Riassunto analitico
Background and aim
Dementia is an extremely severe clinical condition generally affecting elderly subjects, but which may also occur at younger age (<65 years), yielding a condition called early-onset dementia (EOD). For the latter, there are most limited epidemiological data. We aimed at assessing the etiological and prognostic role of some risk factors that may favor EOD onset in the Modena population.
Methods
Using a case-control design, we recruited EOD cases from two Centers of Cognitive Disease of the Neurology Units of the Modena Local Health Unit, and from the community health centers and general practitioners of Modena province. Referent population were care-givers of EOD and LOD subjects. We investigated the possible role of risk factors of environmental exposures, occupation, and dietary habits through two specific questionnaires administered to the patient and to his/her caregiver. The first questionnaire collected information about personal characteristics, family history of disease, clinical history, occupation, leisure activities, domestic use of pesticides, and other. The second questionnaire, a validated semi-quantitative food frequency questionnaire, assessed long-term dietary habits. Study participants were recruited from 2017 to May 2019. We computed the odds ratios (ORs) of EOD along with its 95% confidence intervals (CIs), according to putative risk factors using an unconditional logistic regression model adjusting for sex, age, educational attainment level and total energy intake. For dietary risk factors we calculated EOD risk for increasing tertile of intake using the first tertile as reference, and we further modeled the association non-parametrically using restricted cubic splines.
Results
We eventually recruited 56 cases and 53 controls who agreed to participate, with a slightly higher number of women. Concerning personal characteristics and clinical history, we found a slight increased EOD risk for former trauma, especially head trauma. About comorbidities, previous diagnosis of hypertension or cardiovascular disease was associated with decreased disease risk, while positive associations were also found for stroke, diabetes or dyslipidemia. Occupational exposure to contaminants showed a positive association with risk for selenium, aluminum, pesticides, dyes, paints or thinners. Ever smoking showed increased risk, while null association was found for passive smoking. We found decreased EOD risk for overall sport playing, despite such opposite association was found for football. Regarding dietary habits, we found an increased disease risk for preserved and tinned fish, showing such positive association when daily consumption exceeded 25 g. Also intake of milk and dairy products higher than 500 g/day showed higher risk, as well as sweet products overall considered. Conversely, possible protective factors for EOD onset were high intake of vegetables, particularly green leafy vegetables, dry fruits, use of olive oil, moderate consumption of chocolate and high adherence to the MIND pattern, particularly for women.
Conclusions
Our study assessed possible environmental and occupational risk factors for EOD in the Modena population. About clinical history, a few factors such as previous head trauma, stroke, diabetes or dyslipidemia were positively associated to EOD risk. Regarding occupational factors, our findings suggest that some chemical exposure, such as pesticides, aluminum and selenium, could increase the risk. Conversely, playing sport and high adherence to MIND pattern, particularly for women, suggest a decreased risk of onset. In particular, we found a strong inverse association for some components of the Mediterranean diet and chocolate. Despite the imprecision of such estimates and the possible occurrence of some selection and recall bias, our findings highlight a possible role of some environmental risk factors in EOD etiology.
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Abstract
Background and aim
Dementia is an extremely severe clinical condition generally affecting elderly subjects, but which may also occur at younger age (<65 years), yielding a condition called early-onset dementia (EOD). For the latter, there are most limited epidemiological data. We aimed at assessing the etiological and prognostic role of some risk factors that may favor EOD onset in the Modena population.
Methods
Using a case-control design, we recruited EOD cases from two Centers of Cognitive Disease of the Neurology Units of the Modena Local Health Unit, and from the community health centers and general practitioners of Modena province. Referent population were care-givers of EOD and LOD subjects. We investigated the possible role of risk factors of environmental exposures, occupation, and dietary habits through two specific questionnaires administered to the patient and to his/her caregiver. The first questionnaire collected information about personal characteristics, family history of disease, clinical history, occupation, leisure activities, domestic use of pesticides, and other. The second questionnaire, a validated semi-quantitative food frequency questionnaire, assessed long-term dietary habits. Study participants were recruited from 2017 to May 2019. We computed the odds ratios (ORs) of EOD along with its 95% confidence intervals (CIs), according to putative risk factors using an unconditional logistic regression model adjusting for sex, age, educational attainment level and total energy intake. For dietary risk factors we calculated EOD risk for increasing tertile of intake using the first tertile as reference, and we further modeled the association non-parametrically using restricted cubic splines.
Results
We eventually recruited 56 cases and 53 controls who agreed to participate, with a slightly higher number of women. Concerning personal characteristics and clinical history, we found a slight increased EOD risk for former trauma, especially head trauma. About comorbidities, previous diagnosis of hypertension or cardiovascular disease was associated with decreased disease risk, while positive associations were also found for stroke, diabetes or dyslipidemia. Occupational exposure to contaminants showed a positive association with risk for selenium, aluminum, pesticides, dyes, paints or thinners. Ever smoking showed increased risk, while null association was found for passive smoking. We found decreased EOD risk for overall sport playing, despite such opposite association was found for football. Regarding dietary habits, we found an increased disease risk for preserved and tinned fish, showing such positive association when daily consumption exceeded 25 g. Also intake of milk and dairy products higher than 500 g/day showed higher risk, as well as sweet products overall considered. Conversely, possible protective factors for EOD onset were high intake of vegetables, particularly green leafy vegetables, dry fruits, use of olive oil, moderate consumption of chocolate and high adherence to the MIND pattern, particularly for women.
Conclusions
Our study assessed possible environmental and occupational risk factors for EOD in the Modena population. About clinical history, a few factors such as previous head trauma, stroke, diabetes or dyslipidemia were positively associated to EOD risk. Regarding occupational factors, our findings suggest that some chemical exposure, such as pesticides, aluminum and selenium, could increase the risk. Conversely, playing sport and high adherence to MIND pattern, particularly for women, suggest a decreased risk of onset. In particular, we found a strong inverse association for some components of the Mediterranean diet and chocolate. Despite the imprecision of such estimates and the possible occurrence of some selection and recall bias, our findings highlight a possible role of some environmental risk factors in EOD etiology.
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