{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T14:28:10Z","timestamp":1786976890836,"version":"build-2736575974"},"reference-count":30,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,2,9]],"date-time":"2026-02-09T00:00:00Z","timestamp":1770595200000},"content-version":"vor","delay-in-days":8,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,2,1]],"date-time":"2026-02-01T00:00:00Z","timestamp":1769904000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000065","name":"National Institute of Neurological Disorders and Stroke","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000065","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100030692","name":"Intramural Research Program","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100030692","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["alz-journals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Alzheimer's &amp; Dementia"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>INTRODUCTION<\/jats:title>\n                    <jats:p>Understanding comorbidities\u2019 combined impacts on dementia risk may offer a more comprehensive understanding of individuals\u2019 risk. Using machine\u2010learning, we grouped individuals with similar midlife risk profiles into clusters and explored associations with dementia risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>\n                      Participants without dementia at baseline (1987\u20131989) from the prospective Atherosclerosis Risk in Communities (ARIC) study were included (ages 45\u201364 years;\n                      <jats:italic>N\u00a0<\/jats:italic>\n                      =\u00a015,250). Using unsupervised hierarchical cluster analysis, nine clusters were created and defined based on 14 midlife morbidities. The associations with incident dementia (\n                      <jats:italic>N\u00a0<\/jats:italic>\n                      =\u00a03272 cases, median follow\u2010up 25 years) and deaths (\n                      <jats:italic>N\u00a0<\/jats:italic>\n                      =\u00a09099) were evaluated using time\u2010to\u2010event regression models.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Compared with the healthiest cluster (Cluster 1), Clusters 2 (smoking) (hazard ratio [HR](95% confidence interval [CI])\u00a0=\u00a01.62 (1.08, 2.43)), 5 (obesity, diabetes, hypertension, and hypertriglyceridemia) (HR(95%CI)\u00a0=\u00a01.91 (1.35,2.70)), and 7\/8 (atrial fibrillation\/heart failure) (HR(95%CI)\u00a0=\u00a02.69 (1.59,4.57)) were associated with dementia. Accounting for competing risk of death in the Fine\u2010Gray subdistribution model negated the cluster\u2010dementia association.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>DISCUSSION<\/jats:title>\n                    <jats:p>Midlife morbidity clusters are important for dementia and mortality risk.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/alz.71110","type":"journal-article","created":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T03:51:13Z","timestamp":1770695473000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["The influence of midlife morbidity clusters on dementia risk: The ARIC study"],"prefix":"10.1002","volume":"22","author":[{"given":"Elise","family":"Kinyanjui","sequence":"first","affiliation":[{"name":"Department of Neuroscience St. Mary's College of Maryland  St. Mary's City Maryland USA"},{"name":"National Institute of Neurological Disorders and Stroke Intramural Research Program, National Institutes of Health  Bethesda Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renee C.","family":"Groechel","sequence":"additional","affiliation":[{"name":"National Institute of Neurological Disorders and Stroke Intramural Research Program, National Institutes of Health  Bethesda Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valerie","family":"Morrill","sequence":"additional","affiliation":[{"name":"National Institute of Neurological Disorders and Stroke Intramural Research Program, National Institutes of Health  Bethesda Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keenan A.","family":"Walker","sequence":"additional","affiliation":[{"name":"Laboratory of Behavioral Neuroscience National Institute on Aging Intramural Research Program  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna M.","family":"Kucharska\u2010Newton","sequence":"additional","affiliation":[{"name":"Department of Epidemiology University of North Carolina at Chapel Hill Gillings School of Global Public Health  Chapel Hill North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas H.","family":"Mosley","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Mississippi Medical Center  Jackson Mississippi USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia","family":"Koton","sequence":"additional","affiliation":[{"name":"Department of Nursing The Stanley Steyer School of Health Professions Tel Aviv University  Tel Aviv Israel"},{"name":"Department of Epidemiology Johns Hopkins University School of Public Health  Baltimore Maryland USA"},{"name":"Optimal Aging Institute and Department of Medicine New York University Grossman School of Medicine  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David S.","family":"Knopman","sequence":"additional","affiliation":[{"name":"Department of Neurology Mayo Clinic College of Medicine and Science  Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jordan","family":"Weiss","sequence":"additional","affiliation":[{"name":"Optimal Aging Institute and Department of Medicine New York University Grossman School of Medicine  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca F.","family":"Gottesman","sequence":"additional","affiliation":[{"name":"National Institute of Neurological Disorders and Stroke Intramural Research Program, National Institutes of Health  Bethesda Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Egle","sequence":"additional","affiliation":[{"name":"National Institute of Neurological Disorders and Stroke 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