Dementia risk factors and cognitive decline: Results from the 2023 Behavioral Risk Factor Surveillance System (BRFSS)

Background The potentially modifiable risk factors of obesity, diabetes, hypertension, smoking, physical inactivity, depression, hearing impairment, and excessive alcohol consumption, have been found to be associated with cognitive decline and dementia.

To study the association between subjective cognitive decline (SCD) among survey respondents and the 8 risk factors compared with other potential risks.

Using 2023 Behavioral Risk Factor Surveillance data from 155,112 respondents ages 45+ in 35 states with data on SCD the associations between the 8 dementia risk factors, separately and in a composite measure, plus other demographic and health measures were studied using Stata.

SCD rates were 17.2% overall ranging from 11.0% to 23.9% across states while 81.9% of adults 45+ reported any of the 8 dementia risk factors. Adults with each of the risk factors had higher SCD rates compared with those without the risk factor, with SCD rates ranging from 8.4% for adults with 0 risks, 19.2% for any of the 8 risks, and 45.3% for those with 5 or more. Logistic regression confirmed most results with adjusted odds ratios (AORs) up to 6.0 for 5 or more risk factors, >3.1 for current long COVID and >1.2 for low education. Obesity was not confirmed as a separate risk and highest AOR for age was 1.2 for ages 75+ with 8 risk factors entered separately.

Results suggest that prevention efforts for SCD, which can be a step toward dementia, should focus on 8 common potentially modifiable risk factors plus long COVID. Competing Interest Statement The authors have declared no competing interest. Funding Statement This study did not receive any funding. Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Study used data from CDC available at https://www.cdc.gov/brfss/annual_data/annual_2023.html I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data availability All data used in the study are available on the CDC website at: https://www.cdc.gov/brfss/annual_data/annual_2023.html