Castilhos Raphael Machado, Leotti Vanessa Bielefeldt, Feter Natan, Goulart Alessandra C, Brunoni André Russowsky, Suemoto Claudia Kimie, Giatti Luana, Viana Maria Carmen, Barreto Sandhi Maria, Alvim Sheila, Duncan Bruce B, Schmidt Maria Inês
Cognitive and Behavioral Neurology Center, Neurology Service, Hospital de Clínicas de Porto Alegre, 2350, Ramiro Barcelos Street, Porto Alegre, 90035903, Brazil.
Biostatistics Department, Universidade Federal do Rio Grande do Sul, 9500, Bento Gonçalves Avenue, Porto Alegre, Rio Grande do Sul, 91509900, Brazil.
Lancet Reg Health Am. 2025 Jul 12;49:101184. doi: 10.1016/j.lana.2025.101184. eCollection 2025 Sep.
Population attributable fractions (PAF) of modifiable dementia risk factors are rarely estimated in low- and middle-income countries. We aim to estimate the relative risk (RR) for cognitive impairment and calculate the PAF in the (ELSA-Brasil).
We analyzed adults aged 35-74 at the baseline (2008-2010) and wave 3 (2017-2019). We estimated the prevalence of eight modifiable dementia risk factors at baseline: hypertension, physical inactivity, diabetes, depression, obesity, low education, smoking, and excessive alcohol consumption. Cognition was evaluated at baseline and wave 3 using six standardized tests for the Brazilian Portuguese. A global cognitive score from the individual cognitive tests was created using calculated z-scores each test. A global z-score below -1.5 was considered indicative of cognitive impairment. We calculated the RR and PAF for cognitive impairment at wave 3.
We followed 10,058 adults (56.7% women, median age of 50 [IQR: 44-56] years) for 8.1 (0.6) years. The eight-year incidence of cognitive impairment in wave 3 was 5.5% (n = 549). Low education had the largest RR (4.32) followed by hypertension (1.43), diabetes (1.27), and smoking (1.35). Low education had the largest PAF (95% CI), 14.2% (11.2-17.3), followed by hypertension 13% (7-19), diabetes 4.2% (0.7-7.7), and smoking 3.2% (0.45-6). The total PAF for significant risk factors was 34.7% (28.2-41.3).
The findings highlight the importance of early-life and midlife prevention strategies in low- and middle-income countries, with a focus on addressing educational and cardiovascular risk factors.
RMC received Alzheimer's Association grant (AARGD-21-846545).
在低收入和中等收入国家，可改变的痴呆风险因素的人群归因分数（PAF）很少被估算。我们旨在估算认知障碍的相对风险（RR），并计算巴西老年健康与生活方式研究（ELSA-Brasil）中的PAF。
我们分析了基线期（2008 - 2010年）和第3轮随访（2017 - 2019年）时年龄在35 - 74岁的成年人。我们估算了基线期8种可改变的痴呆风险因素的患病率：高血压、缺乏身体活动、糖尿病、抑郁症、肥胖、低教育程度、吸烟和过量饮酒。在基线期和第3轮随访时，使用针对巴西葡萄牙语的6项标准化测试评估认知情况。通过计算每项测试的z分数，为个体认知测试创建一个总体认知分数。总体z分数低于 -1.5被认为表明存在认知障碍。我们计算了第3轮随访时认知障碍的RR和PAF。
我们对10,058名成年人（56.7%为女性，中位年龄50岁[四分位间距：44 - 56岁]）进行了8.1（0.6）年的随访。第3轮随访中认知障碍的8年发病率为5.5%（n = 549）。低教育程度的RR最大（4.32），其次是高血压（1.43）、糖尿病（1.27）和吸烟（1.35）。低教育程度的PAF最大（95%置信区间），为14.2%（11.2 - 17.3），其次是高血压13%（7 - 19）、糖尿病4.2%（0.7 - 7.7）和吸烟3.2%（0.45 - 6）。显著风险因素的总PAF为34.7%（28.2 - 41.3）。
研究结果突出了低收入和中等收入国家早期和中年预防策略的重要性，重点是解决教育和心血管风险因素。
RMC获得了阿尔茨海默病协会资助（AARGD - 21 - 846545）。
