Overall Health May Predict Dementia Risk Better Than Previously Identified Risk Factors

A new study of data on 7,239 Canadian adults aged 65 and older has found that overall health, measured by a combination of health factors not traditionally associated with dementia, such as denture fit, vision, hearing, and 16 others, was significantly related to and predictive of the risk of developing dementia within 5 or 10 years.

In fact, the researchers found that the composite of these overall health factors not traditionally associated with dementia was a better predictor of whether the participants would develop Alzheimer’s Disease 5 or 10 years later, than was a measure including the traditionally identified cognitive risk factors of high blood pressure, heart disease, history of stroke, and diabetes.

The study, conducted by Kenneth Rockwood, MD, of Dalhousie University in Halifax, Nova Scotia, Canada, and colleagues, was published in the July 13, 2011 online issue of Neurology®, the medical journal of the American Academy of Neurology.

“Our study suggests that rather than just paying attention to already known risk factors for dementia, such as diabetes or heart disease, keeping up with your general health may help reduce the risk for dementia,” Dr. Rockwood said.

Study Method

The study included 7,239 people free of dementia ages 65 and older from the Canadian Study of Health and Aging. At the beginning of the study, participants answered a questionnaire including questions about 19 health problems not previously reported to predict dementia.

Based on participant’s responses to these 19 general health questions, the researchers developed a “frailty index of nontraditional risk factors (FI-NTRF)” which they used to assign overall health scores to the participants. The 19 general health questions included in the FI-NTRF index were:

  1. How good is your health?
  2. How good is your eyesight?
  3. How good is your hearing?
  4. Does the denture fit?
  5. Arthritis or rheumatism?
  6. Eye trouble?
  7. Ear trouble?
  8. Trouble with your stomach?
  9. Kidney trouble?
  10. Lose control of your bladder?
  11. Lose control of your bowels?
  12. Trouble with your feet or ankles?
  13. Nose stuffed up or sneezing?
  14. Any fractures?
  15. Chest problems?
  16. Have you had a cough?
  17. Skin problems?
  18. Dental problems?
  19. Have you had other problems?

For each of these questions, participants were given a choice of 5 responses ranging from “poor” to “very good.” In the FI-NTRF index, each participant received a “health deficit” of 1 point for each of the above conditions to which they responded “not too good,” “poor,” or “very poor.” They received a score of 0 (or no health deficit) if they responded “pretty good” or “very good.”

For comparison, a separate but similar index was developed to evaluate the participants based upon their responses to questions about the principal health factors traditionally associated with risk of developing dementia: (i) high blood pressure, (ii) heart disease, (iii) history of stroke, and (iv) diabetes. All of these traditional factors were excluded from the FI-NTRF index devised by the researchers to measure the above nontraditional risk factors.

After five years and again after 10 years, the number of deaths of study participants was recorded, and the surviving participants were evaluated for Alzheimer’s disease and all types of dementia.

After 10 years, 2,915 of the participants had died, 883 were cognitively healthy, 416 had Alzheimer’s disease, 191 had other types of dementia, 677 had cognitive problems but no dementia, and the cognitive status of 1,023 people was not clear.


The study found that, when considered individually, most of the 19 factors listed above did not significantly predict the risk of death or dementia, however the participants’ combined FI-NTRF score (measuring their overall health by the 19 listed factors) at the beginning of the study was significantly predictive of their likelihood of dying or developing Alzheimer’s Disease (AD) or other dementia in 5 years and in 10 years.

The study report states:

“In general, people who maintained cognitive health over 10 years were healthier at baseline (i.e., had lower FI-NTRF scores) than those who died or developed dementia. The rate of death over 5 or 10 years increased with the increase in the FI-NTRF… The risk of AD or of all-type dementia … also increased with the FI-NTRF; the strongest correlation was observed for the 10-year follow-up…”

In fact, the researchers stated, “the FI-NTRF yielded statistically significant AD risk estimates, and outperformed the traditional cognitive risk factors,” in predicting the likelihood of developing Alzheimer’s Disease.

The study found that each health deficit in the FI-NTRF index (i.e. presence of each health factor in the list of 19) increased a person’s odds of developing dementia by 3.2 percent compared to people without such health problems. Older adults without health problems at baseline had an 18 percent chance to become demented in 10 years, while such risk increased to 30 percent and 40 percent in those who had 8 and 12 health problems, respectively.


In summary, the authors stated,

“We evaluated several health deficits that are not known to be risks for dementia, and found that, combined in an index variable, they were significantly associated not just with survival, but also with the incidence of AD and dementia of all types over 5-year and 10-year intervals. These associations were maintained even after adjusting for traditional risk factors and for age.”

They further commented that:

“The cumulative effects of sometimes small and cognitively irrelevant insults [health problems] is in general compatible with the idea that factors which take a toll on general bodily health also are associated with—or set up the conditions for—factors that give rise to dementia. In this way, these data also draw attention to the possibility that improving the overall health of the population might lessen the burden of late-life dementia. The very broad nature of the range of factors that give rise to dementia suggests, at a minimum, that general health may be an important confounder to consider in evaluating dementia risk, especially with older samples, so that a more comprehensive view of health needs to be considered.”

“More research needs to be done to confirm that these non-traditional health problems may indeed be linked to an increased risk of dementia, but if confirmed, the consequences of these findings could be significant and could lead to the development of preventive or curative strategies for Alzheimer’s disease,” said Jean François Dartigues, MD, PhD, with the National Institute of Health and Medical Research (INSERM) in Paris, France, in an accompanying editorial also published in the July 13, 2011 issue of Neurology®.

The study was supported by the Canadian Institutes of Health Research, the Nova Scotia Health Research Foundation and the Alzheimer Society of Canada.

More Information

The full report of the new study, Nontraditional risk factors combine to predict Alzheimer disease and dementia, is available in the July 13, 2011 online issue of Neurology®, the medical journal of the American Academy of Neurology.

For more information about Alzheimer’s Disease and dementia, see HelpingYouCare™’s resource pages on Alzheimer’s/ Dementia, including:

For further information on some of the 19 general health conditions identified in the study as predictive, in combination, of future risk of dementia, see generally HelpingYouCare™’s resource pages on Medical Conditions Commonly Faced by Seniors.

See also our resource pages on Wellness/ Healthy Living for Seniors and Caregivers.


Copyright © 2011 Care-Help LLC


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