{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,7]],"date-time":"2026-11-07T15:27:57Z","timestamp":1794065277825,"version":"4.8.0"},"reference-count":28,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2013,9,12]],"date-time":"2013-09-12T00:00:00Z","timestamp":1378944000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"Kaiser Permanente Community Benefits Grant"},{"name":"Fulbright fellowship"}],"content-domain":{"domain":["alz-journals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Alzheimer's &amp;amp; Dementia"],"published-print":{"date-parts":[[2014,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>The objective of this study was to obtain external validation of the only available midlife dementia risk score cardiovascular risk factors , aging and dementia study (CAIDE) constituting age, education, hypertension, obesity, and hyperlipidemia in a larger, more diverse population. Our second aim was to improve the CAIDE risk score by additional midlife risk factors.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This retrospective cohort study was conducted in an integrated health care delivery system. A total of 9480 Kaiser Permanente members who participated in a health survey study (age range, 40\u201355\u00a0years) from 1964 to 1973 were included in this study. Dementia diagnoses from primary care and medical specialist visits were collected from January 1, 1994 to January 16, 2006, using International Classification of Diseases 9 codes 290.0, 290.1 for \u201cpossible dementia,\u201d and 331.0 and 290.4 for \u201cspecialist confirmed dementia.\u201d Risk model prediction and validation were examined with the C statistic, net reclassification improvement, and integrated discrimination improvement. Dementia risk per sum score was calculated with Kaplan\u2010Meier estimates.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 2767 participants (25%) were diagnosed with any type of dementia, of which 1011 diagnoses (10.7%) were specialist\u2010confirmed diagnoses. Average time between midlife examination and end of follow\u2010up was 36.1\u00a0years. The CAIDE risk score replicated well with a C statistic of 0.75, quite similar to the original CAIDE C statistic of 0.78. The CAIDE score also predicted well within different race strata. Other midlife risk factors (central obesity, depressed mood, diabetes mellitus, head trauma, lung function, and smoking) did not improve predictability. The risk score allowed stratification of participants into those with 40\u2010year low (9%) and high (29%) dementia risk.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>A combination of modifiable vascular risk factors in midlife is highly predictive of the likelihood of dementia decades later. Possible dementia prevention strategies should point to a life course perspective on maintaining vascular health.<\/jats:p><\/jats:sec>","DOI":"10.1016\/j.jalz.2013.05.1772","type":"journal-article","created":{"date-parts":[[2013,9,10]],"date-time":"2013-09-10T18:11:02Z","timestamp":1378836662000},"page":"562-570","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":256,"title":["Midlife risk score for the prediction of dementia four decades later"],"prefix":"10.1002","volume":"10","author":[{"given":"Lieza G.","family":"Exalto","sequence":"first","affiliation":[{"name":"Kaiser Permanente Division of Research Oakland CA USA"},{"name":"Department of Neurology Rudolf Magnus Institute of Neuroscience, University Medical Centre Utrecht Utrecht Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles P.","family":"Quesenberry","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Division of Research Oakland CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deborah","family":"Barnes","sequence":"additional","affiliation":[{"name":"University of California San Francisco CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miia","family":"Kivipelto","sequence":"additional","affiliation":[{"name":"Karolinska Aging Research Centre Karolinska University Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geert Jan","family":"Biessels","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Division of Research Oakland CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel A.","family":"Whitmer","sequence":"additional","affiliation":[{"name":"Department of Neurology Rudolf Magnus Institute of Neuroscience, University Medical Centre Utrecht Utrecht Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2013,9,12]]},"reference":[{"key":"e_1_2_6_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jalz.2007.04.381"},{"key":"e_1_2_6_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(09)70299-6"},{"key":"e_1_2_6_4_2","doi-asserted-by":"publisher","DOI":"10.1161\/HYPERTENSIONAHA.109.128744"},{"key":"e_1_2_6_5_2","doi-asserted-by":"publisher","DOI":"10.1001\/archneur.62.1.55"},{"key":"e_1_2_6_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(96)90608-X"},{"key":"e_1_2_6_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(05)70284-2"},{"key":"e_1_2_6_8_2","doi-asserted-by":"publisher","DOI":"10.1212\/01.WNL.0000149519.47454.F2"},{"key":"e_1_2_6_9_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.97.18.1837"},{"key":"e_1_2_6_10_2","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/23.3.495"},{"key":"e_1_2_6_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(06)70537-3"},{"key":"e_1_2_6_12_2","volume-title":"Multiphasic health testing services","author":"Collen MF","year":"1978"},{"key":"e_1_2_6_13_2","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.82.5.703"},{"key":"e_1_2_6_14_2","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.54.5.741"},{"key":"e_1_2_6_15_2","first-page":"355","article-title":"The multitest laboratory in health care","volume":"11","author":"Collen MF","year":"1969","journal-title":"J Occup Med."},{"key":"e_1_2_6_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9149(94)90676-9"},{"key":"e_1_2_6_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/0022-2496(75)90001-2"},{"key":"e_1_2_6_18_2","doi-asserted-by":"publisher","DOI":"10.1002\/sim.4026"},{"key":"e_1_2_6_19_2","doi-asserted-by":"publisher","DOI":"10.1159\/000231980"},{"key":"e_1_2_6_20_2","doi-asserted-by":"publisher","DOI":"10.1002\/sim.4085"},{"key":"e_1_2_6_21_2","doi-asserted-by":"publisher","DOI":"10.1002\/sim.2929"},{"key":"e_1_2_6_22_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-009-1248-6"},{"key":"e_1_2_6_23_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0b013e3181a81636"},{"key":"e_1_2_6_24_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0016852"},{"key":"e_1_2_6_25_2","doi-asserted-by":"publisher","DOI":"10.1001\/archneurol.2010.136"},{"key":"e_1_2_6_26_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(11)70072-2"},{"key":"e_1_2_6_27_2","doi-asserted-by":"publisher","DOI":"10.1159\/000295659"},{"key":"e_1_2_6_28_2","doi-asserted-by":"publisher","DOI":"10.1159\/000327518"},{"key":"e_1_2_6_29_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.2009.02217.x"}],"container-title":["Alzheimer's &amp; 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