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Table 1.  

Characteristic Sample Prevalence of risk factors, % (95% CI)
No. (%) High blood pressure Not meeting aerobic physical activity guideline Obesity Diabetes Depression Current cigarette smoking Hearing loss Binge drinking
Overall 140,076 49.9 (49.4–50.4) 49.7 (49.2–50.3) 35.3 (34.8–35.8) 18.6 (18.2–19.0) 18.0 (17.6–18.4) 14.9 (14.6–15.3) 10.5 (10.2–10.8) 10.3 (9.9–10.6)
Age group, yrs
45–54** 27,500 (28.3) 36.3 (35.3–37.4) 52.7 (51.6–53.9) 39.0 (37.9–40.1) 12.5 (11.7–13.2) 19.9 (19.1–20.8) 18.6 (17.8–19.5) 4.8 (4.4–5.3) 16.2 (15.4–17.0)
55–64 39,421 (30.9) 47.8 (46.8–48.8)†† 50.3 (49.3–51.4)†† 37.9 (37.0–38.9) 17.9 (17.1–18.6)†† 20.7 (19.9–21.4)†† 18.8 (18.0–19.5) 7.9 (7.3–8.5)†† 11.9 (11.2–12.6)††
65–74 42,016 (24.2) 59.0 (58.0–59.9)†† 46.2 (45.2–47.1)†† 34.9 (34.0–35.8)†† 23.8 (22.9–24.6)†† 17.2 (16.5–17.9)†† 12.3 (11.7–13.0)†† 12.7 (12.1–13.4)†† 6.6 (6.0–7.1)††
>75 31,139 (16.6) 63.7 (62.6–64.8)†† 48.6 (47.5–50.0)†† 24.7 (23.7–25.6)†† 23.0 (22.0–23.9)†† 11.2 (10.5–11.9)†† 5.4 (4.9–5.9)†† 22.0 (21.1–22.9)†† 2.7 (2.3–3.1)††
Sex
Men** 60,436 (46.6) 52.5 (51.7–53.3) 46.9 (46.1–47.7) 35.6 (34.8–36.3) 20.1 (19.5–20.7) 12.9 (12.4–13.5) 15.9 (15.3–16.5) 13.3 (12.8–13.9) 14.0 (13.4–14.6)
Women 79,640 (53.4) 47.6 (46.9–48.3)†† 52.2 (51.5–52.9)†† 35.0 (34.3–35.7) 17.3 (16.8–17.8)†† 22.5 (21.9–23.1)†† 14.1 (13.6–14.6)†† 8.1 (7.7–8.4)†† 7.1 (6.7–7.4)††
Sexual and gender minority status
Non-LGBT** 87,585 (96.1) 50.2 (49.5–50.8) 48.5 (47.8–49.2) 35.0 (34.3–35.6) 18.5 (18.0–19.0) 17.6 (17.1–18.1) 14.7 (14.2–15.2) 10.2 (9.8–10.6) 10.4 (9.9–10.8)
LGBT 3,226 (3.9) 49.2 (45.6–52.7) 53.9 (50.3–57.5)†† 33.7 (30.4–37.0) 20.5 (17.9–23.0) 25.4 (22.4–28.5)†† 18.1 (15.5–20.7)†† 10.1 (8.5–11.7) 13.4 (10.9–15.9††
Race/Ethnicity
American Indian or Alaska Native, non-Hispanic 2,059 (1.2) 54.1 (48.7–59.5)†† 59.8 (55.1–64.6)†† 39.4 (34.4–44.4) 24.7 (20.7–28.7)†† 22.9 (18.0–27.8) 26.5 (21.8–31.1)†† 17.5 (12.9–22.1)†† 9.6 (6.8–12.4)
Asian or Pacific Islander, non-Hispanic 923 (2.0) 35.8 (29.8–41.8)†† 45.6 (39.2–52.0) 13.6 (9.8–17.5)†† 19.0 (14.1–23.9) 7.2 (3.2–11.2)†† 5.4 (3.0–7.9)†† 4.4 (2.0–6.8)†† 5.0 (2.4–7.6)††
Black, non-Hispanic 11,947 (12.4) 64.7 (63.0–66.4)†† 57.8 (56.1–59.6)†† 45.0 (43.2–46.7)†† 27.2 (25.7–28.7)†† 15.7 (14.4–17.0)†† 17.5 (16.1–18.8)†† 6.4 (5.6–7.1)†† 8.2 (7.3–9.1)††
Hispanic 5,927 (9.1) 44.3 (41.5–47.0)†† 58.6 (55.7–61.4)†† 37.3 (34.5–40.1)†† 23.3 (21.1–25.6)†† 15.9 (14.0–17.9)†† 13.1 (11.2–15.0) 8.6 (6.9–10.3)†† 11.6 (9.5–13.8)
