Nontraditional risk factors combine to predict Alzheimer disease and dementia

Objective: To investigate whether dementia risk can be estimated using only health deficits not known to predict dementia. Methods: A frailty index consisting of 19 deficits not known to predict dementia (the nontraditional risk factors index [FI-NTRF]) was constructed for 7,239 cognitively healthy, communitydwelling older adults in the Canadian Study of Health and Aging. From baseline, their 5-year and 10-year risks for Alzheimer disease (AD), dementia of all types, and survival were estimated. Results: The FI-NTRF was closely correlated with age (r² >0.96, p < 0.001). The incidence of AD and dementia increased exponentially with the FI-NTRF (r² > 0.75, p <; 0.001 over 10 years). Adjusted for age, sex, education, and baseline cognition, the odds ratio of dementia increased by 3.2% (p < 0.021) for each deficit (that was not known to predict dementia) accumulated, outperforming the individual cognitive risk factors. The FI-NTRF discriminated people with AD and allcause dementia from those who were cognitively healthy with an area under the receiver operating characteristic curve of 0.66 ± 0.03. Conclusions: Comprehensive re-evaluation of a well-characterized cohort showed that ageassociated decline in health status, in addition to traditional risk factors, is a risk factor for AD and dementia. General health may be an important confounder to consider in dementia risk factor evaluation. If a diverse range of deficits is associated with dementia, then improving general health might reduce dementia risk.