What is the clinical evidence from this study?

Study design: Cohort. Population: Adults aged approximately 47-82 years in Norway without prior cardiovascular disease, evaluated for 10-year cardiovascular risk and followed for dementia and mild cognitive impairment outcomes 22 years later (n=6971). Intervention: NORRISK 2 score assessment vs. Lower NORRISK 2 score levels. Primary outcome: Incidence of dementia and mild cognitive impairment (MCI) at 22 years follow-up, categorized as cognitively unimpaired, MCI, or dementia (Relative risk ratio (RRR) per 1% increase in NORRISK 2 score).

What question did this study set out to answer?

This research aims to explore the long-term relationship between NORRISK 2 scores and the incidence of dementia and mild cognitive impairment (MCI) in a population-based cohort.

March 1, 2026Open Access

NORRISK 2 score is associated with dementia and MCI—the HUNT study

Key Result

Higher NORRISK 2 scores were associated with increased risk of dementia by 14% per 1% increase in score for males (RRR 1.14, 95% CI 1.12-1.17) and 28% for females (RRR 1.28, 95% CI 1.25-1.31), and increased risk of MCI by 4% for males (RRR 1.04, 95% CI 1.02-1.05) and 10% for females (RRR 1.10, 95% CI 1.08-1.12) after 22 years.

Key Points

This research aims to explore the long-term relationship between NORRISK 2 scores and the incidence of dementia and mild cognitive impairment (MCI) in a population-based cohort.
Analyzed data from the Trøndelag Health Study (HUNT) with follow-up after 22 years.
Utilized NORRISK 2 scores based on health data collected between 1995-1997.
Cognitive status was assessed through a sub-study between 2017-2019 and categorized into cognitively unimpaired, MCI, or dementia.
Employed multinomial logistic regression to evaluate the association between NORRISK 2 scores and cognitive status.
14.0% of participants developed dementia and 34.6% developed MCI after 22 years.
A 1% increase in NORRISK 2 score correlated with a 14% increased risk of dementia in males and a 28% increase in females.
The risk of developing MCI increased by 4% for men and 10% for women with each 1% rise in NORRISK 2 score.

Study Design

Type

Cohort (n=6,971)

Multicenter

Yes

Structured PICO

Does a higher NORRISK 2 cardiovascular risk score predict the development of dementia and mild cognitive impairment in adults without prior cardiovascular disease?

Population

6,971 adults without prior cardiovascular disease (excluded prior myocardial infarction, angina pectoris, or stroke) from the population-based HUNT study in Norway, mean age 56.1 years, 57.6% female.

Intervention

NORRISK 2 score (a cardiovascular disease risk model estimating 10-year risk of fatal and non-fatal CVD) evaluated as a continuous predictor.

Outcome

Presence of dementia and mild cognitive impairment (MCI) at 22 years of follow-up.hard clinical

Higher midlife cardiovascular risk, as measured by the NORRISK 2 score, is strongly associated with an increased long-term risk of developing dementia and MCI, with the strongest associations observed in females.

Main Result

Effect estimate: Relative risk ratio (RRR) per 1% increase in NORRISK 2 score

Limitations

Reliance on some self-reported data may introduce bias.
Cognitive status measured only at follow-up; exact onset time unknown.
Potential reverse causation cannot be excluded due to long prodromal dementia phase.
Lower participation among individuals with poorer health may cause selection bias and underestimation of associations.
Survival bias and competing risk of death may affect results as high NORRISK 2 scores increase premature mortality risk.
Ethnically homogenous Norwegian population limits generalizability to other ethnicities.
Use of NORRISK 2 score developed for Norwegian population may limit applicability to other populations.

Abstract

Background Cardiovascular disease (CVD) risk factors are associated with the risk of cognitive decline and dementia. Composite CVD risk scores integrate multiple risk factors and may capture the cumulative burden of CVD risk relevant to cognitive outcomes. However, the long-term association between established CVD risk scores and subsequent dementia and mild cognitive impairment (MCI), and potential differences in these associations between males and females, remains insufficiently studied. This study examined the association between NORRISK 2, a CVD risk model estimating 10-year risk of fatal- and non-fatal CVD, and the presence of dementia and mild cognitive impairment (MCI) in males and females, after 22 years of follow-up. Methods Participants from The Trøndelag Health Study (HUNT), a longitudinal, population-based health study, were included. NORRISK 2 scores were based on data from HUNT2 (1995-1997). Cognitive status was assessed in the sub-study HUNT4 70+ (2017–2019) and categorized as cognitively unimpaired (CU), MCI, or dementia. We used multinomial logistic regression with NORRISK 2 as the predictor and cognitive status 22 years later as the main covariate. Results The study sample consisted of 6,971 participants (57.6% females, mean age at HUNT2 56.1 years). At HUNT4 70+, 14.0% of the participants had developed dementia, and 34.6% had developed MCI. Per one percent increase in NORRISK 2 score, the relative risk of developing dementia increased by 14% for males (relative risk ratio (RRR) = 1.14; 95% CI 1.12–1.17) and 28% for females (RRR = 1.28; 95% CI 1.25–1.31). The relative risk of developing MCI increased by 4% for men (RRR = 1.04; 95% CI 1.02–1.05) and 10% for women (RRR = 1.10; 95% CI 1.08–1.12). Conclusion A higher NORRISK 2 score was associated with an increased risk of dementia and MCI in both males and females, with the strongest associations observed in females.

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