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Frailty, lifestyle, genetics and dementia risk
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  • Published on:
    Concerns regarding methodology in the purview of definitions and reference intervals
    • H Shafeeq Ahmed, Medical Student Bangalore Medical College and Research Institute, India

    The research study conducted by Ward et al., [1] has effectively marked an understandable association between frailty, lifestyle and genetics as factors of dementia in adults aged 60 and above. The findings of this study could potentially have major implications in the field of neuropsychiatric research in the field of geriatric studies.

    One of the concerns regarding the methodology of classification of a healthy lifestyle score was that participants who were currently non-smokers were identified as a valid classification in the healthy subgroup. This is questionable due to the fact that, for this classification, no reference was cited to accept non current smokers as a valid factor in the healthy lifestyle score. According to several studies, smoking was indicated as one of the major risk factors for dementia among the elderly. [2] A 2019 Lancet commission identified that smoking was the third among nine modifiable risk factors for dementia. Furthermore a review of 37 studies in the field of association of smoking as a risk factor for dementia identified that compared to never smokers, smokers had a 30% higher chance of developing dementia in general along with a 40% higher chance of developing Alzheimers. [3] So to associate non-current smokers into a healthy lifestyle category is concerning but instead, the classification should have been rather as never-smokers and smokers (both current and non-current). An appropriate classification of smokers and non-smokers...

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    Conflict of Interest:
    None declared.
  • Published on:
    Frailty, genetics, and dementia risk: why stop at lifestyle?

    Ward et al.'s recent study on frailty, lifestyle, genetics and dementia risk (1) is a major contribution to the growing multimorbidity approach towards dementia. But it is not clear why the authors exclusively frame their discussion on practical steps to reduce dementia risk around healthy lifestyle. They paradoxically argue that "adherence to national guidelines for healthy lifestyle behaviours is central to dementia risk reduction recommendations," while also recognising that multi-domain lifestyle interventions have a weak evidence base in favour of them. An exclusive focus on lifestyle to achieve reduction of frailty and dementia overlooks social gradients of health, particularly the unequal distribution of access to the kind of safe and stimulating living and working environments in which risk reduction can take place through high-quality stimulation and the absence of stressors like noise and air pollution (2). The authors make no mention of social determinants. People with higher income are more likely to part in lifestyle interventions (3), and focusing exclusively on conscious behavioural change to achieve dementia risk reduction may therefore worsen inequalities in dementia risk (4). Therefore, to address not only dementia risk reduction but also the reduction of health inequities, as well as promoting lifestyle changes, the research community ought to stress the need for action against the social determinants of frailty and dementia (5).


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    Conflict of Interest:
    None declared.
  • Published on:
    Re: Frailty, lifestyle, genetics and dementia risk

    Ward et al. reported the relationships between frailty index, healthy lifestyle and polygenic risk scores, and incident all-cause dementia (1). The adjusted hazard ratio (HR) (95% CI) of participants with high frailty for incident dementia was 3.68 (3.11 to 4.35). In addition, the adjusted HR (95% CI) of participants with high genetic risk and high frailty for incident dementia was 5.81 (4.01 to 8.42).The authors emphasized of controlling frailty for dementia prevention strategies, even among subjects at high genetic risk. I have two comments about their study.

    First, Lourida et al. investigated the association between healthy lifestyles and risk of dementia by considering genetic risk (2). The adjusted HR (95% CI) of participants with high genetic risk and unfavorable lifestyle for incident dementia was 2.83 (2.09 to 3.83). In addition, a favorable lifestyle was associated with a lower dementia risk among participants with high genetic risk. There was no significant interaction between genetic risk and lifestyle factors, and I suppose that unfavorable lifestyles and genetic factors independently contribute to the risk of dementia. The level of frailty may be related to lifestyles and contribute to subsequent progression of cognitive impairment.

    Second, Kojima et al. conducted a meta-analysis regarding the effect of frailty on the incident dementia among community-dwelling older people (3). Th pooled HRs (95% CIs) of frailty for the incident Alzheimer disease...

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    Conflict of Interest:
    None declared.