The Burden of Alzheimer’s Disease and Other Dementias Attribute to Metabolic Risks in Western Europe From 1990 to 2023

BACKGROUND: Alzheimer's disease and other dementias (ADOD) impose a growing burden in aging high-SDI regions, a composite of income, education, and fertility. Metabolic risks are major modifiable contributors, but region-specific estimates for Western Europe are limited. METHODS: Using GBD 2023 data, we estimated deaths, disability-adjusted life years (DALYs), age-standardized mortality rates (ASMR), and age-standardized DALYs rates (ASDR) attributable to metabolic risks in 24 countries. Analyses were stratified by sex, age, and Level 2 metabolic risks (high BMI, high FPG). Temporal trends were assessed using estimated annual percentage change (EAPC), and decomposition analysis quantified contributions from population growth, aging, and epidemiological change. RESULTS: In 2023, ASMR and ASDR were 6.84 (95% UI: 1.38-18.30) and 117.80 (35.67-252.14) per 100 000, increasing 18.8% and 17.6% from 1990; corresponding EAPCs were 0.45 and 0.43. Metabolic risks accounted for 90094.8 deaths (18262.6-241493.9). Females had higher age-standardized rates; males showed slightly higher EAPCs. High FPG remained dominant, while high BMI increased faster, particularly among males. Monaco had the highest ASMR and ASDR, whereas Germany, Italy, and the United Kingdom contributed the largest absolute burden. Decomposition analysis showed demographic changes primarily drove high FPG burden, while epidemiological changes contributed more to high BMI outcomes. CONCLUSIONS: ADOD burden attributable to metabolic risks continues to rise across Western Europe, with substantial variation across countries, sex, age, and risk factors. High FPG burden is largely demographic-driven; high BMI burden reflects adverse epidemiological trends. Findings support targeted metabolic interventions, including obesity control and diabetes management integrated into dementia prevention strategies.