Skip to main content Accessibility help
×
Home

Parity and the risk of incident dementia: a COSMIC study

  • J. B. Bae (a1) (a2), D. M. Lipnicki (a3), J. W. Han (a1) (a2), P. S. Sachdev (a3) (a4), T. H. Kim (a5), K. P. Kwak (a6), B. J. Kim (a7), S. G. Kim (a8), J. L. Kim (a9), S. W. Moon (a10), J. H. Park (a11), S.-H. Ryu (a12), J. C. Youn (a13), D. Y. Lee (a2) (a14), D. W. Lee (a15), S. B. Lee (a16), J. J. Lee (a16), J. H. Jhoo (a17), I. Skoog (a18), J. Najar (a18), T. R. Sterner (a18), N. Scarmeas (a19) (a20), M. Yannakoulia (a21), E. Dardiotis (a22), S. Riedel-Heller (a23), S. Roehr (a23), A. Pabst (a23), D. Ding (a24) (a25), Q. Zhao (a24) (a25), X. Liang (a24) (a25), A. Lobo (a26) (a27) (a28), C. De-la-Cámara (a26) (a27) (a28), E. Lobo (a26) (a27) (a28), K. W. Kim (a1) (a2) (a29) and for Cohort Studies of Memory in an International Consortium (COSMIC) (a1)...

Abstract

Aims

To investigate the association between parity and the risk of incident dementia in women.

Methods

We pooled baseline and follow-up data for community-dwelling women aged 60 or older from six population-based, prospective cohort studies from four European and two Asian countries. We investigated the association between parity and incident dementia using Cox proportional hazards regression models adjusted for age, educational level, hypertension, diabetes mellitus and cohort, with additional analysis by dementia subtype (Alzheimer dementia (AD) and non-Alzheimer dementia (NAD)).

Results

Of 9756 women dementia-free at baseline, 7010 completed one or more follow-up assessments. The mean follow-up duration was 5.4 ± 3.1 years and dementia developed in 550 participants. The number of parities was associated with the risk of incident dementia (hazard ratio (HR) = 1.07, 95% confidence interval (CI) = 1.02–1.13). Grand multiparity (five or more parities) increased the risk of dementia by 30% compared to 1–4 parities (HR = 1.30, 95% CI = 1.02–1.67). The risk of NAD increased by 12% for every parity (HR = 1.12, 95% CI = 1.02–1.23) and by 60% for grand multiparity (HR = 1.60, 95% CI = 1.00–2.55), but the risk of AD was not significantly associated with parity.

Conclusions

Grand multiparity is a significant risk factor for dementia in women. This may have particularly important implications for women in low and middle-income countries where the fertility rate and prevalence of grand multiparity are high.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Parity and the risk of incident dementia: a COSMIC study
      Available formats
      ×

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Parity and the risk of incident dementia: a COSMIC study
      Available formats
      ×

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Parity and the risk of incident dementia: a COSMIC study
      Available formats
      ×

Copyright

This is an Open Access article, distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike licence (http://creativecommons.org/licenses/by-nc-sa/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the same Creative Commons licence is included and the original work is properly cited. The written permission of Cambridge University Press must be obtained for commercial re-use.