White, non-Hispanic** 113,697 (73.8) 48.5 (48.0–49.0) 47.2 (46.6–47.7) 33.9 (33.4–34.4) 16.5 (16.1–16.8) 18.9 (18.4–19.3) 14.7 (14.4–15.1) 11.3 (11.0–11.7) 10.7 (10.3–11.0)
Multiple races, non-Hispanic 1,848 (1.0) 52.3 (48.3–56.2) 50.5 (46.4–54.6) 39.3 (35.4–43.2)†† 22.5 (19.3–25.8)†† 23.9 (20.8–26.9)†† 25.1 (21.6–28.5)†† 13.5 (10.9–16.2) 11.6 (8.6–14.6)
Other race, non-Hispanic §§ 920 (0.6) 46.5 (40.7–52.3) 52.6 (46.4–58.7) 34.7 (28.8–40.5) 20.1 (15.2–25.1) 20.1 (15.1–25.1) 15.2 (11.0–19.3) 12.5 (9.1–15.9) 9.8 (6.4–13.1)
Education level
Not a high school graduate**¶¶ 10,172 (12.7) 58.1 (56.1–60.1) 67.1 (65.1–69.0) 37.0 (35.1–38.9) 26.9 (25.1–28.6) 23.3 (21.7–25.0) 25.9 (24.3–27.6) 15.4 (14.0–16.8) 9.8 (8.4–11.3)
High school graduate 38,766 (28.8) 54.4 (53.4–55.4)†† 56.6 (55.6–57.6)†† 38.4 (37.4–39.3) 20.5 (19.8–21.3)†† 18.0 (17.3–18.8)†† 19.0 (18.3–19.8)†† 12.2 (11.6–12.8)†† 10.5 (9.9–11.1)
Some college or more 90,690 (58.5) 46.0 (45.4–46.6)†† 42.5 (41.9–43.2)†† 33.4 (32.8–34.0)†† 15.9 (15.5–16.4)†† 16.9 (16.5–17.4)†† 10.6 (10.2–11.0)†† 8.7 (8.4–9.0)†† 10.3 (9.9–10.7)
Employment status
Employed**,*** 55,023 (45.1) 39.1 (38.3–39.9) 47.6 (46.7–48.4) 35.9 (35.1–36.7) 11.9 (11.4–12.4) 12.7 (12.2–13.2) 13.6 (13.1–14.2) 5.7 (5.3–6.0) 14.7 (14.1–15.3)
Unemployed 3,987 (3.8) 49.0 (45.5–52.5)†† 52.2 (48.5–55.9)†† 36.3 (33.1–39.5) 18.2 (16.0–20.5)†† 29.5(26.6–32.5)†† 28.6 (25.6–31.6)†† 9.5 (6.4–12.5)†† 15.4 (11.9–19.0)
Retired 61,309 (35.7) 60.3 (59.5–61.1)†† 44.5 (43.7–45.3)†† 31.9 (31.2–32.7)†† 22.8 (22.1–23.5)†† 14.9 (14.3–15.4)†† 10.5 (10.0–11.0)†† 15.7 (15.1–16.2)†† 5.9 (5.5–6.3)††
Unable to work 12,686 (10.5) 64.8 (63.1–66.4)†† 74.9 (73.4–76.3)†† 46.0 (44.3–47.8)†† 34.6 (33.0–36.3)†† 48.0 (46.3–49.7)†† 32.9 (31.3–34.5)†† 16.2 (15.0–17.3)†† 7.2 (6.4–8.0)††
Other††† 6,251 (4.9) 43.4 (40.9–45.9)†† 51.1 (48.4–53.7)†† 30.7 (28.3–33.0)†† 15.8 (13.9–17.6)†† 18.3 (16.3–20.2)†† 11.1 (9.4–12.7)†† 6.5 (5.5–7.5) 4.6 (3.8–5.5)††
Has a primary care provider
Yes** 125,402 (88.5) 52.3 (51.7–52.8) 49.1 (48.5–49.6) 36.0 (35.5–36.6) 19.9 (19.4–20.3) 18.5 (18.1–19.0) 13.6 (13.3–14.0) 10.7 (10.4–11.1) 9.6 (9.3–10.0)
No 14,155 (11.5) 31.9 (30.2–33.5)†† 54.5 (52.6–56.3)†† 29.4 (27.8–31.0)†† 9.0 (8.0–9.9)†† 14.3 (13.2–15.5)†† 24.8 (23.4–26.3)†† 8.7 (7.5–9.9)†† 15.4 (14.0–16.8)††
SCD
Yes 15,608 (11.3) 60.9 (59.4–62.4)†† 63.5 (62.0–64.9)†† 39.2 (37.7–40.7)†† 28.7 (27.3–30.2)†† 45.6 (44.1–47.2)†† 24.4 (23.0–25.8)†† 23.1 (21.9–24.3)†† 10.3 (9.4–11.4)
No** 124,468 (88.7) 48.5 (47.9–49.1) 48.0 (47.4–48.5) 34.8 (34.2–35.3) 17.3 (16.9–17.8) 14.5 (14.2–14.9) 13.8 (13.4–14.1) 8.9 (8.6–9.2) 10.3 (9.9–10.7)

