Hypertension, Diabetes and Depression as Modifiable Risk Factors for Dementia: A Common Data Model Approach in a Population-Based Cohort, with Study Protocol and Preliminary Results.

Abstract

Background/Objectives: Dementia is a major public health challenge, with age as its primary non-modifiable risk factor. Several modifiable conditions, such as hypertension, diabetes, and depression, have been identified as potential targets for prevention. The aim is to describe the methodology and preliminary results of a study that will be conducted within the Italian National Health Service (INHS), designed to assess the impact of hypertension, diabetes, depression, and their interactions on the onset of dementia. Methods: This population-based cohort study, part of the PREV-ITA-DEM project, was conducted using a Common Data Model (CDM) approach across five Italian regions and cities participating in the NeuroEpiNet network. Individuals aged ≥ 50 years without prior diagnoses of dementia, depression, diabetes, or hypertension were followed from cohort entry (2011-2013) until dementia diagnosis, death, emigration, or study end (2019-2022). Exposures were time-dependent and defined using validated algorithms applied to Healthcare Utilization Databases (HUDs). Associations between chronic conditions and dementia risk will be estimated using competing risks regression models adjusted for confounders. Results: The final cohort comprised more than 3 million individuals, with a mean baseline age of 63-65 years and a female proportion of 52-55%. On 1 January 2011, the prevalence of individuals aged ≥ 50 years with dementia ranged from 8.7 to 14.7 per 1000 population. A harmonized methodological framework based on a CDM was developed and implemented across all sites, incorporating a shared protocol, standardized local databases, and uniform analytic scripts, and the results will be pooled using meta-analytic techniques. Conclusions: Preliminary findings confirm the feasibility of a standardized, multi-regional CDM approach and the potential for HUDs to support large-scale dementia prevention studies in real-world settings.