Corresponding author

Author for correspondence: Ki Woong Kim, E-mail: kwkimmd@snu.ac.kr

References

Hide All
Abdelsalam, K and Elamin, A (2017) Influence of grand multiparity on the levels of insulin, glucose and HOMA-IR in comparison with nulliparity and primiparity. Pakistan Journal of Biological Sciences 20, 4246.
Albanese, E, Launer, LJ, Egger, M, Prince, MJ, Giannakopoulos, P, Wolters, FJ and Egan, K (2017) Body mass index in midlife and dementia: systematic review and meta-regression analysis of 589,649 men and women followed in longitudinal studies. Alzheimers & Dementia 8, 165178.
American Psychiatric Association (1987) Diagnostic and Statistical Manual of Mental Disorders; Revised (DSM-III-R). Washington, DC: American Psychiatric Association.
American Psychiatric Association (1994) Diagnostic and Statistical Manual of Mental Disorders. Washington, DC: American Psychiatric Association.
Babinszki, A, Kerenyi, T, Torok, O, Grazi, V, Lapinski, RH and Berkowitz, RL (1999) Perinatal outcome in grand and great-grand multiparity: effects of parity on obstetric risk factors. American Journal of Obstetrics and Gynecology 181, 669674.
Bachman, DL, Wolf, PA, Linn, R, Knoefel, J, Cobb, J, Belanger, A, White, L and D'agostino, R (1993) Incidence of dementia and probable Alzheimer's disease in a general population: the Framingham study. Neurology 43, 515515.
Barha, CK and Galea, LA (2010) Influence of different estrogens on neuroplasticity and cognition in the hippocampus. Biochimica et Biophysica Acta 1800, 1056–67.
Barrett, ES, Parlett, LE, Windham, GC and Swan, SH (2014) Differences in ovarian hormones in relation to parity and time since last birth. Fertility and Sterility 101, 177380 e1.
Beydoun, MA, Beydoun, HA, Gamaldo, AA, Teel, A, Zonderman, AB and Wang, Y (2014) Epidemiologic studies of modifiable factors associated with cognition and dementia: systematic review and meta-analysis. BMC Public Health 14, 643.
Chavez-Macgregor, M, Van Gils, CH, Van Der Schouw, YT, Monninkhof, E, Van Noord, PA and Peeters, PH (2008) Lifetime cumulative number of menstrual cycles and serum sex hormone levels in postmenopausal women. Breast Cancer Research and Treatment 108, 101–12.
Crane, PK, Walker, R, Hubbard, RA, Li, G, Nathan, DM, Zheng, H, Haneuse, S, Craft, S, Montine, TJ and Kahn, SE (2013) Glucose levels and risk of dementia. New England Journal of Medicine 369, 540548.
Dardiotis, E, Kosmidis, MH, Yannakoulia, M, Hadjigeorgiou, GM and Scarmeas, N (2014) The hellenic longitudinal investigation of aging and diet (HELIAD): rationale, study design, and cohort description. Neuroepidemiology 43, 914.
Ding, D, Zhao, Q, Guo, Q, Meng, H, Wang, B, Yu, P, Luo, J, Zhou, Y, Yu, L, Zheng, L, Chu, S, Mortimer, JA, Borenstein, AR and Hong, Z (2014) The Shanghai aging study: study design, baseline characteristics, and prevalence of dementia. Neuroepidemiology 43, 114–22.
Han, JW, Kim, TH, Kwak, KP, Kim, K, Kim, BJ, Kim, SG, Kim, JL, Kim, TH, Moon, SW, Park, JY, Park, JH, Byun, S, Suh, SW, Seo, JY, So, Y, Ryu, S-H, Youn, JC, Lee, KH, Lee, DY, Lee, DW, Lee, SB, Lee, JJ, Lee, JR, Jeong, H, Jeong, H-G, Jhoo, JH, Han, K, Hong, JW and Kim, KW (2018) Overview of the Korean longitudinal study on cognitive aging and dementia. Psychiatry Investigation. 15, 767.
Hill, G (2003) Neyman's bias re-visited. Journal of Clinical Epidemiology 56, 293296.
Hinkula, M, Kauppila, A, Nayha, S and Pukkala, E (2006) Cause-specific mortality of grand multiparous women in Finland. American Journal of Epidemiology 163, 367–73.
Humphries, KH, Westendorp, IC, Bots, ML, Spinelli, JJ, Carere, RG, Hofman, A and Witteman, JC (2001) Parity and carotid artery atherosclerosis in elderly women: the Rotterdam study. Stroke 32, 22592264.
Inagaki, T, Gautreaux, C and Luine, V (2010) Acute estrogen treatment facilitates recognition memory consolidation and alters monoamine levels in memory-related brain areas. Hormones and Behavior 58, 415426.
Jang, H, Bae, JB, Dardiotis, E, Scarmeas, N, Sachdev, PS, Lipnicki, DM, Han, JW, Kim, TH, Kwak, KP and Kim, BJ (2018) Differential effects of completed and incomplete pregnancies on the risk of Alzheimer disease. Neurology 91, e643e651.
Kuiper, JS, Zuidersma, M, Oude Voshaar, RC, Zuidema, SU, Van Den Heuvel, ER, Stolk, RP and Smidt, N (2015) Social relationships and risk of dementia: a systematic review and meta-analysis of longitudinal cohort studies. Ageing Research Reviews 22, 3957.
Lawlor, DA (2003) Is the association between parity and coronary heart disease due to biological effects of pregnancy or adverse lifestyle risk factors associated with child-rearing?: Findings from the British women's heart and health study and the British regional heart study. Circulation 107, 12601264.
Lewis, CE, Funkhouser, E, Raczynski, JM, Sidney, S, Bild, DE and Howard, BV (1996) Adverse effect of pregnancy on high density lipoprotein (HDL) cholesterol in young adult women: the CARDIA study. American Journal of Epidemiology 144, 247254.
Li, FD, He, F, Chen, TR, Xiao, YY, Lin, ST, Shen, W, Wang, XY, Zhai, YJ, Shang, XP and Lin, JF (2016) Reproductive history and risk of cognitive impairment in elderly women: a cross-sectional study in eastern China. Journal of Alzheimer's Disease 49, 139–47.