Table 1. Prevalence of selected modifiable risk factors* among adults aged ≥45 years, by selected characteristics and subjective cognitive decline status — Behavioral Risk Factor Surveillance System, 31 states and District of Columbia,§ 2019

Abbreviations: LGBT = lesbian, gay, bisexual, or transgender; SCD = subjective cognitive decline.
*Behavioral Risk Factor Surveillance System survey questions and calculated variables for 2019 are available at https://www.cdc.gov/brfss/questionnaires/pdf-ques/2019-BRFSS-Questionnaire-508.pdf and https://www.cdc.gov/brfss/annual_data/2019/pdf/2019-calculated-variables-version4-508.pdf, respectively. Not meeting the aerobic physical activity guideline was defined as answering "no" to question C11.01 or reporting <150 minutes per week of moderate-intensity aerobic activity, or <75 minutes per week of vigorous-intensity aerobic activity, or an equivalent combination of the two based on questions C11.02–C11.07 consistent with the Physical Activity Guidelines for Americans, 2nd edition (https://health.gov/our-work/nutrition-physical-activity/physical-activity-guidelines/current-guidelines). Obesity was defined as having a calculated body mass index of ≥30 kg/m2 based on self-reported height and weight from questions C08.17 and C08.18. High blood pressure, diabetes, depression, and hearing loss were defined as answering "yes" to questions C04.01 (excluding pregnancy-related high blood pressure), C06.11 (excluding pregnancy-related diabetes), C06.09, and C08.20, respectively. Binge drinking was defined as reporting having had one or more alcoholic beverages in the previous 30 days and responding "one or more" when asked how many times during the past 30 days they had had X [X = 5 for men and X = 4 for women] or more drinks on an occasion (questions C10.01 and C10.03, respectively). Current cigarette smoking was defined as reporting having smoked ≥100 cigarettes in their lifetime and now smoking every day or some days in response to questions C09.01 and C09.02, respectively.
SCD was defined as the self-reported experience of worsening confusion or memory loss in the previous year.
§The following U.S. jurisdictions administered the SCD module in 2019: Alabama, Connecticut, District of Columbia, Florida, Georgia, Indiana, Iowa, Kansas, Louisiana, Maryland, Michigan, Minnesota, Mississippi, Missouri, Nebraska, Nevada, New Mexico, New York, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, and Wisconsin.
Number of respondents for some characteristics might not sum to overall total because of missing information; column percentages might not sum to 100% because of rounding. Reported totals are unweighted.
**Indicates the referent group used for t-tests to determine significant differences between levels of each characteristic for the prevalence of risk factors (p<0.05).
††Indicates significant difference (p<0.05) based on t-tests in the prevalence of risk factors between the indicated level of each characteristic and the referent group.
§§"Other race, non-Hispanic" includes respondents who reported they are of some other race group not listed in the survey question responses and are not of Hispanic origin.
¶¶Includes general educational development certificate.
***Includes self-employed persons.
†††Includes students and homemakers.

