Kivipelto et al developed 2 risk scores for predicting the risk of dementia in 20 years for a middle-aged adult. This can help identify a person who may benefit from more aggressive management of risk factors. The authors are from the Karolinska Institute in Stockholm, University Hospital Huddinge, University of Kuopio, University of Helsinki and South Ostrobothnia Central Hospital (Seinajoki, Finland).
Patient selection: middle aged adults (participants in reference population were 65 to 79; an adult 20 years younger would be 45 to 59)
Parameters:
(1) age in years
(2) education
(3) gender
(4) systolic blood pressure
(5) body mass index
(6) total cholesterol in mmol/L
(7) physical activity
(8) APOE epsilon-4 status
|
Parameter |
Finding |
Score 1 |
Score 2 |
|
age in years |
< 47 years |
0 |
0 |
|
|
47 to 53 years |
3 |
3 |
|
|
> 53 years |
4 |
5 |
|
education |
0 to 6 years |
3 |
4 |
|
|
7 to 9 years |
2 |
3 |
|
|
>= 10 years |
0 |
0 |
|
gender |
female |
0 |
0 |
|
|
male |
1 |
1 |
|
systolic blood pressure |
<= 140 mm Hg |
0 |
0 |
|
|
> 140 mm Hg |
2 |
2 |
|
body mass index |
<= 30 kg per sq meter |
0 |
0 |
|
|
> 30 kg per sq meter |
2 |
2 |
|
total cholesterol |
<= 6.5 mmol/L |
0 |
0 |
|
|
> 6.5 mmol/L |
2 |
1 |
|
physical activity |
active |
0 |
0 |
|
|
inactive |
1 |
1 |
|
APOE epsilon 4 |
absent |
NA |
0 |
|
|
present |
NA |
2 |
total risk score 1 =
= SUM(points for score 1)
total risk score 2 =
= SUM(points for score 2)
Interpretation:
• minimum risk scores: 0
• maximum risk score 1: 15
• maximum risk score 2: 18
• The higher the risk score the greater the risk of dementia.
|
Total Risk Score 1 |
Risk of Dementia |
|
0 to 5 |
1% |
|
6 or 7 |
1.9% |
|
8 or 9 |
4.2% |
|
10 or 11 |
7.4% |
|
12 to 15 |
16.4% |
|
Total Risk Score 2 |
Risk of Dementia |
|
0 to 5 |
0.3% |
|
6 to 8 |
1.7% |
|
9 to 12 |
4.4 - 4.6% |
|
13 to 18 |
16.3% |
Performance:
• The sensitivity of risk score 1 with a cutoff set at 9 was 77% and the specificity was 63%, which are not stellar. The negative predictive value was 98%.
• The range in the reference population was 14 years (65-79 years). A younger person is going to have a lower risk just because they are younger.
Specialty: Neurology
