{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T13:00:50Z","timestamp":1790773250942,"version":"4.1.0"},"reference-count":37,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T00:00:00Z","timestamp":1776902400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Alzheimer\u2019s Disease"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Underweight, defined as a body mass index (BMI)\u2009&lt;\u200918.5\u2005kg\/m2, has been associated with increased risk of dementia in older adults. However, whether this association reflects a causal relationship remains unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To examine the association between low BMI and dementia, independent of brain magnetic resonance imaging findings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We analyzed data from patients aged \u2265 65 years with vascular risk factors enrolled in a Japanese observational registry. Patients were categorized by BMI as underweight (&lt;18.5\u2005kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      ), normal weight (18.5\u201324.9\u2005kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      ), or overweight (\u226525.0\u2005kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      ). The outcomes were all-cause dementia and Alzheimer's disease (AD) dementia.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 607 patients (median age, 74 years) were included: 58 underweight, 389 normal weight, and 160 overweight. During a median follow-up of 4.7 years, 39 patients developed dementia and 30 developed AD dementia. Kaplan\u2013Meier analysis showed that underweight group had a significantly higher incidence of all-cause dementia (p\u2009=\u20090.002) and AD dementia (p\u2009=\u20090.009) compared with the other groups. Cox regression hazard analysis adjusted for age and sex revealed that underweight had a higher risk of all-cause dementia (hazard ratio, 3.38; 95% confidence interval, 1.49\u20137.67) compared with normal weight. In exploratory analysis, the association between underweight and all-cause dementia remained significant after adjustment for additional confounders, medial temporal atrophy, and white matter hyperintensities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Underweight in older adults was associated with increased risk of all-cause dementia independent of age, sex, confounding factors, brain atrophy and white matter hyperintensities. These findings warrant confirmation in larger cohorts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Trial Registration<\/jats:title>\n                    <jats:p>UMIN000026671<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/13872877261443944","type":"journal-article","created":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T14:32:14Z","timestamp":1776954734000},"page":"1676-1683","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Underweight is associated with increased risk of all-cause dementia in older adults with vascular risk factors, independent of brain atrophy and small vessel disease"],"prefix":"10.1177","volume":"111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7669-231X","authenticated-orcid":false,"given":"Kazuo","family":"Kitagawa","sequence":"first","affiliation":[{"name":"Suita Municipal Hospital"},{"name":"Tokyo Women's Medical University Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sono","family":"Toi","sequence":"additional","affiliation":[{"name":"Tokyo Women's Medical University Hospital"},{"name":"Tokyo Women's Medical University Adachi Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroshi","family":"Yoshizawa","sequence":"additional","affiliation":[{"name":"Tokyo Women's Medical University Hospital"},{"name":"Tokyo Women's Medical University Yachiyo Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenichi","family":"Todo","sequence":"additional","affiliation":[{"name":"Tokyo Women's Medical University Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,4,23]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.dadm.2017.05.007"},{"key":"e_1_3_3_3_2","first-page":"739","article-title":"2003-2013: a decade of body mass index, Alzheimer's disease, and dementia","volume":"43","author":"Emmerzaal TL","unstructured":"Emmerzaal TL, Kiliaan AJ, Gustafson DR. 2003-2013: a decade of body mass index, Alzheimer's disease, and dementia. 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