Heterogeneity in risk factors for cognitive impairment, no dementia: Population-based longitudinal study from the Kungsholmen Project

Roberto Monastero, Katie Palmer, Chengxuan Qiu, Bengt Winblad, Laura Fratiglioni

Research output: Contribution to journalArticlepeer-review


Objectives: The objectives of this study were to investigate the relation of vascular, neuropsychiatric, social, and frailty-related factors with "Cognitive impairment, no dementia" (CIND) and to verify their effect independently of future progression to Alzheimer disease (AD). Methods: Seven hundred eighteen subjects aged 75+ years who attended baseline, 3- and 6-year follow-up examinations of the Kungsholmen Project, a Swedish prospective cohort study, were studied. CIND was defined according to the performance on the Mini-Mental State Examination. Potential risk factors were collected at baseline and clustered according to four research hypotheses (frailty, vascular, neuropsychiatric, and social hypothesis), each representing a possible pathophysiological mechanism of CIND independently of subsequent development of AD. Results: Over a mean 3-4 years of follow up, 82 participants (11.4%) developed CIND. When the population was subsequently followed for a mean of 2.7 years, subjects with CIND had a threefold increased risk to progress to AD. After multiple adjustments, including adjustment for the development of AD at the 6-year follow up, risk factors for CIND were hip fracture, polypharmacy, and psychoses. Conclusions: The results suggest that not only the AD-type neurodegenerative process, but also neuropsychiatric- and frailty-related factors may induce cognitive impairment in nondemented elderly. These findings may have relevant preventive and therapeutic implications.

Original languageEnglish
Pages (from-to)60-69
Number of pages10
JournalAmerican Journal of Geriatric Psychiatry
Issue number1
Publication statusPublished - Jan 2007


  • Alzheimer disease
  • Hip fracture
  • Mild cognitive impairment
  • Polypharmacy
  • Psychosis

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Geriatrics and Gerontology


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