Table 2.  

Risk factor % (95% CI) p-value **
Overall 11.3 (11.0–11.6) NA
High blood pressure
No 8.8 (8.4–9.3) Ref
Yes 13.8 (13.3–14.3) <0.001
Not meeting aerobic physical activity guideline
No 8.3 (7.9–8.7) Ref
Yes 14.5 (14.0–15.1) <0.001
Obesity
No 10.8 (10.3–11.2) Ref
Yes 12.7 (12.1–13.3) <0.001
Diabetes
No 9.9 (9.6–10.2) Ref
Yes 17.4 (16.5–18.4) <0.001
Depression
No 7.5 (7.2–7.8) Ref
Yes 28.5 (27.4–29.6) <0.001
Current cigarette smoking
No 10.1 (9.7–10.4) Ref
Yes 18.4 (17.3–19.6) <0.001
Hearing loss
No 9.7 (9.4–10.0) Ref
Yes 24.7 (23.5–26.0) <0.001
Binge drinking
No 11.2 (10.9–11.6) Ref
Yes 11.3 (10.2–12.4) 0.9
Total no. of risk factors §
None 3.9 (3.4–4.4) Ref
One 6.2 (5.8–6.7) <0.001
Two 9.6 (9.0–10.2) <0.001
Three 15.0 (14.2–15.9) <0.001
Four or more 25.0 (23.9–26.2) <0.001

Table 2. Prevalence of subjective cognitive decline* among adults aged ≥45 years, by risk factor status and total number of risk factors§ — Behavioral Risk Factor Surveillance System, United States, 2019

Abbreviations: NA = not applicable; Ref = referent group; SCD = subjective cognitive decline.
*SCD was defined as the self-reported experience of worsening confusion or memory loss in the previous year.
Behavioral Risk Factor Surveillance System survey questions and calculated variables for 2019 are available at https://www.cdc.gov/brfss/questionnaires/pdf-ques/2019-BRFSS-Questionnaire-508.pdf and https://www.cdc.gov/brfss/annual_data/2019/pdf/2019-calculated-variables-version4-508.pdf, respectively. Not meeting the aerobic physical activity guideline was defined as answering "no" to question C11.01 or reporting <150 minutes per week of moderate-intensity aerobic activity, or <75 minutes per week of vigorous-intensity aerobic activity, or an equivalent combination of the two based on questions C11.02–C11.07 consistent with the Physical Activity Guidelines for Americans, 2nd edition (https://health.gov/our-work/nutrition-physical-activity/physical-activity-guidelines/current-guidelines). Obesity was defined as having a calculated body mass index of ≥30 kg/m 2 based on self-reported height and weight from questions C08.17 and C08.18. High blood pressure, diabetes, depression, and hearing loss were defined as answering "yes" to questions C04.01 (excluding pregnancy-related high blood pressure), C06.11 (excluding pregnancy-related diabetes), C06.09, and C08.20, respectively. Binge drinking was defined as reporting having had one or more alcoholic beverages in the previous 30 days and responding "one or more" when asked how many times during the past 30 days they had had X [X = 5 for men and X = 4 for women] or more drinks on an occasion (questions C10.01 and C10.03, respectively). Current cigarette smoking was defined as reporting having smoked ≥100 cigarettes in their lifetime and now smoking every day or some days in response to questions C09.01 and C09.02, respectively.
§ Total number of risk factors was defined as the sum of any of the following risk factors reported by the respondent: high blood pressure, not meeting the aerobic physical activity guideline, obesity, diabetes, depression, current cigarette smoking, hearing loss, or binge drinking.
The following U.S. jurisdictions administered the SCD module in 2019: Alabama, Connecticut, District of Columbia, Florida, Georgia, Indiana, Iowa, Kansas, Louisiana, Maryland, Michigan, Minnesota, Mississippi, Missouri, Nebraska, Nevada, New Mexico, New York, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, and Wisconsin.
**p-value using t-tests for comparisons of prevalence of SCD between the following groups: 1) adults with versus without each risk factor and 2) adults with no risk factors versus one, two, three, or four or more risk factors.

