Association between mid- to late life physical fitness and dementia: evidence from the CAIDE study

Authors

  • J. Kulmala,

    Corresponding author
    1. Gerontology Research Center and Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland
    • Correspondence: Jenni Kulmala, PhD, Gerontology Research Center and Department of Health Sciences, P.O Box 35, FIN – 40014 University of Jyväskylä, Jyväskylä, Finland.

      (fax: +358-14-2604600; e-mail: jenni.kulmala@jyu.fi).

      and

      Alina Solomon, MD, PhD, Aging Research Center, Karolinska Institutet, Stockholm, Gävlegatan 16, SE-113 30 Stockholm, Sweden.

      (fax: +46 8 690 5954; e-mail: alina.solomon@ki.se).

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    • These authors contributed equally to the manuscript.
  • A. Solomon,

    Corresponding author
    1. Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
    2. Aging Research Center, Karolinska Institute and Stockholm University, Stockholm, Sweden
    3. Karolinska Institute Alzheimer Disease Research Center, Stockholm, Sweden
    • Correspondence: Jenni Kulmala, PhD, Gerontology Research Center and Department of Health Sciences, P.O Box 35, FIN – 40014 University of Jyväskylä, Jyväskylä, Finland.

      (fax: +358-14-2604600; e-mail: jenni.kulmala@jyu.fi).

      and

      Alina Solomon, MD, PhD, Aging Research Center, Karolinska Institutet, Stockholm, Gävlegatan 16, SE-113 30 Stockholm, Sweden.

      (fax: +46 8 690 5954; e-mail: alina.solomon@ki.se).

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    • These authors contributed equally to the manuscript.
  • I. Kåreholt,

    1. Aging Research Center, Karolinska Institute and Stockholm University, Stockholm, Sweden
    2. Institute for Gerontology, School of Health Sciences, Jönköping University, Jönköping, Sweden
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  • T. Ngandu,

    1. Karolinska Institute Alzheimer Disease Research Center, Stockholm, Sweden
    2. Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland
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  • T. Rantanen,

    1. Gerontology Research Center and Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland
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  • T. Laatikainen,

    1. Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland
    2. Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Joensuu, Finland
    3. Hospital District of North Karelia, Joensuu, Finland
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  • H. Soininen,

    1. Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
    2. Department of Neurology, Kuopio University Hospital, Kuopio, Finland
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  • J. Tuomilehto,

    1. Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland
    2. Center for Vascular Prevention, Danube-University Krems, Krems, Austria
    3. Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia
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  • M. Kivipelto

    1. Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
    2. Aging Research Center, Karolinska Institute and Stockholm University, Stockholm, Sweden
    3. Karolinska Institute Alzheimer Disease Research Center, Stockholm, Sweden
    4. Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland
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Abstract

Objectives

This study investigated the association between perceived physical fitness at midlife, changes in perceived fitness during the three decades from mid- to late life and dementia risk.

Design

Prospective cohort study.

Setting

Cardiovascular risk factors, ageing and incidence of dementia (CAIDE) study.

Subjects

Subjects were selected from four independent, random samples of population-based cardiovascular surveys and were first examined in 1972, 1977, 1982 or 1987, when they were on average 50 years old. The CAIDE target population included 3559 individuals. A random sample of 2000 individuals still alive in 1997 was drawn for re-examinations (performed in 1998 and 2005–2008) that consisted of cognitive assessments, with 1511 subjects participating in at least one re-examination. Dementia diagnoses were also confirmed from national registers for the entire target population.

Main outcome measure

All-cause dementia.

Results

Poor physical fitness at midlife was associated with increased dementia risk in the entire target population [hazard ratio (HR), 1.5; 95% confidence interval (CI), 1.1–2.0]. In participants, odds ratio (OR) was 2.0 (95% CI, 0.9–4.0). This association was significant in apolipoprotein E ε4 allele (APOEε4) noncarriers (OR, 4.3; 95% CI, 1.4–13.3), men (HR, 1.8; 95% CI, 1.1–3.0) and people with chronic conditions (HR, 2.9; 95% CI, 1.3–6.6). A decline in fitness after midlife was also associated with dementia (OR, 3.0; 95% CI, 1.7–5.1), which was significant amongst both men and women and more pronounced in APOEε4 carriers (OR, 4.4; 95% CI, 2.1–9.1).

Conclusions

Perceived poor physical fitness reflects a combination of biological and lifestyle-related factors that can increase dementia risk. A simple question about perceived physical fitness may reveal at-risk individuals who could benefit from preventive interventions.

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