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Race-Specific Dementia Risk Prediction Using 2024 Lancet Commission Risk Factors and Resting Heart Rate: A Survival Analysis of 55,004 NACC Participants
Alaka, S. A.; Ngan, S.-F. C.; Iyappan, R.; Nwaeze, J.; D'Amore, B.; Katoueezadeh, M.; Thinakaran, Y.; Laein et al.. medRxiv (preprint), 2026-08-25
Topic: Risk, prevention and care in population studies
Persistent racial disparities in dementia raise concerns regarding the validity and generalizability of existing prognostic models across diverse populations. We evaluated the utility of the 2024 Lancet Commission risk factors and resting heart rate (RHR) for race-specific dementia risk prediction using data from 55,004 participants in the National Alzheimers Coordinating Center cohort. Cox proportional hazards and Random Survival Forest (RSF) models were developed separately for Black, White, Asian, and American Indian participants to predict 1-, 3-, and 5-year time to dementia. RSF consistently outperformed Cox models across all racial groups and prediction horizons, achieving 5-year AUCs of 0.88-0.91 compared with 0.69-0.81 for Cox models. Inclusion of RHR modestly and consistently improved predictive performance across racial groups. Predictor importance varied between racial groups, suggesting heterogeneity in dementia risk profiles and disease presentation. These findings support the potential utility of RHR as a complementary prognostic biomarker and highlight the importance of equitable, personalized dementia risk prediction across diverse populations.
Key findings
- RSF consistently outperformed Cox models across all racial groups and prediction horizons, achieving 5-year AUCs of 0.88-0.91 compared with 0.69-0.81 for Cox models.
- These findings support the potential utility of RHR as a complementary prognostic biomarker and highlight the importance of equitable, personalized dementia risk prediction across diverse populations.
Why it matters
Using NACC data, this analysis found that random survival forest models predicted dementia risk better than Cox models across racial groups, and that adding resting heart rate modestly improved prediction. It is about risk prediction tools, not treating, curing or preventing Alzheimer's disease.
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Study details
- Participants55,004
- Evidence strengthModerate
How this study scored 16/100
Preprint — not yet peer-reviewed. It scored 29 on the same rubric, but non-peer-reviewed sources are capped at 16, so it shows as 16. Scored zero for study design, effect reported and randomised / blinded because the record does not state it. We have no data on impact for its field and year, so that was left out: it earned 27 of the 94 points we could judge it on, which is 29 out of 100.
| Component | Points | Why |
|---|---|---|
| Journal tier | 2 / 10 | Tier 4 — not a peer-reviewed journal (medRxiv (preprint)) |
| Journal's citation record | 0 / 4 | Not a journal article, so the journal's record does not count |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 3 / 5 | Rated “moderate” in our summary |
| Peer-review validation | 4 / 10 | Preprint — not yet peer-reviewed. Hosted on a preprint server. |
| How recent | 5 / 5 | 2026 — within 1 year(s) of the newest study here |
| Sample size | 4 / 4 | 55,004 participants |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| 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 | 0 / 7 | Cited 0 times (OpenAlex, 2026-10-10) |
| Citations per year | 0 / 5 | 0.0 citations a year over 2 year(s) since 2026 |
| Impact for its field and year | — / 6 | No field-weighted citation impact (OpenAlex has none yet) — left out of this score |
| Cited by studies here | 0 / 6 | No other study in this library cites it |
| Still being cited | 0 / 4 | Cited 0 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 3 / 4 | Last-listed author Siu Kwan Sze: h-index 66 (OpenAlex, whole career) |
| Institution's track record | 0 / 3 | Brock University: institution h-index 308 (OpenAlex) |
| Multi-centre collaboration | 0 / 3 | OpenAlex lists 1 institution(s) in 1 country — scores zero (affiliation lists can be incomplete) |
| Indexed in PubMed | 1 / 2 | Not in PubMed, but has a DOI |
| Free to read | 2 / 2 | Free to read |
| Points | 27 / 94 | Scored on 19 of 20 parts. We have no data for the rest, so they are left out: 27 of the 94 points we could judge it on is 29 out of 100. |
| Total | 29 / 100 | Capped to 16 because this is not a peer-reviewed article. |
What each of these 20 components measures, and what this score is not →
Read the original
Full text: free to read — OpenAlex lists this copy as free to read: the link above (checked 6 Feb 1020).
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. The record's author list ends in “et al.”, so not every author is named. Check the citation against the original before you use it.
APA 7th
Alaka, S. A., Ngan, S.-F. C., Iyappan, R., Nwaeze, J., D'Amore, B., Katoueezadeh, M., et al. (2026). Race-Specific Dementia Risk Prediction Using 2024 Lancet Commission Risk Factors and Resting Heart Rate: A Survival Analysis of 55,004 NACC Participants. medRxiv (preprint). https://doi.org/10.64898/2026.08.23.26361129
Vancouver
Alaka SA, Ngan S.-FC, Iyappan R, Nwaeze J, D'Amore B, Katoueezadeh M, et al. Race-Specific Dementia Risk Prediction Using 2024 Lancet Commission Risk Factors and Resting Heart Rate: A Survival Analysis of 55,004 NACC Participants. medRxiv (preprint). 2026. doi:10.64898/2026.08.23.26361129.
BibTeX
@article{alaka2026-cbc65893,
author = {Alaka, S. A. and Ngan, S.-F. C. and Iyappan, R. and Nwaeze, J. and D'Amore, B. and Katoueezadeh, M. and Thinakaran, Y. and Laein and others},
title = {{Race-Specific Dementia Risk Prediction Using 2024 Lancet Commission Risk Factors and Resting Heart Rate: A Survival Analysis of 55,004 NACC Participants}},
journal = {medRxiv (preprint)},
year = {2026},
doi = {10.64898/2026.08.23.26361129},
url = {https://doi.org/10.64898/2026.08.23.26361129}
}
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