CME / ABIM MOC / CE

Modifiable Risk Factors for Alzheimer Disease and Related Dementias Among Adults Aged ≥45 Years — United States, 2019

  • Authors: John D. Omura, MD; Lisa C. McGuire, PhD; Roshni Patel, MPH; Matthew Baumgart; Raza Lamb; Eva M. Jeffers, MPH; Benjamin S. Olivari, MPH; Janet B. Croft, PhD; Craig W. Thomas, PhD; Karen Hacker, MD
  • CME / ABIM MOC / CE Released: 9/23/2022
  • Valid for credit through: 9/23/2023
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    • Letter of Completion
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Target Audience and Goal Statement

This activity is intended for public health and prevention officials, neurologists, psychiatrists, internists, family practitioners, nurses, and other clinicians caring for patients with or at risk for Alzheimer’s disease and related dementias (ADRD).

The goal of this activity is for learners to be better able to describe the status of 8 potential modifiable risk factors (high blood pressure, not meeting the aerobic physical activity guideline, obesity, diabetes, depression, current cigarette smoking, hearing loss, and binge drinking) for ADRD, according to an analysis of data from the cognitive decline module administered to adults aged ≥ 45 years in 31 states and District of Columbia in the 2019 Behavioral Risk Factor Surveillance System (BRFSS) survey.

Upon completion of this activity, participants will:

  • Describe the prevalence of 8 potential modifiable risk factors for Alzheimer’s disease and related dementias (ADRD), according to an analysis of 2019 Behavioral Risk Factor Surveillance System (BRFSS) data
  • Describe the prevalence of subjective cognitive decline and its association with 8 potential modifiable risk factors for ADRD, according to an analysis of 2019 BRFSS data
  • Identify public health implications of the status of 8 potential modifiable risk factors for ADRD, according to an analysis of 2019 BRFSS data


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Faculty

  • John D. Omura, MD

    National Center for Chronic Disease Prevention and Health Promotion
    Centers for Disease Control and Prevention (CDC)

    Disclosures

    John D. Omura, MD, has no relevant financial relationships.

  • Lisa C. McGuire, PhD

    National Center for Chronic Disease Prevention and Health Promotion
    Centers for Disease Control and Prevention (CDC)

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    Lisa C. McGuire, PhD, has no relevant financial relationships.

  • Roshni Patel, MPH

    CyberData Technologies, Inc.
    Herndon, Virginia

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    Roshni Patel, MPH, has no relevant financial relationships.

  • Matthew Baumgart

    Alzheimer’s Association
    Chicago, Illinois

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    Matthew Baumgart has no relevant financial relationships.

  • Raza Lamb

    Alzheimer’s Association
    Chicago, Illinois

    Disclosures

    Raza Lamb has no relevant financial relationships.

  • Eva M. Jeffers, MPH

    National Center for Chronic Disease Prevention and Health Promotion
    Centers for Disease Control and Prevention (CDC)
    Oak Ridge Institute for Science and Education
    Oak Ridge, Tennessee

    Disclosures

    Eva M. Jeffers, MPH, has no relevant financial relationships.

  • Benjamin S. Olivari, MPH

    National Center for Chronic Disease Prevention and Health Promotion
    Centers for Disease Control and Prevention (CDC)

    Disclosures

    Benjamin S. Olivari, MPH, has no relevant financial relationships.

  • Janet B. Croft, PhD

    National Center for Chronic Disease Prevention and Health Promotion
    Centers for Disease Control and Prevention (CDC)

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    Janet B. Croft, PhD, has no relevant financial relationships.

  • Craig W. Thomas, PhD

    National Center for Chronic Disease Prevention and Health Promotion
    Centers for Disease Control and Prevention (CDC)

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    Craig W. Thomas, PhD, has no relevant financial relationships.

