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Alzheimers Dement. 2017 Apr;13(4):406-418. doi: 10.1016/j.jalz.2016.07.152. Epub 2016 Sep 4.

Systematic evaluation of the associations between environmental risk factors and dementia: An umbrella review of systematic reviews and meta-analyses.

Author information

1
Department of Hygiene and Epidemiology, University of Ioannina Medical School, Ioannina, Greece.
2
Department of Hygiene and Epidemiology, University of Ioannina Medical School, Ioannina, Greece; Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, UK.
3
Neuroepidemiology and Ageing Research Unit, School of Public Health, Imperial College London, London, UK.
4
Department of Medicine, Stanford Prevention Research Center, Stanford, CA, USA; Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA, USA; Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, USA; Department of Statistics, Stanford University School of Humanities and Sciences, Stanford, CA, USA.
5
Department of Hygiene and Epidemiology, University of Ioannina Medical School, Ioannina, Greece; Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK. Electronic address: vangelis@cc.uoi.gr.

Abstract

INTRODUCTION:

Dementia is a heterogeneous neurodegenerative disease, whose etiology results from a complex interplay between environmental and genetic factors.

METHODS:

We searched PubMed to identify meta-analyses of observational studies that examined associations between nongenetic factors and dementia. We estimated the summary effect size using random-effects and fixed-effects model, the 95% CI, and the 95% prediction interval. We assessed the between-study heterogeneity (I-square), evidence of small-study effects, and excess significance.

RESULTS:

A total of 76 unique associations were examined. By applying standardized criteria, seven associations presented convincing evidence. These associations pertained to benzodiazepines use, depression at any age, late-life depression, and frequency of social contacts for all types of dementia; late-life depression for Alzheimer's disease; and type 2 diabetes mellitus for vascular dementia and Alzheimer's disease.

DISCUSSION:

Several risk factors present substantial evidence for association with dementia and should be assessed as potential targets for interventions, but these associations may not necessarily be causal.

KEYWORDS:

Alzheimer's disease; Dementia; Epidemiology; Risk factors; Umbrella review

PMID:
27599208
DOI:
10.1016/j.jalz.2016.07.152
[Indexed for MEDLINE]
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