Lobo, A, Lopez-Anton, R, Santabarbara, J, De-La-Cámara, C, Ventura, T, Quintanilla, M, Roy, J, Campayo, A, Lobo, E and Palomo, T (2011) Incidence and lifetime risk of dementia and Alzheimer's disease in a Southern European population. Acta Psychiatrica Scandinavica 124, 372383.
Mazure, CM and Swendsen, J (2016) Sex differences in Alzheimer's disease and other dementias. The Lancet Neurology 15, 451452.
McKhann, G, Drachman, D, Folstein, M, Katzman, R, Price, D and Stadlan, EM (1984) Clinical diagnosis of Alzheimer's disease report of the NINCDS-ADRDA work group* under the auspices of department of health and human services task force on Alzheimer's disease. Neurology 34, 939939.
Medel-Anonuevo, C (1995) Women, Education and Empowerment: Pathways Towards Autonomy. UIE Studies 5. Hamburg: United Nations Educational, Scientific, and Cultural Organization.
Mueller, N, Mueller, N, Odegaard, A, Gross, M, Koh, W, Yuan, J and Pereira, M (2013) Higher parity is associated with an increased risk of type-II diabetes in Chinese women: the Singapore Chinese health study. BJOG: An International Journal of Obstetrics & Gynaecology 120, 14831489.
Munro, CJ, Stabenfeldt, G, Cragun, J, Addiego, L, Overstreet, J and Lasley, B (1991) Relationship of serum estradiol and progesterone concentrations to the excretion profiles of their major urinary metabolites as measured by enzyme immunoassay and radioimmunoassay. Clinical Chemistry 37, 838844.
Nicholson, WK, Asao, K, Brancati, F, Coresh, J, Pankow, JS and Powe, NR (2006) Parity and risk of type 2 diabetes: the atherosclerosis risk in communities study. Diabetes Care 29, 2349–54.
Ott, A, Stolk, R, Van Harskamp, F, Pols, H, Hofman, A and Breteler, M (1999) Diabetes mellitus and the risk of dementia: the Rotterdam study. Neurology 53, 19371937.
Paykel, ES, Brayne, C, Huppert, FA, Gill, C, Barkley, C, Gehlhaar, E, Beardsall, L, Girling, DM, Pollitt, P and O'connor, D (1994) Incidence of dementia in a population older than 75 years in the United Kingdom. Archives of General Psychiatry 51, 325332.
Prince, M, Acosta, D, Ferri, CP, Guerra, M, Huang, Y, Rodriguez, JJL, Salas, A, Sosa, AL, Williams, JD, Dewey, ME, Acosta, I, Jotheeswaran, AT and Liu, Z (2012) Dementia incidence and mortality in middle-income countries, and associations with indicators of cognitive reserve: a 10/66 Dementia Research Group population-based cohort study. The Lancet 380, 5058.
Ptok, U, Barkow, K and Heun, R (2002) Fertility and number of children in patients with Alzheimer's disease. Archives of Women's Mental Health 5, 83–6.
Rasmussen, KL, Tybjærg-Hansen, A, Nordestgaard, BG and Frikke-Schmidt, R (2015) Plasma levels of apolipoprotein E and risk of dementia in the general population. Annals of Neurology 77, 301311.
Reitz, C, Tang, MX, Schupf, N, Manly, JJ, Mayeux, R and Luchsinger, JA (2010) Association of higher levels of high-density lipoprotein cholesterol in elderly individuals and lower risk of late-onset Alzheimer disease. Archives of Neurology 67, 1491–7.
Riedel-Heller, SG, Busse, A, Aurich, C, Matschinger, H and Angermeyer, MC (2001) Prevalence of dementia according to DSM–III–R and ICD–10: results of the Leipzig longitudinal study of the aged (LEILA75+) Part 1. The British Journal of Psychiatry 179, 250254.
Rizzi, L, Rosset, I and Roriz-Cruz, M (2014) Global epidemiology of dementia: Alzheimer's and vascular types. BioMed Research Internationa 2014, 908915.
Ruitenberg, A, Ott, A, Van Swieten, JC, Hofman, A and Breteler, MM (2001) Incidence of dementia: does gender make a difference? Neurobiology of Aging 22, 575580.
Sachdev, PS, Lipnicki, DM, Kochan, NA, Crawford, JD, Rockwood, K, Xiao, S, Li, J, Li, X, Brayne, C and Matthews, FE (2013) COSMIC (Cohort Studies of Memory in an International Consortium): an international consortium to identify risk and protective factors and biomarkers of cognitive ageing and dementia in diverse ethnic and sociocultural groups. BMC Neurology 13, 165.
Shen, L and Ji, HF (2015) Vitamin D deficiency is associated with increased risk of Alzheimer's disease and dementia: evidence from meta-analysis. Nutrition Journal 14, 76.
Solanke, BL (2019) Maternal socio-demographic factors associated with low parity and grand multiparity in Nigeria. Women & Health 59, 118.
Thorvaldsson, V, Karlsson, P, Skoog, J, Skoog, I and Johansson, B (2017) Better cognition in new birth cohorts of 70 year olds, but greater decline thereafter. The Journals of Gerontology. Series B, Psychological Sciences and Social Sciences 72, 1624.
Tripepi, G, Jager, KJ, Dekker, FW and Zoccali, C (2010) Selection bias and information bias in clinical research. Nephron Clinical Practice 115, c94–9.
United Nations (2019) World Population Prospects: 2019. New York: United Nations.
Winblad, B, Amouyel, P, Andrieu, S, Ballard, C, Brayne, C, Brodaty, H, Cedazo-Minguez, A, Dubois, B, Edvardsson, D and Feldman, H (2016) Defeating Alzheimer's disease and other dementias: a priority for European science and society. The Lancet Neurology 15, 455532.
Yaffe, K, Lui, L-Y, Grady, D, Cauley, J, Kramer, J and Cummings, SR (2000) Cognitive decline in women in relation to non-protein-bound oestradiol concentrations. The Lancet 356, 708712.

