001). Conclusions Higher depressive symptoms were associated with 5-year acceleration in AD; higher neuroticism with 4-year acceleration and higher cognitive activity with a 3.5-year delay. To translate findings, prior health services research in the USA indicates delaying dementia 5 years could add 3 years of life and reduce individual costs of care >$60 000. These results provide a rigorous, easily translatable metric for communicating and evaluating the potential public health impact of psychosocial and experiential interventions.

Automated summary

This study aimed to investigate the associations between modifiable psychosocial risk factors and the age of onset of Alzheimer's dementia (AD). The results showed that depressive symptoms and neuroticism were associated with an earlier onset of AD, while higher cognitive activity was associated with a delayed onset of AD.