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Choi Y. The effect of socioeconomic status on mortality among Alzheimer's disease patients: A nationwide population-based cohort study in Korea. Medicine (Baltimore) 2022; 101:e29527. [PMID: 35905220 PMCID: PMC9333517 DOI: 10.1097/md.0000000000029527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
To investigate the effects of household income level on all-cause mortality in patients with Alzheimer's disease (AD). Data was obtained from 7,937 participants in the Korean National Health Insurance cohort who was newly diagnosed with Alzheimer's disease using the anti-dementia medication between 2003 and 2013. All individuals were followed-up until December 2013 or death, whichever came first. Individual income was estimated from the national health insurance premium. Information on mortality was obtained from the Korean National Statistical Office. Cox proportional hazard models were used to compare mortality rates between different income groups after adjusting for possible confounding risk factors. Of 7937 participants, 2292 AD patients (28.9%) died. Those with low, middle-low, middle income level were likely to have more increasing risk of mortality (HR 1.142 [1.022-1.276], HR 1.211 [1.045-1.402], and HR 1.158 [1.009-1.328], respectively), compared to those with high income level. The findings of this study indicate that AD patients with low income level have higher risk for mortality. Promotion of targeted policies and priority support for these groups may help reduce the mortality rate in this vulnerable group.
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Affiliation(s)
- Young Choi
- Department of Healthcare Management, Catholic University of Pusan, Busan, Republic of Korea
- Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Republic of Korea
- *Correspondence: Young Choi, Department of Healthcare Management, Catholic University of Pusan, Oryundae-ro 57, Geumjeong-gu, Busan, 46252, Korea (e-mail: )
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Global mortality from dementia: Application of a new method and results from the Global Burden of Disease Study 2019. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2021; 7:e12200. [PMID: 34337138 PMCID: PMC8315276 DOI: 10.1002/trc2.12200] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 04/09/2021] [Accepted: 05/24/2021] [Indexed: 12/02/2022]
Abstract
INTRODUCTION Dementia is currently one of the leading causes of mortality globally, and mortality due to dementia will likely increase in the future along with corresponding increases in population growth and population aging. However, large inconsistencies in coding practices in vital registration systems over time and between countries complicate the estimation of global dementia mortality. METHODS We meta-analyzed the excess risk of death in those with dementia and multiplied these estimates by the proportion of dementia deaths occurring in those with severe, end-stage disease to calculate the total number of deaths that could be attributed to dementia. RESULTS We estimated that there were 1.62 million (95% uncertainty interval [UI]: 0.41-4.21) deaths globally due to dementia in 2019. More dementia deaths occurred in women (1.06 million [0.27-2.71]) than men (0.56 million [0.14-1.51]), largely but not entirely due to the higher life expectancy in women (age-standardized female-to-male ratio 1.19 [1.10-1.26]). Due to population aging, there was a large increase in all-age mortality rates from dementia between 1990 and 2019 (100.1% [89.1-117.5]). In 2019, deaths due to dementia ranked seventh globally in all ages and fourth among individuals 70 and older compared to deaths from other diseases estimated in the Global Burden of Disease (GBD) study. DISCUSSION Mortality due to dementia represents a substantial global burden, and is expected to continue to grow into the future as an older, aging population expands globally.
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Tommiska P, Korja M, Siironen J, Kaprio J, Raj R. Mortality of older patients with dementia after surgery for chronic subdural hematoma: a nationwide study. Age Ageing 2021; 50:815-821. [PMID: 33022060 DOI: 10.1093/ageing/afaa193] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND dementia is associated with an excess risk of death but mortality after chronic subdural hematoma (CSDH) evacuation in older people with dementia is unknown. We assessed the association between dementia and 1-year case-fatality in older persons undergoing CSDH evacuation. METHODS we conducted a nationwide Finnish cohort study including all older persons (≥60 years) undergoing CSDH evacuation during 1997-2014 (referred to as cases). We identified controls, without a diagnosis of CSDH, that were matched for age, sex and year of first hospitalisation with a new dementia diagnosis. We identified cases and controls with a pre-existing diagnosis of dementia. Outcome was 12-month mortality. Mortality was compared in case-only and case-control analyses. RESULTS of 7,621 included cases, 885 (12%) had a pre-existing diagnosis of dementia. The proportion of cases increased from 9.7% in 1997-2002 to 12.2% in 2012-2014 (P = 0.038 for trend). In the case-analysis, dementia independently associated with 1-year case-fatality (dementia vs. no dementia odds ratio [OR] 1.50, 95% confidence interval [CI] 1.26-1.78). Sensitivity analysis suggested the association to be strongest for those 60-69 years old (OR 3.21, 95% CI 1.59-6.47). In the case-control matched analysis, 1-year mortality was 26% in the dementia CSDH surgery group compared to 16% in the dementia non-CSDH controls (P < 0.001). CONCLUSION dementia is a significant risk factor for 1-year mortality after CSDH surgery in older people. The proportion of older CSDH patients having a pre-existing diagnosis of dementia is increasing. Thus, there is a need for improved evidence regarding the indications and benefits of CSDH evacuation among older persons.
