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José A. Luchsinger, MD; Bindu Patel, MPH; Ming-Xin Tang, PhD; Nicole Schupf, PhD; Richard Mayeux, MD

Arch Neurol. 2007;64(3):392-398.

Background  Studies relating adiposity to dementia are conflicting. We explored the associations of body mass index (BMI), (calculated as weight in kilograms divided by the square of height in meters) waist circumference, and weight change to dementia, probable Alzheimer disease, and dementia associated with stroke (DAS).

Design  Persons without dementia were followed up for 5 years; 893 persons had BMI data, 907 had waist circumference data, and 709 had a second weight measurement. Dementia was ascertained using standard methods. Cox proportional hazards regression was used for analyses using follow-up as time to event, adjusting for demographics and apolipoprotein E-4 status.

Results  Compared with persons in the first quartile of BMI, persons in the third quartile had a lower dementia and Alzheimer disease risk and persons in the second quartile had a lower DAS risk. The association between BMI and dementia resembled a U shape in those younger than 76 years, while dementia risk decreased with higher BMI in those 76 years and older. The fourth quartile of waist circumference was related to a higher DAS risk in the whole sample, and to dementia and Alzheimer disease in persons younger than 76 years. Weight loss was related to a higher dementia and DAS risk, and weight gain was related to a higher DAS risk only.

Conclusions  The prospective association between adiposity and dementia differs depending on the anthropometric measure used, and is modified by age. This may explain previous conflicting reports.

Author Affiliations: Taub Institute for Research of Alzheimer's Disease and the Aging Brain (Drs Luchsinger, Tang, Schupf, and Mayeux and Ms Patel), Departments of Epidemiology (Drs Luchsinger, Schupf, and Mayeux) and Biostatistics (Dr Tang), Joseph P. Mailman School of Public Health, and Gertrude H. Sergievsky Center (Drs Schupf and Mayeux), Columbia University; and Division of General Medicine, Department of Medicine (Dr Luchsinger), and Departments of Neurology and Psychiatry (Dr Mayeux), Columbia University College of Physicians and Surgeons, New York, NY.

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