  • Karen Hacker, MD

    National Center for Chronic Disease Prevention and Health Promotion
    Centers for Disease Control and Prevention (CDC)

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    Karen Hacker, MD, has no relevant financial relationships.

CME Author

  • Laurie Barclay, MD

    Freelance writer and reviewer
    Medscape, LLC

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    Laurie Barclay, MD, has the following relevant financial relationships:
    Formerly owned stocks in: AbbVie

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  • Leigh Schmidt, MSN, RN, CNE, CHCP

    Associate Director, Accreditation and Compliance, Medscape, LLC

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CME / ABIM MOC / CE

Modifiable Risk Factors for Alzheimer Disease and Related Dementias Among Adults Aged ≥45 Years — United States, 2019

Authors: John D. Omura, MD; Lisa C. McGuire, PhD; Roshni Patel, MPH; Matthew Baumgart; Raza Lamb; Eva M. Jeffers, MPH; Benjamin S. Olivari, MPH; Janet B. Croft, PhD; Craig W. Thomas, PhD; Karen Hacker, MDFaculty and Disclosures

CME / ABIM MOC / CE Released: 9/23/2022

Valid for credit through: 9/23/2023

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Introduction

Alzheimer disease,* the most common cause of dementia, affects an estimated 6.5 million persons aged ≥65 years in the United States.[1] A growing body of evidence has identified potential modifiable risk factors for Alzheimer disease and related dementias (ADRD).[1–3] In 2021, the National Plan to Address Alzheimer's Disease (National Plan) introduced a new goal to "accelerate action to promote healthy aging and reduce risk factors for Alzheimer's disease and related dementias" to help delay onset or slow the progression of ADRD.[3] To assess the status of eight potential modifiable risk factors (i.e., high blood pressure, not meeting the aerobic physical activity guideline, obesity, diabetes, depression, current cigarette smoking, hearing loss, and binge drinking), investigators analyzed data from the cognitive decline module that was administered to adults aged ≥45 years in 31 states and the District of Columbia (DC) in the 2019 Behavioral Risk Factor Surveillance System (BRFSS) survey. Among the risk factors, prevalence was highest for high blood pressure (49.9%) and lowest for binge drinking (10.3%) and varied by selected demographic characteristics. Adults with subjective cognitive decline (SCD),§ an early indicator of possible future ADRD,[4] were more likely to report four or more risk factors than were those without SCD (34.3% versus 13.1%). Prevalence of SCD was 11.3% overall and increased from 3.9% among adults with no risk factors to 25.0% among those with four or more risk factors. Implementing evidence-based strategies to address modifiable risk factors can help achieve the National Plan's new goal to reduce risk for ADRD while promoting health aging.¶,**

BRFSS is a cross-sectional, random-digit–dialed, annual telephone survey of noninstitutionalized U.S. adults aged ≥18 years. BRFSS is administered by state and territorial health departments, and responses are weighted to produce data representative of each state. The 2019 combined (landline and mobile) median response rate was 49.4%.†† In 2019, the cognitive decline module was administered to adults aged ≥45 years in 31 states and DC.

Eight modifiable risk factors were assessed: high blood pressure, not meeting the aerobic physical activity guideline, obesity, diabetes, depression, current cigarette smoking, hearing loss, and binge drinking.§§ The total number of risk factors per respondent was defined as the sum of any risk factors reported and was grouped into no, one, two, three, or four or more risk factors. Respondents were classified as experiencing SCD if they responded "yes" when asked if they had experienced worsening or more frequent confusion or memory loss in the previous 12 months. Data were collected from 161,941 respondents; 21,865 (13.5%) respondents who refused to respond to the question assessing SCD or who responded, "don't know/not sure," were excluded. Respondents with missing data for risk factors (ranging from 0.2% for diabetes to 8.8% for obesity) were excluded from corresponding prevalence estimate calculations.

