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Midlife risk score for the prediction of dementia four decades later
Exalto LG, Quesenberry CP, Barnes D, Kivipelto M, Biessels GJ, Whitmer RA.. Alzheimer's & dementia : the journal of the Alzheimer's Association, 2013-09-10
Topic: Risk, prevention and care in population studies
Objective The objective of this study was to obtain external validation of the only available midlife dementia risk score cardiovascular risk factors , aging and dementia study (CAIDE) constituting age, education, hypertension, obesity, and hyperlipidemia in a larger, more diverse population. Our second aim was to improve the CAIDE risk score by additional midlife risk factors. Methods This retrospective cohort study was conducted in an integrated health care delivery system. A total of 9480 Kaiser Permanente members who participated in a health survey study (age range, 40-55 years) from 1964 to 1973 were included in this study. Dementia diagnoses from primary care and medical specialist visits were collected from January 1, 1994 to January 16, 2006, using International Classification of Diseases 9 codes 290.0, 290.1 for "possible dementia," and 331.0 and 290.4 for "specialist confirmed dementia." Risk model prediction and validation were examined with the C statistic, net reclassification improvement, and integrated discrimination improvement. Dementia risk per sum score was calculated with Kaplan-Meier estimates. Results A total of 2767 participants (25%) were diagnosed with any type of dementia, of which 1011 diagnoses (10.7%) were specialist-confirmed diagnoses. Average time between midlife examination and end of follow-up was 36.1 years. The CAIDE risk score replicated well with a C statistic of 0.75, quite similar to the original CAIDE C statistic of 0.78. The CAIDE score also predicted well within different race strata. Other midlife risk factors (central obesity, depressed mood, diabetes mellitus, head trauma, lung function, and smoking) did not improve predictability. The risk score allowed stratification of participants into those with 40-year low (9%) and high (29%) dementia risk. Conclusions A combination of modifiable vascular risk factors in midlife is highly predictive of the likelihood of dementia decades later. Possible dementia prevention strategies should point to a life course perspective on maintaining vascular health.
Key findings
- Results A total of 2767 participants (25%) were diagnosed with any type of dementia, of which 1011 diagnoses (10.7%) were specialist-confirmed diagnoses.
Why it matters
In 9,480 Kaiser Permanente members aged 40-55 in 1964-1973, the CAIDE midlife score (age, education, hypertension, obesity, high cholesterol) predicted dementia diagnoses about 36 years later about as well as in the original study (C statistic 0.75 vs 0.78), including within different race groups. People in the lowest and highest score groups had a 9% and 29% 40-year dementia risk. Adding smoking, diabetes, depressed mood, head trauma, central obesity or lung function did not improve prediction. This is a prediction study: it did not test whether changing any of these factors lowers dementia risk.
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Study details
- Study designcohort study
- Participants2,767
- Effect size10.7%
- Evidence strengthModerate
How this study scored 67/100
Published in a leading specialty journal, and it is a cohort study following people over time. Scored zero for randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 9 / 10 | Tier 2 — leading specialty journal (Alzheimer's & dementia : the journal of the Alzheimer's Association) |
| Journal's citation record | 2 / 4 | Alzheimer s & Dementia: journal h-index 228 (OpenAlex, 2026-10-29) |
| Study design | 7 / 12 | A cohort study following people over time |
| Strength of evidence | 3 / 5 | Rated “moderate” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 1 / 5 | 2014 — within 20 year(s) of the newest study here |
| Sample size | 3 / 4 | 2,767 participants |
| Effect reported | 2 / 3 | Effect reported as a number, without an interval or test |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 5 / 7 | Cited 278 times (OpenAlex, 2026-10-10) |
| Citations per year | 3 / 5 | 19.9 citations a year over 14 year(s) since 2014 |
| Impact for its field and year | 4 / 6 | Cited 9.4× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 3 / 6 | Cited by 26 other studies in this library |
| Still being cited | 3 / 4 | Cited 73 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 3 / 4 | Last-listed author Rachel A. Whitmer: h-index 63 (OpenAlex, whole career) |
| Institution's track record | 2 / 3 | University of California, San Francisco: institution h-index 1,915 (OpenAlex) |
| Multi-centre collaboration | 2 / 3 | OpenAlex lists 4 institution(s) in 3 countries |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 24035147) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Total | 67 / 100 | — |
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Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. Check the citation against the original before you use it.
APA 7th
Exalto, L. G., Quesenberry, C. P., Barnes, D., Kivipelto, M., Biessels, G. J., & Whitmer, R. A. (2014). Midlife risk score for the prediction of dementia four decades later. Alzheimer's & dementia : the journal of the Alzheimer's Association. https://doi.org/10.1016/j.jalz.2013.05.1772
Vancouver
Exalto LG, Quesenberry CP, Barnes D, Kivipelto M, Biessels GJ, Whitmer RA. Midlife risk score for the prediction of dementia four decades later. Alzheimer's & dementia : the journal of the Alzheimer's Association. 2014. doi:10.1016/j.jalz.2013.05.1772. PMID: 24035147.
BibTeX
@article{exalto2014-24035147,
author = {Exalto, L. G. and Quesenberry, C. P. and Barnes, D. and Kivipelto, M. and Biessels, G. J. and Whitmer, R. A.},
title = {{Midlife risk score for the prediction of dementia four decades later}},
journal = {Alzheimer's \& dementia : the journal of the Alzheimer's Association},
year = {2014},
doi = {10.1016/j.jalz.2013.05.1772},
pmid = {24035147},
url = {https://doi.org/10.1016/j.jalz.2013.05.1772}
}
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