Objective physical activity in people with young onset dementia,late onset dementia,and without dementia: A UK Biobank study

Abstract

Background

Current physical activity literature does not distinguish between young (dementia diagnosed before 65) and late onset dementia despite differences between these groups such as age, being known to influence physical activity levels.

Objective

The primary aim was to compare objective physical activity levels between people with young onset dementia, late onset dementia, and age-matched control participants without dementia.

Methods

This cross-sectional analysis included four groups (young onset dementia [n = 23]; young onset control [n = 782]; late onset dementia [n = 30]; late onset control [n = 918]) of participants aged 49 to 76 (56% male) from the UK Biobank. Objective light intensity physical activity, moderate-vigorous intensity physical activity, sedentary behavior, and sleep were measured using 7-day wrist-worn accelerometry.

Results

People with young onset dementia did more light and moderate-vigorous intensity physical activity than those with late onset dementia, with these differences becoming nonsignificant when controlling for age. There were no significant differences between people with young onset dementia and the young onset control group. Comparatively, people with late onset dementia did less light intensity physical activity and spent more time sedentary and sleeping than the late onset control group.

Conclusions

This study highlights the distinct physical activity levels of people with young onset and late onset dementia. Future physical activity research should distinguish between young onset and late onset dementia. Such an approach will be important for producing findings that are more applicable for individuals diagnosed with dementia at all stages of life.

Keywords

accelerometer Alzheimer's disease cognitive decline early-onset dementia

Introduction

Dementia is characterized by significant cognitive decline and functional impairment, and is a growing public health concern.¹ Within the diverse spectrum of dementia, the age of onset can contribute substantially to distinctive clinical presentations, disease progression, and associated challenges.² Young onset dementia refers to a diagnosis of any form of dementia prior to the age of 65³ and is associated with a more diverse set of underlying pathologies and symptoms compared to late onset dementia.^4–6 For instance, in late-onset dementia (diagnosed ≥ 65 years), Alzheimer's disease accounts for 60–80% of all cases,⁷ compared to approximately one third of all young onset dementia cases,⁵ where variants such as frontotemporal dementia and vascular dementia are more prevalent.⁵ These pathological differences, in conjunction with inherent differences in age at the time of diagnosis, have led to the assumption that people with young onset dementia are more physically active compared to those with late onset dementia.^8–10 While differences in physical activity levels between these groups are likely to have implications for optimal post-diagnostic support, there is currently little empirical evidence to quantify this.

The physical activity levels of people with young onset dementia are most likely reflective of the combined effects of dementia pathology and relatively younger age. Considering pathology, the limited available evidence suggests that people with dementia are generally less physically active and more sedentary than those without dementia, of the same age.¹¹ Initial evidence suggests this pathological effect appears similar in young onset dementia populations, where physical activity is different relative to those without dementia of a similar age.¹² While there is some evidence investigating the pathological effects of dementia on physical activity, there is even less known about the role of age and age of diagnosis. This is particularly important in the context of people with young onset dementia, who at the time of diagnosis are, by definition, younger than those with late onset dementia. As such, during this younger stage of life, those with young onset dementia are more likely to be engaged in employment, caregiving, social, or domestic responsibilities.^4,13 This combination of greater lifestyle demands, and presence of potentially less age-related functional decline present a logical rationale as to why people with young onset dementia are assumed to be more physically active than those with late onset dementia. Currently, a comparison of physical activity levels between young onset dementia and late onset dementia has not been reported. To more completely understand the physical activity levels within young onset dementia specifically, consideration of both the effects of dementia pathology and age would be beneficial.