Keywords

Related content

Powered by UNSILO

Parity and the risk of incident dementia: a COSMIC study

  • J. B. Bae (a1) (a2), D. M. Lipnicki (a3), J. W. Han (a1) (a2), P. S. Sachdev (a3) (a4), T. H. Kim (a5), K. P. Kwak (a6), B. J. Kim (a7), S. G. Kim (a8), J. L. Kim (a9), S. W. Moon (a10), J. H. Park (a11), S.-H. Ryu (a12), J. C. Youn (a13), D. Y. Lee (a2) (a14), D. W. Lee (a15), S. B. Lee (a16), J. J. Lee (a16), J. H. Jhoo (a17), I. Skoog (a18), J. Najar (a18), T. R. Sterner (a18), N. Scarmeas (a19) (a20), M. Yannakoulia (a21), E. Dardiotis (a22), S. Riedel-Heller (a23), S. Roehr (a23), A. Pabst (a23), D. Ding (a24) (a25), Q. Zhao (a24) (a25), X. Liang (a24) (a25), A. Lobo (a26) (a27) (a28), C. De-la-Cámara (a26) (a27) (a28), E. Lobo (a26) (a27) (a28), K. W. Kim (a1) (a2) (a29) and for Cohort Studies of Memory in an International Consortium (COSMIC) (a1)...

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed.