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Worldwide surveys indicate that about half of adults do not meet recommended fluid intake and may be chronically underhydrated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>We examined associations between intracellular hydration markers and dementia risk in 13,535 participants from the Atherosclerosis Risk in Communities (ARIC) study and 395,802 individuals from Israel's Leumit Health Services. Serum sodium, glucose\u2010corrected sodium, and tonicity were modeled using restricted cubic splines in adjusted Cox models of incident dementia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Across both cohorts, with up to 30 years of follow\u2010up, dementia risk showed a nonlinear association with hydration markers. Risk began increasing within the mid\u2010normal range, around 141\u00a0mmol\/L for serum sodium and 287 mosmol\/kg for tonicity, reaching a 1.5\u2010 to 3\u2010fold increase at the upper end and beyond.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>DISCUSSION<\/jats:title>\n                    <jats:p>These findings suggest hypertonic underhydration as early marker of dementia risk and support adequate water intake and glycemic control for dementia prevention.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/alz.71725","type":"journal-article","created":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T06:24:41Z","timestamp":1787207081000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Serum sodium, tonicity, and risk of dementia in cohort and healthcare populations"],"prefix":"10.1002","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8074-6950","authenticated-orcid":false,"given":"Natalia I.","family":"Dmitrieva","sequence":"first","affiliation":[{"name":"The Laboratory of Cardiovascular Regenerative Medicine National Heart Lung and Blood Institute  Bethesda Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Rabinowitz","sequence":"additional","affiliation":[{"name":"Wellness Lab and Louis and Gabi Weisfeld School of Social Work Bar\u2010Ilan University  Ramat Gan Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric S.","family":"Leifer","sequence":"additional","affiliation":[{"name":"Office of Biostatistics Research National Heart Lung and Blood Institute  Bethesda Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Delong","family":"Liu","sequence":"additional","affiliation":[{"name":"The Laboratory of Cardiovascular 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