A commentary on studies presenting projections of the future prevalence of dementia

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Abstract

Background

Population ageing over the first half of this century is likely to lead to dramatic increases in the prevalence of dementia. This will affect all regions of the world, but particularly developing regions. Dementia projections have been used extensively to support policy. It is therefore important these projections are as accurate as possible.

Discussion

In this paper we provide a commentary on studies projecting the future prevalence of dementia for the world or for individual continents. We identify some important limitations of the methods used in published projections and provide recommendations to improve the accuracy of future projections, and allow for the checking of the accuracy of the predictions.

Summary

Accurate projections of dementia incidence, at both the global and local level, are essential for healthcare planners.

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Most cited references 17

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Alzheimer disease in the US population: prevalence estimates using the 2000 census.

Liesi Hebert, Paul Scherr, Julia L Bienias … (2003)

Current and future estimates of Alzheimer disease (AD) are essential for public health planning. To provide prevalence estimates of AD for the US population from 2000 through 2050. Alzheimer disease incidence estimates from a population-based, biracial, urban study, using a stratified random sampling design, were converted to prevalence estimates and applied to US Census Bureau estimates of US population growth. A geographically defined community of 3 adjacent neighborhoods in Chicago, Ill, applied to the US population. Alzheimer disease incidence was measured in 3838 persons free of AD at baseline; 835 persons were evaluated for disease incidence. Main Outcome Measure Current and future estimates of prevalence of clinically diagnosed AD in the US population. In 2000, there were 4.5 million persons with AD in the US population. By 2050, this number will increase by almost 3-fold, to 13.2 million. Owing to the rapid growth of the oldest age groups of the US population, the number who are 85 years and older will more than quadruple to 8.0 million. The number who are 75 to 84 years old will double to 4.8 million, while the number who are 65 to 74 years old will remain fairly constant at 0.3 to 0.5 million. The number of persons with AD in the US population will continue to increase unless new discoveries facilitate prevention of the disease.

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Is dementia incidence declining?: Trends in dementia incidence since 1990 in the Rotterdam Study.

E Schrijvers, B F J Verhaaren, P. Koudstaal … (2012)

To investigate whether dementia incidence has changed over the last 2 decades. We compared dementia incidence in 2 independent subcohorts of persons aged 60-90 years from the Rotterdam Study, a population-based cohort study. The first subcohort started in 1990 (n = 5,727), the second in 2000 (n = 1,769). Participants were dementia-free at baseline and followed for at maximum 5 years. We calculated age-adjusted dementia incidence rates for the 2 subcohorts in total, in 10-year age strata, and for men and women separately. We also compared mortality rates, differences in prevalence of vascular risk factors, and medication use. Finally, we compared brain volumes and the extent of cerebral small vessel disease in participants who underwent brain imaging 5 years after the baseline examinations. In the 1990 subcohort (25,696 person-years), 286 persons developed dementia, and in the 2000 subcohort (8,384 person-years), 49 persons. Age-adjusted dementia incidence rates were consistently, yet nonsignificantly, lower in the 2000 subcohort in all strata, reaching borderline significance in the overall analysis (incidence rate ratio 0.75, 95% confidence interval [CI] 0.56-1.02). Mortality rates were also lower in the 2000 subcohort (rate ratio 0.63, 95% CI 0.52-0.77). The prevalence of hypertension and obesity significantly increased between 1990 and 2000. This was paralleled by a strong increase in use of antithrombotics and lipid-lowering drugs. Participants in 2005-2006 had larger total brain volumes (p < 0.001) and less cerebral small vessel disease (although nonsignificant in men) than participants in 1995-1996. Although the differences in dementia incidence were nonsignificant, our study suggests that dementia incidence has decreased between 1990 and 2005.

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The incidence of dementia: a meta-analysis.

Jennifer Jolley, A Jorm (1998)

To carry out a meta-analysis of the age-specific incidence of all dementias, including AD and vascular dementia. Several meta-analyses have been carried out on dementia prevalence, but none on its incidence. We used loess-curve fitting to analyze data from 23 published studies reporting age-specific incidence data. The incidence of both dementia and AD rose exponentially up to the age of 90 years, with no sign of leveling off. The incidence rates for vascular dementia varied greatly from study to study, but the trend was also for an exponential rise with age. There was no sex difference in dementia incidence (p = 0.21), but women tended to have a higher incidence of AD in very old age, and men tended to have a higher incidence of vascular dementia at younger ages. East Asian countries had a lower incidence of dementia than Europe (p = 0.0004), and also tended to have a lower incidence of AD. The incidence of dementia rises exponentially to the age of 90 years. Any sex differences are small, and incidence is lower in East Asia than in Europe.

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Author and article information

Contributors

Sam Norton

Fiona E Matthews

Carol Brayne

Journal

Journal ID (nlm-ta): BMC Public Health

Journal ID (iso-abbrev): BMC Public Health

Title: BMC Public Health

Publisher: BioMed Central

ISSN (Electronic): 1471-2458

Publication date Collection: 2013

Publication date (Electronic): 2 January 2013

Volume: 13

Page: 1

Affiliations

[1 ]Institute of Public Health, University of Cambridge, Robinson WayCambridge, CB2 0SR, UK

[2 ]MRC Biostatistics Unit, Robinson Way, Cambridge, CB2 0SR, UK

Article

Publisher ID: 1471-2458-13-1

DOI: 10.1186/1471-2458-13-1

PMC ID: 3547813

PubMed ID: 23280303

SO-VID: dede871a-36d9-408c-9432-92edc7675088

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

A commentary on studies presenting projections of the future prevalence of dementia

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Abstract

Background

Discussion

Summary

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Future Science Group: Coronavirus

Most cited references 17

Alzheimer disease in the US population: prevalence estimates using the 2000 census.

Is dementia incidence declining?: Trends in dementia incidence since 1990 in the Rotterdam Study.

The incidence of dementia: a meta-analysis.

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