An important reason to measure physical activity is to derive and inform recommendations, which exist to provide a target volume of physical activity that benefits physical, cognitive, and metabolic health.¹⁴ Current physical activity recommendations suggest that individuals should aim for >150 min of moderate-vigorous intensity physical activity per week.^15,16 In healthy older people, evidence suggests that achieving these recommendations is protective against cognitive^16,17 and physical decline.¹⁶ Total time in other activities, such as sleep, is associated with cognition¹⁸ and regional brain volumes¹⁹ in apparently healthy populations. Greater time spent in sedentary behavior is also associated with declines in physical²⁰ and cognitive²¹ health. Hence, identification of differences in physical activity between those with young onset, and late onset dementia may support the need to investigate more informed recommendations for people with dementia.

To better understand the physical activity levels of people with young onset dementia, we employed two complementary comparison approaches. First, by comparing people with young onset and late onset dementia, we sought to explore the influence of both age of dementia diagnosis and current age on physical activity. Second, by comparing each dementia group to an age-matched control group, we sought to investigate the influence of dementia pathology on physical activity. As such, the specific aims of this study were to: (i) Compare the duration of objectively measured light and moderate-vigorous intensity physical activity, sedentary, and sleep behavior of participants with young onset dementia to those with late onset dementia; (ii) investigate how the objective physical activity of people with young onset and late onset dementia may differ compared to individual age and sex-matched control groups without dementia; and (iii) identify what proportion of people with young onset and late onset dementia meet current physical activity recommendations.

Methods

Study design and participants

Participants were sampled from members of the United Kingdom (UK) population that participated in the UK Biobank study, a large ongoing prospective study assessing environmental, lifestyle and genetic information of participants across the United Kingdom.²² The UK Biobank study includes 502,655 participants aged 37–73 years at baseline who were recruited from April 2007 to December 2010. This initial assessment will be referred from here on as the baseline assessment, where environmental, lifestyle, and genetic data were collected at one of 22 UK Biobank assessment centers. Between February 2013 and December 2015, participants with valid contact information were chosen at random, and invited via email to participate in an accelerometry sub-study.²³ A subset of participants (n = 103,648) wore an accelerometer for seven days to measure sleep and physical activity, referred from here on as the accelerometer assessment.

The selection of participants for both people with young onset and late onset dementia is further detailed in Figure 1. Dementia diagnoses were obtained from a combination of hospital admissions records and primary care records. This approach has been validated within the UK Biobank study.^24,25 Participants with a diagnosis of dementia were included in this analysis if they had available medical history, demographic, and accelerometer data. Participants were then categorized as having young onset dementia (n = 23) if they were diagnosed with dementia before the age of 65, or late onset dementia (n = 30) if they were diagnosed with dementia at or after the age of 65.

Figure 1.

Participant selection from the main UK Biobank study. *Descriptive data: Body mass index, cardiovascular health, years of education, socioeconomic status. **Neurological conditions: Huntington's disease, multiple sclerosis, Parkinson's disease, stroke. ***Control group participants were matched exactly for age, sex, and month of accelerometer collection, and nearest neighbor matched for date of accelerometer collection.

The age-matched control groups for both the young onset dementia and late onset dementia groups were selected from the participants with complete medical history, demographic and accelerometer data, but with no known diagnosis of dementia or other neurological conditions. Both age-matched control groups were created by selecting participants that exactly matched their age, and the month which they completed the accelerometer sub-study to participants with dementia. Controls were then assigned to either the young onset control, or late onset control group depending on whether they were matched to participants with young onset dementia or late onset dementia. Participants were nearest neighbor matched for sex, and the day of accelerometer collection using the R package Match-It.²⁶ The reason that participants were exact matched for the month of accelerometer assessment and nearest neighbor matched for day of accelerometer assessment was to reduce potential seasonal effects on physical activity.²⁷ As a result, Match-It identified 782 young onset control, and 918 late onset control participants with no significant differences between the age-matched control and groups of young onset and late onset dementia for all matched variables. The UK Biobank received ethical approval from the Northwest Multi-centre Research Ethics Committee (REC reference: 11/NW/0382). All participants gave written informed consent before enrolment in the study, which was conducted in accordance with the principles of the Declaration of Helsinki. This project was conducted under UK Biobank approval number: 47813.

Objectively measured physical activity, sedentary behavior, and sleep

Physical activity was measured objectively with an accelerometer (AX3 triaxial accelerometer, Axivity, United Kingdom) worn on the wrist for 7 full days. The wrist-worn AX3 triaxial accelerometer is a validated measure of physical activity within older populations.²⁸ The accelerometers collected data at a sampling rate of 100 Hz (1 Hz = 1 sample per second). Participants were excluded if their accelerometer recorded implausible average acceleration values (>100 milligravities) or they wore the accelerometer for <3 days.²³ Categories of physical activity are routinely utilized within physical activity literature to contextualize the amount of time spent in different intensities of activity throughout the day, and typically include, sedentary, light intensity and moderate-vigorous intensity.²⁹ Sedentary activity includes time which is spent seated or lying with little additional movement, light intensity activity can be sustained for over 60 min and does not noticeably alter breathing rate, and moderate-vigorous intensity includes those activities which cannot be sustained for over 60 min, alter breathing rate, and ability to maintain a conversation.²⁹ Established cutoffs for each category of physical activity were utilized in the processing of raw data.²³ Processed data was provided to the UK Biobank as a supplementary dataset,³⁰ which contained the variables used within this study. The derived accelerometer data was separated into four categories (light intensity, moderate-vigorous intensity, sedentary behavior, and sleep), each expressed as the average minutes spent in each activity per week (mins/wk⁻¹).

Health and sociodemographic variables

To contextualize the study population, several variables that are associated with dementia risk and physical activity were included within the descriptive statistics. Constitutional risk factors reported include age, sex, body mass index, cardiovascular disease incidence, years of education, and APOE ε4 carrier status. Additional clinical characteristics included date of dementia diagnosis, and date of baseline and accelerometer assessments. These variables were used to calculate the age of participants at their accelerometer assessment, and the length of time between dementia diagnosis and accelerometer assessment as a measure for time living with dementia. Health and sociodemographic variables are presented in Table 1.

Table 1.

Demographic and health characteristics of the study population.

	Young onset dementia		Late onset dementia
	Dementia(N = 23)	Age-matched control(N = 782)	Dementia(N = 30)	Age-matched control(N = 918)
Sex – Male, n (%)	12 (52%)	408 (52%)	16 (53%)	539 (59%)
Age (y) – mean (SD)	63 (± 5)	63 (± 5)	72 (± 3)	71 (± 3)
Age of dementia diagnosis (years) – mean (SD)	56 (± 6)	NA	70 (± 3)	NA
Time since dementia diagnosis (days) – mean (SD)	2510 (± 1740)	NA	832 (± 974)	NA
Body mass index (BMI) – mean (SD)	26 (± 4)	27 (± 5)	28 (± 5)	27 (± 4)
Education (y) – mean (SD)	17 (± 4)	16 (± 5)	14 (± 5)	15 (± 5)
Cardiovascular disease, n (%)	9 (39%)	235 (30%)	22 (73%)	444 (48%)
APOE ε4/ε4 allele, n (%)	5 (22%)	21 (3%)	1 (3%)	17 (2%)
Objective Physical Activity Behavior (min/wk⁻¹)
Light physical activity (SD)	2210 (± 758)	2080 (± 675)	1630 (± 777)	2060 (± 647)
Moderate-vigorous physical activity (SD)	307 (± 244)	323 (± 254)	196 (± 199)	266 (± 228)
Sedentary physical activity (SD)	3950 (± 915)	3960 (± 733)	4280 (± 952)	3980 (± 737)
Sleep (SD)	3610 (± 608)	3720 (± 498)	3980 (± 737)	3770 (± 521)
Achieved physical activity guidelines of >150 min of moderate-vigorous physical Activity per week, n (%)	15 (65%)	574 (73%)	15 (50%)	582 (63%)

Statistical analysis

Statistical analysis was conducted in, R version 4.2.2,³¹ in RStudio version 2023.9.0.463.³² The mean and standard deviation of outcome measures were calculated individually for the dementia and control groups. Linear regression models were computed to investigate the difference in objective physical activity, sedentary, and sleep behavior between groups. In each model, the dependent variable was a single measure of physical activity intensity, sedentary, sleep behavior, or proportion of participants meeting physical activity guidelines (Figure 1). Statistical significance was reported at an adjusted p < 0.050 using the Benjamini-Hochberg procedure.³³ As outlined below, separate models were created in line with the aims of this study. This enabled selection of the most appropriate covariates depending on the population included in the model.

To address aim 1, which compared young onset dementia to late onset dementia, a base set of models (model 1) were computed with participant group as the independent variable (2 levels: young onset dementia, late onset dementia), and length of time the participants had been diagnosed with dementia, and sex included as covariates. To consider for the role of age in any observed differences, a second set of models (model 2) included age, as age is regarded as a predictor of declining physical activity.³⁴

To address aim 2, separate models were computed to compare the young onset dementia or late onset dementia participants to their respective age-matched control groups, with sex and age included as predetermined covariates.

The linear models are supported graphically and were visualized in R Studio using ggplot2,³⁵ with raincloud plots of the raw data that identify the differences between groups for time spent in physical activity, sedentary, and sleep behaviors.

To address aim 3, participants were grouped depending on whether they achieved an average of 150 min or more of moderate-vigorous intensity physical activity per week, in line with suggested physical activity recommendations.^15,16 Separate models were computed to compare the proportion of individuals with young onset dementia, late onset dementia, and the respective age-matched control groups that achieved the threshold of 150 min of moderate-vigorous activity per week. The summary of group comparisons is reported in Supplemental Table 7.

Results

Participant characteristics

The demographic and health characteristics of the study sample are presented in Table 1. By design, there were no significant differences in age between people with young onset or late onset dementia and their respective age-matched control groups (all p > 0.950). Individuals with young onset dementia were living with dementia for a longer period of time compared to those with late onset dementia (p < 0.001). Those with young onset dementia were also more likely to be homozygous for APOE ε4 than both people with late onset dementia, and the young onset control group (all p < 0.001). Excluding objective physical activity outcomes which are reported below, there were no other statistically significant differences between groups of interest for any of the health and demographic variables outlined in Table 1.

Comparison of young onset dementia and late onset dementia

Addressing aim 1, model 1 identified that people with young onset dementia engaged in more light intensity (p = 0.011; Figure 2A) and moderate-vigorous intensity (p = 0.047; Figure 2B) physical activity than those with late onset dementia, with no differences between groups in time spent in sedentary behavior, or sleep (Table 2). Model 2, which investigated the role of age, resulted in the differences for both light intensity (p = 0.182) and moderate-vigorous intensity (p = 0.922) physical activity becoming non-significant (Table 3).

Figure 2.

Raincloud plots of raw data displaying the differences between the young onset dementia, late onset dementia, young onset control, and late onset control groups. Each panel represents a different category of physical behavior: (A) light intensity physical activity (LIPA), (B) moderate-vigorous intensity physical activity (MVPA), (C) sedentary behavior, and (D) sleep, and are reported as minutes per week.

Table 2.

Summary of group comparisons of objectively measured physical activity, sedentary and sleep behavior between groups from model 1.

Objective Physical Activity, Sedentary and Sleep Behaviors
	Light intensity physical activity		Moderate-vigorous intensity physical activity		Sedentary behavior		Sleep
Comparison	b (CI)	p*	b (CI)	p*	b (CI)	p*	b (CI)	p*
Young onset dementia - Late onset dementia**	−578 (−1016, −139)	0.011	−119 (−237, −1)	0.047	348 (−178, 875)	0.189	349 (−29, 726)	0.069
Young control - Late control***	2 (−59, 63)	0.942	−63 (−86, −41)	<0.001	7 (−62, 76)	0.835	54 (5, 103)	0.031

b: unstandardized regression coefficient; CI: 95% confidence interval.

*Adjusted p-value, with p-values which met the criteria for statistical significance being represented in bold.

**This model controls for the length of time since being diagnosed with dementia and sex, the full model summary can be found in Supplemental Table 1.

***This model controls for sex; the full model summary can be found in Supplemental Table 2.

Table 3.

Summary of group comparisons of objectively measured physical activity, sedentary and sleep behaviors between groups from model 2, which controlled for age.

Objective Physical Activity, Sedentary and Sleep Behaviors
	Light intensity physical activity		Moderate-vigorous intensity physical activity		Sedentary behavior		Sleep
Comparison	b (CI)	p*	b (CI)	p*	b (CI)	p*	b (CI)	p*
Young onset dementia - Late onset dementia**	−438 (−1090, 213)	0.182	−8 (−179, 162)	0.922	59 (−717, 836)	0.878	387 (−175, 950)	0.173
Young control - Late control***	−45 (−133, 43)	0.315	−38 (−71, −6)	0.022	41 (−59, 141)	0.422	43 (−28, 113)	0.240

b: unstandardized regression coefficient; CI: 95% confidence interval.

*Adjusted p-value, with p-values which met the criteria for statistical significance being represented in bold.

**This model controls for age, the length of time since being diagnosed with dementia and sex, the full model summary can be found in Supplemental Table 3.

***This model controls for age and sex; the full model summary can be found in Supplemental Table 4.

The proportion of participants with young onset dementia achieving current physical activity recommendations (65%) was not significantly different to those with late onset dementia (50%; p = 0.277; Supplemental Table 7).

Comparison of dementia groups to their age-matched control groups

Addressing aim 2, there were no differences in the duration of physical activity, sedentary behavior or sleep between people with young onset dementia and the young onset control group (Table 4). However, people with late onset dementia did significantly less light intensity physical activity (p < 0.001; Figure 2A), and spent more time in sedentary behavior (p = 0.024; Figure 2C) and sleeping (p = 0.040; Figure 2D) compared to the late onset control group (Table 4). There were no differences in moderate-vigorous intensity physical activity when comparing either dementia group to their respective age-matched control group (Table 4).

Table 4.

Summary of group comparisons of objectively measured physical activity, sedentary and sleep behavior, comparing each young onset and late onset dementia group to their respective age and sex-matched control groups.

Objective Physical Activity, Sedentary and Sleep Behaviors
	Light intensity physical activity		Moderate-vigorous intensity physical activity		Sedentary behavior		Sleep
Comparison	b (CI)	p*	b (CI)	p*	b (CI)	p*	b (CI)	p*
Young onset dementia - Young control**	−128 (−400, 143)	0.354	16 (−88, 121)	0.761	5 (−296, 306)	0.974	107 (−101, 315)	0.314
Late onset dementia - Late control**	448 (220, 677)	<0.001	204 (−19, 142)	0.134	−307 (−576, −40)	0.024	−202 (−395, −9)	0.040

b: unstandardized regression coefficient; CI: 95% confidence interval.

*Adjusted p-value, with p-values which met the criteria for statistical significance being represented in bold.

**These models control for age and sex; the full model summaries can be found in Supplemental Tables 5 and 6.

There were no differences in the proportion of individuals meeting current physical activity recommendations when comparing individuals with young onset dementia (65%) to the young onset control group (73%; p = 0.383; Supplemental Table 7) or comparing those with late onset dementia (50%) to the late onset control group (63%; p = 0.135; Supplemental Table 7).

Discussion

Previous literature has postulated that individuals with young onset dementia are more physically active than people with late onset dementia.^8–10 Here, we add to the limited evidence available to support this claim, by taking an approach that considers the role of age and pathology in a complimentary manner. Within the present study, individuals with young onset dementia engaged in more light and moderate-vigorous intensity physical activity compared to their late onset dementia counterparts, with age appearing to be a primary explanatory factor. Further supporting the distinction between these groups, people with young onset dementia were similarly active to their age matched controls, while people with late onset dementia did less light intensity physical activity and were more sedentary relative to their controls. These distinctions in findings highlight a nuanced relationship where the influence of dementia pathology on physical activity appears to be closely related to age at diagnosis and current age. Given that current dementia interventions are designed for people with late onset dementia, emphasis should be placed on developing young onset dementia specific research and interventions.

In the current study, people with young onset dementia were more physically active compared to people with late onset dementia, with age as a likely explanatory factor. Similar age-related differences have been observed in cognitively healthy populations of a comparative age to the current study.³⁶ Our findings suggest that differences in age between our dementia groups may account for the differences in physical activity between those with young onset dementia and late onset dementia. This effect of age is likely due to a combination of factors associated with age related physiological declines in bone density,^37,38 cardiovascular function,³⁹ and muscle mass.⁴⁰ Furthermore, age related declines in domestic, employment, caregiving or social responsibilities that people with young onset dementia are more likely to engage in, may also contribute.^4,13 Future research, investigating the nuanced factors associated with age, beyond considering it as simply a variable, would be beneficial in identifying and explaining differences in physical activity and optimizing post-diagnostic interventions for both young onset and late onset dementia.

The differences between people with young onset dementia and late onset dementia were further exemplified when we compared them to their age-matched controls. In this sense, these models provided distinction from normal age-related changes and may be reflective of the role of dementia. Interestingly, there were no differences in physical activity between the young onset dementia group and young onset control group. In the one other study specifically examining objective physical activity in people with young onset dementia, Hayes et al. (2024) found that people with young onset dementia did less moderate-vigorous physical activity and spent more time sedentary compared to age-matched controls without dementia.¹² It is not clear why Hayes et al. (2024) found these differences between groups, given similarities in young onset dementia sample size and age ranges with our study.¹² While speculative, it could be that our more exact matching for age alongside a larger control group which may be more representative of the population, contributed to these differences. In contrast to our findings for young onset dementia, we found that people with late onset dementia did less light intensity physical activity and spent more time sedentary compared to the age matched control group. While the late onset dementia group did 70 min per week less moderate-vigorous physical activity than the late control group, this difference did not reach statistical significance. This may be due to the relatively large variability in moderate-vigorous physical activity within groups and the smaller sample size in the late onset dementia group, which together may have reduced the statistical power to detect a difference. These findings add to the limited evidence available that people with late onset dementia engage in more sedentary lifestyles than those without dementia.¹¹ Previous literature has hypothesized that such declines in physical activity may be a consequence of dementia symptomology. For example, impairment to executive functioning may lead to apathy⁴¹ and subsequently lower physical activity levels⁴² compared to those without dementia. Our overall findings add to the literature by suggesting that the effect of dementia on physical activity levels may become more pronounced with increased age.

Currently, physical activity recommendations for people with dementia are identical to those for healthy adults, being >150 min of moderate-vigorous intensity per week.^15,16 Compared to the broader population in 2016, the NHS Health Survey for England, which used a self-report measure of physical activity, estimated that 44% of adults aged over 65 met these recommendations.⁴³ This does not align with the current study, where 68% of all participants (young onset dementia: 65%; late onset dementia: 50%; young onset control: 73%; late onset control: 63%) met this threshold. While this could be interpreted that this study's sample was highly active, it is more likely that physical activity recommendations, which are derived from self-reported measures of physical activity, are not equivalent to objective measures such as accelerometry.⁴⁴ Future work to align these measures in the context of physical activity guidelines, alongside the development of more individualized guidelines for dementia groups will be essential for the translation of research findings for practical and clinical applications.

