Risk factors and population attributable fraction for dementia in American Indians: The Strong Heart Study

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INTRODUCTION: Previous works implicate 14 modifiable risk factors as underlying 45% of dementia cases. Population attributable fraction (PAF) is population-specific, limiting generalizability. Little is known about the risk and PAF of dementia in American Indians. METHODS: American Indians from the Southwest, Southern Plains, and Northern Plains made multiple visits from mid- to late-life (1989 to 2019). Cognitive status was adjudicated by panel consensus (ages 70 to 95). Logistic regression models assessed relative risk and PAF for dementia. RESULTS: American Indians had distinctive patterns of factor prevalence. The proportion with limited education and social isolation was similar. Mid-life depression, head injury, smoking, hypertension, obesity, and diabetes were more common. High low-density lipoprotein levels, sedentary/inactivity, and consumption of ≥21 units of alcohol/week were less common. We did not assess hearing loss, vision loss, or air pollution. Significant risk factors for dementia with PAF percentage were as follows: education (19%), hypertension (11%), isolation (13%), and depression (60%). DISCUSSION: Important, unique risk patterns were detected for American Indians, in contrast to prior models.

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