Prevalence of each modifiable risk factor was estimated overall and by SCD status and selected demographic characteristics. The proportion of respondents with no, one, two, three, or four or more risk factors was determined by SCD status. Prevalence of SCD was determined among respondents with and without each risk factor and by number of risk factors. All percentages were weighted and unadjusted. Analyses were conducted using SAS-callable SUDAAN (version 9.4; SAS Institute) to account for complex survey design and weighting. T-tests were used to determine statistically significant differences by subgroup (p<0.05). All estimates met reliability standards by having a relative SE <30%. This activity was reviewed by CDC and was conducted consistent with applicable federal law and CDC policy.¶¶

In 2019, the prevalence of SCD among adults aged ≥45 years in 31 participating states and DC was 11.3% (Table 1). The most common modifiable risk factor for ADRD was high blood pressure (49.9%), followed by not meeting the aerobic physical activity guideline (49.7%), obesity (35.3%), diabetes (18.6%), depression (18.0%), current cigarette smoking (14.9%), hearing loss (10.5%), and binge drinking (10.3%). The prevalences of risk factors varied by selected demographic characteristics, including race and ethnicity. For example, the prevalence of several risk factors was higher among adults who were American Indian or Alaska Native, non-Hispanic Black or African American, or Hispanic, than among non-Hispanic White adults. Adults with SCD were more likely to report most of the modifiable risk factors and were more likely to report four or more risk factors (34.3%) than were those without SCD (13.1%) (Figure).

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Figure 1. Proportion of adults aged ≥45 years with total number of risk factors,* by subjective cognitive decline status — Behavioral Risk Factor Surveillance System, United States,§ 2019

Adults with each modifiable risk factor, except for binge drinking, were more likely to report SCD than were those without the risk factor (Table 2). Prevalence of SCD ranged from a high of 28.5% among persons with depression and 24.7% among those with hearing loss to 11.3% among those who reported binge drinking. SCD prevalence increased from 3.9% among those with no risk factors to 25.0% among those with four or more risk factors.

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 * Although the term “Alzheimer’s disease” is frequently used, this report uses “Alzheimer disease” in accordance with the American Medical Association Manual of Style 11th Edition and MMWR style.

† The following U.S. jurisdictions administered the SCD module in 2019: Alabama, Connecticut, District of Columbia, Florida, Georgia, Indiana, Iowa, Kansas, Louisiana, Maryland, Michigan, Minnesota, Mississippi, Missouri, Nebraska, Nevada, New Mexico, New York, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, and Wisconsin.

§ SCD was defined as the self-reported experience of worsening confusion or memory loss in the previous year.

¶ https://www.uspreventiveservicestaskforce.org/uspstf/

** https://www.thecommunityguide.org

†† https://www.cdc.gov/brfss/annual_data/2019/pdf/2019-response-rates-table-508.pdf

§§ BRFSS survey questions and calculated variables for 2019 are available at https://www.cdc.gov/brfss/questionnaires/pdf-ques/2019-BRFSS-Questionnaire-508.pdf and https://www.cdc.gov/brfss/annual_data/2019/ pdf/2019-calculated-variables-version4-508.pdf, respectively. Not meeting the aerobic physical activity guideline was defined as answering “no” to question C11.01 or reporting <150 minutes per week of moderate-intensity aerobic activity, or <75 minutes per week of vigorous-intensity aerobic activity, or an equivalent combination of the two based on questions C11.02–C11.07 consistent with the Physical Activity Guidelines for Americans, 2nd edition (https://health.gov/our-work/nutrition-physical-activity/physical-activity-guidelines/current-guidelines). Obesity was defined as having a calculated body mass index of ≥30 kg/m2 based on self-reported height and weight from questions C08.17 and C08.18. High blood pressure, diabetes, depression, and hearing loss were defined as answering “yes” to questions C04.01 (excluding pregnancy-related high blood pressure), C06.11 (excluding pregnancy-related diabetes), C06.09, and C08.20, respectively. Binge drinking was defined as reporting having had one or more alcoholic beverages in the previous 30 days and responding “one or more” when asked how many times during the past 30 days they had had X [X = 5 for men and X = 4 for women] or more drinks on an occasion (questions C10.01 and C10.03, respectively). Current cigarette smoking was defined as reporting having smoked ≥100 cigarettes in their lifetime and now smoking every day or some days in response to questions C09.01 and C09.02, respectively.

¶¶ 45 C.F.R. part 46.102(l)(2), 21 C.F.R. part 56; 42 U.S.C. Sect. 241(d); 5 U.S.C. Sect. 552a; 44 U.S.C. Sect. 3501 et seq.