These findings must be considered in the context of several limitations. Firstly, the sample size in the two dementia groups for this investigation is relatively small within a heterogeneous population, although comparable to existing literature.¹² Whilst the findings still provide valuable insights in conjunction with the limited evidence available, a larger sample size would enhance the generalizability of the results and may enable further subgroup analyses (e.g., by dementia subtype). Secondly, the cross-sectional nature of the study meant the trajectory of physical activity levels and dementia progression could not be assessed. A longitudinal study would enable investigation of changes in physical activity, sedentary behavior, and sleep time with dementia progression. Thirdly, although the UK Biobank provides a date of diagnosis, there is no clinical data reporting dementia severity and as such we were unable to account for this. Finally, the number of individuals with a dementia diagnosis in the accelerometer assessment sample is disproportionately low relative to population prevalence. Therefore, it is unknown whether the criteria for reporting dementia diagnoses may be a limitation, or whether the sample may be biased toward those with greater functionality, who could complete the accelerometer assessment. Despite this, the time between dementia diagnosis and accelerometer collection was reported, providing information for the length of time participants were living with dementia prior to wearing the accelerometer to provide some context on disease progression.

In conclusion, this study highlights the distinct physical activity levels of individuals with young onset and late onset dementia. These findings support the need to distinguish between young onset and late onset dementia in future research. Such an approach will be important for producing findings that are more applicable and representative to individuals diagnosed with dementia at all stages of life, with the goal of preserving physical health, cognitive health, and quality of life.

Supplemental Material

sj-docx-1-alz-10.1177_13872877251374261 - Supplemental material for Objective physical activity in people with young onset dementia, late onset dementia, and without dementia: A UK Biobank study

Supplemental material, sj-docx-1-alz-10.1177_13872877251374261 for Objective physical activity in people with young onset dementia, late onset dementia, and without dementia: A UK Biobank study by Nicholas H Lawlis, Nicolas Cherbuin, Ananthan Ambikairajah, Hollie Speer, Nathan M D'Cunha, Ben Rattray and Joseph M Northey in Journal of Alzheimer's Disease

Footnotes

Acknowledgements

We would like to acknowledge and thank all UK Biobank participants and the UK Biobank team for their work. This project has been conducted using the UK Biobank resource under application number 47813. This work uses data provided by patients and collected by the NHS as part of their care and support.

ORCID iDs

Nicholas H Lawlis

Nicolas Cherbuin

Ananthan Ambikairajah

Hollie Speer

Nathan M D’Cunha

Ben Rattray

Joseph M Northey

Ethical considerations

The UK Biobank received ethical approval from the Northwest Multi-centre Research Ethics Committee (REC reference: 11/NW/0382). This project was conducted under UK Biobank approval number: 47813.

Consent to participate

All participants gave written informed consent before enrolment in the study, which was conducted in accordance with the principles of the Declaration of Helsinki.

Author contributions

Nicholas H Lawlis: Conceptualization; Data curation; Formal analysis; Investigation; Methodology; Project administration; Visualization; Writing – original draft; Writing – review & editing.

Nicolas Cherbuin: Data curation; Methodology; Project administration; Resources; Writing – review & editing.

Ananthan Ambikairajah: Formal analysis; Methodology; Supervision; Writing – review & editing.

Hollie Speer: Formal analysis; Methodology; Supervision; Writing – review & editing.

Nathan M D'Cunha: Conceptualization; Methodology; Project administration; Supervision; Writing – review & editing.

Ben Rattray: Conceptualization; Investigation; Methodology; Supervision; Writing – review & editing.

Joseph M Northey: Conceptualization; Formal analysis; Investigation; Methodology; Project administration; Supervision; Writing – review & editing.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: No funding was sought to conduct this research. N Lawlis was supported by an Australian Government Research Training Program (RTP) Domestic and Fee-Offset Scholarships, and the 2024 Dementia Australia Research Foundation Dr Maree Farrow Clinical Postgraduate Stipend.

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data availability statement

Researchers can apply to use the UK Biobank resource and access the data used. No additional data are available.

Supplemental material

Supplemental material for this article is available online.

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