Multimorbidity pattern and risk of dementia in later life: an 11-year follow-up study using a large community cohort and linked electronic health records
Multimorbidity pattern and risk of dementia in later life: an 11-year follow-up study using a large community cohort and linked electronic health records
BACKGROUND: Several long-term chronic illnesses are known to be associated with an increased risk of dementia independently, but little is known how combinations or clusters of potentially interacting chronic conditions may influence the risk of developing dementia.
METHODS: 447 888 dementia-free participants of the UK Biobank cohort at baseline (2006-2010) were followed-up until 31 May 2020 with a median follow-up duration of 11.3 years to identify incident cases of dementia. Latent class analysis (LCA) was used to identify multimorbidity patterns at baseline and covariate adjusted Cox regression was used to investigate their predictive effects on the risk of developing dementia. Potential effect moderations by C reactive protein (CRP) and Apolipoprotein E (APOE) genotype were assessed via statistical interaction.
RESULTS: LCA identified four multimorbidity clusters representing Mental health, Cardiometabolic, Inflammatory/autoimmune and Cancer-related pathophysiology, respectively. Estimated HRs suggest that multimorbidity clusters dominated by Mental health (HR=2.12, p<0.001, 95% CI 1.88 to 2.39) and Cardiometabolic conditions (2.02, p<0.001, 1.87 to 2.19) have the highest risk of developing dementia. Risk level for the Inflammatory/autoimmune cluster was intermediate (1.56, p<0.001, 1.37 to 1.78) and that for the Cancer cluster was least pronounced (1.36, p<0.001, 1.17 to 1.57). Contrary to expectation, neither CRP nor APOE genotype was found to moderate the effects of multimorbidity clusters on the risk of dementia.
CONCLUSIONS: Early identification of older adults at higher risk of accumulating multimorbidity of specific pathophysiology and tailored interventions to prevent or delay the onset of such multimorbidity may help prevention of dementia.
Humans, Aged, Follow-Up Studies, Multimorbidity, Electronic Health Records, Chronic Disease, Neoplasms/epidemiology, Cardiovascular Diseases
285-292
Khondoker, Mizanur
e849cf3f-c8b2-49ea-b2d4-d1da9bb16596
Macgregor, Alexander
36685a0f-6d1b-4f64-aad3-3ef40c6b8a11
Bachmann, Max O
7cff92eb-4431-4851-9721-1e573beff777
Hornberger, Michael
a48c1c63-422a-4c11-9a51-c7be0aa3026d
Fox, Chris
06b59c5d-a369-4443-b5ae-d9a06f622d9f
Shepstone, Lee
7ca551e6-b5ca-4984-a5c7-8d6983f23580
8 March 2023
Khondoker, Mizanur
e849cf3f-c8b2-49ea-b2d4-d1da9bb16596
Macgregor, Alexander
36685a0f-6d1b-4f64-aad3-3ef40c6b8a11
Bachmann, Max O
7cff92eb-4431-4851-9721-1e573beff777
Hornberger, Michael
a48c1c63-422a-4c11-9a51-c7be0aa3026d
Fox, Chris
06b59c5d-a369-4443-b5ae-d9a06f622d9f
Shepstone, Lee
7ca551e6-b5ca-4984-a5c7-8d6983f23580
Khondoker, Mizanur, Macgregor, Alexander, Bachmann, Max O, Hornberger, Michael, Fox, Chris and Shepstone, Lee
(2023)
Multimorbidity pattern and risk of dementia in later life: an 11-year follow-up study using a large community cohort and linked electronic health records.
Journal of Epidemiology and Community Health, 77 (5), .
(doi:10.1136/jech-2022-220034).
Abstract
BACKGROUND: Several long-term chronic illnesses are known to be associated with an increased risk of dementia independently, but little is known how combinations or clusters of potentially interacting chronic conditions may influence the risk of developing dementia.
METHODS: 447 888 dementia-free participants of the UK Biobank cohort at baseline (2006-2010) were followed-up until 31 May 2020 with a median follow-up duration of 11.3 years to identify incident cases of dementia. Latent class analysis (LCA) was used to identify multimorbidity patterns at baseline and covariate adjusted Cox regression was used to investigate their predictive effects on the risk of developing dementia. Potential effect moderations by C reactive protein (CRP) and Apolipoprotein E (APOE) genotype were assessed via statistical interaction.
RESULTS: LCA identified four multimorbidity clusters representing Mental health, Cardiometabolic, Inflammatory/autoimmune and Cancer-related pathophysiology, respectively. Estimated HRs suggest that multimorbidity clusters dominated by Mental health (HR=2.12, p<0.001, 95% CI 1.88 to 2.39) and Cardiometabolic conditions (2.02, p<0.001, 1.87 to 2.19) have the highest risk of developing dementia. Risk level for the Inflammatory/autoimmune cluster was intermediate (1.56, p<0.001, 1.37 to 1.78) and that for the Cancer cluster was least pronounced (1.36, p<0.001, 1.17 to 1.57). Contrary to expectation, neither CRP nor APOE genotype was found to moderate the effects of multimorbidity clusters on the risk of dementia.
CONCLUSIONS: Early identification of older adults at higher risk of accumulating multimorbidity of specific pathophysiology and tailored interventions to prevent or delay the onset of such multimorbidity may help prevention of dementia.
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Published date: 8 March 2023
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© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.
Keywords:
Humans, Aged, Follow-Up Studies, Multimorbidity, Electronic Health Records, Chronic Disease, Neoplasms/epidemiology, Cardiovascular Diseases
Identifiers
Local EPrints ID: 505263
URI: http://eprints.soton.ac.uk/id/eprint/505263
ISSN: 0143-005X
PURE UUID: b9ffc55f-b824-4531-9b43-932a6ee14473
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Date deposited: 02 Oct 2025 16:56
Last modified: 03 Oct 2025 02:18
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Contributors
Author:
Mizanur Khondoker
Author:
Alexander Macgregor
Author:
Max O Bachmann
Author:
Michael Hornberger
Author:
Chris Fox
Author:
Lee Shepstone
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