Dose-Response Association of Handgrip Strength With Alzheimer's Disease: A Longitudinal Study Involving 85,979 Adults

Objective: To investigate the dose-response relationship between handgrip strength and incidence of Alzheimer's disease (AD) in middle-aged and older adults. Design: Longitudinal study. Patients and Methods: A longitudinal study was conducted in people over 50 years old in 27 European countries and Israel. Data were collected from waves 1, 2, 4, 5, 6, 7 and 8 of the Survey of Health, Ageing and Retirement in Europe (SHARE) between February 2004 and January 2021. Handgrip strength was measured with a hand dynamometer. AD was self-reported based on previous diagnosis. Dose-response associations were assessed by restricted cubic splines. Results: A total of 85,979 (55.8% female) participants were followed for a median of 9.3 years. Over this time, 3324 (3.9%) developed AD. In the adjusted model, for participants < 65 years, those in the middle third of handgrip strength showed a lower risk of AD compared to the lower third (HR = 0.63, 95% CI: 0.47–0.84), as well as participants in the upper third (HR = 0.63, 95% CI: 0.47–0.85). The spline model determined that the minimum and optimal doses of handgrip strength for a significant reduction in the risk of AD for those aged < 65 years were 54 kg (HR = 0.99; 95% CI: 0.08–0.99) and 56 kg (HR = 0.27; 95% CI: 0.08–0.91), respectively. Among those aged ≥ 65 years, the minimum and optimal doses were 31 kg (HR = 0.69; 95% CI: 0.48–0.99) and 49 kg (HR = 0.57; 95% CI: 0.43–0.76), respectively. Conclusion: Higher levels of handgrip strength showed a lower risk of developing AD, among adults aged 50 years and over. However, the dose-response relationship is limited to specific ranges according to age group. We identified a range between 54 and 56 kg years and a range between 31 and 49 kg as suitable to prevent AD in adults aged 50–64 and ≥ 65 years, respectively. Routine assessment of hand grip strength can help healthcare professionals identify people at increased risk of AD. Strength-based interventions could provide a practical strategy to support cognitive health and reduce the risk of dementia in clinical practice.