Associations of Vestibular Disorders With Risk of All‐Cause and Cause‐Specific Dementia: A Longitudinal Cohort Study in UK Biobank

ABSTRACT To explore associations of vestibular disorders with all‐cause and cause‐specific dementia and underlying biological mechanisms/neuroimaging changes. A population‐based cohort study of 406,348 UK Biobank participants was conducted. Inverse probability of treatment weighting (IPTW) balanced baseline covariates, and Cox proportional hazards models estimated hazard ratios (HRs) for dementia outcomes. Inflammatory markers, plasma metabolites, and brain structure changes were analyzed. During 13.9 (SD 2.1) years of follow‐up, 6702 dementia cases occurred. Vestibular disorders were linked to higher risks of all‐cause dementia (HR 1.86 and 95% CI 1.04–3.30), Alzheimer's disease (AD, 2.36, and 1.01–5.51), and vascular dementia (VD, 3.35, and 1.48–7.59). Eight metabolites (e.g., VLDL cholesterol, and histidine) mediated the vestibular disorder‐dementia association. Vestibular disorders also correlated with alterations in dementia‐related brain structures (cortex, subcortical regions, and white matter tracts). Vestibular disorders increase all‐cause and cause‐specific dementia risk. This modifiable factor should be incorporated into dementia prevention initiatives.