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Affiliation(s)
- Pihla Tommiska
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Miikka Korja
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jari Siironen
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jaakko Kaprio
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Rahul Raj
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Bae JB, Han JW, Kwak KP, Kim BJ, Kim SG, Kim JL, Kim TH, Ryu SH, Moon SW, Park JH, Youn JC, Lee DY, Lee DW, Lee SB, Lee JJ, Jhoo JH, Kim KW. Is Dementia More Fatal Than Previously Estimated? A Population-based Prospective Cohort Study. Aging Dis 2019; 10:1-11. [PMID: 30705763 PMCID: PMC6345342 DOI: 10.14336/ad.2018.0123] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 01/23/2018] [Indexed: 11/01/2022] Open
Abstract
Dementia increases the risk of mortality (ROM) in the elderly and estimates of hazard ratio (HR) of dementia for mortality have ranged from 1.7 to 6.3. However, previous studies may have underestimated ROM of dementia due to length bias, which occurs when failing to include the persons with rapidly progressive diseases, who died before they could be included in the study. This population-based prospective cohort study conducted on 6,752 randomly sampled Koreans, aged 60 years or older (the Korean Longitudinal Study on Cognitive Aging and Dementia). Cognitive disorders were evaluated at baseline and 2-year follow-up using the Korean version of the Consortium to Establish a Registry for Alzheimer's Disease Assessment Packet (CERAD-K), and prevalent and incident cases of dementia were identified. The participants' deaths were confirmed through the National Mortality Database of Statistics Korea. We compared the ROM between prevalent and incident dementia, and estimated HR of dementia for mortality using Cox proportional hazards model. Of the 5,097 responders to the 2-year follow-up assessment, 150 participants had dementia from the baseline (prevalent dementia), and 95 participants developed dementia during the 2-year follow-up period (incident dementia). The ROM of participants with incident dementia was about 3 times higher than the ROM of those with prevalent dementia (HR = 3.04, 95% confidence interval [CI] = 1.34-6.91). Compared to cognitively normal participants at both the baseline and 2-year follow-up assessments, the ROM of those with incident dementia approximately 8 times higher (HR = 8.37, 95 % CI = 4.23-16.54). In conclusion, the ROM of dementia using prevalent cases was underestimated due to length bias, and dementia may be much more fatal than previously estimated. In clinical settings, the ROM of dementia warrants the attention of physicians, particularly in recently incident dementia cases.
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Affiliation(s)
- Jong Bin Bae
- 1Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea
| | - Ji Won Han
- 2Department of Neuropsychiatry, Seoul National University Bundang Hospital, Gyeonggido, Korea
| | - Kyung Phil Kwak
- 3Department of Psychiatry, Dongguk University Gyeongju Hospital, Gyeongju, Korea
| | - Bong Jo Kim
- 4Department of Psychiatry, Gyeongsang National University, School of Medicine, Jinju, Korea
| | - Shin Gyeom Kim
- 5Department of Neuropsychiatry, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Jeong Lan Kim
- 6Department of Psychiatry, School of Medicine, Chungnam National University, Daejeon, Korea
| | - Tae Hui Kim
- 7Department of Psychiatry, Yonsei University Wonju Severance Christian Hospital, Wonju, Korea
| | - Seung-Ho Ryu
- 8Department of Psychiatry, School of Medicine, Konkuk University, Konkuk University Medical Center, Seoul, Korea
| | - Seok Woo Moon
- 9Department of Psychiatry, School of Medicine, Konkuk University, Konkuk University Chungju Hospital, Chungju, Korea
| | - Joon Hyuk Park
- 10Department of Neuropsychiatry, Jeju National University Hospital, Jeju, Korea
| | - Jong Chul Youn
- 11Department of Neuropsychiatry, Kyunggi Provincial Hospital for the Elderly, Korea
| | - Dong Young Lee
- 1Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea.,12Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Korea
| | - Dong Woo Lee
- 13Department of Neuropsychiatry, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Seok Bum Lee
- 14Department of Psychiatry, Dankook University Hospital, Cheonan, Korea
| | - Jung Jae Lee
- 14Department of Psychiatry, Dankook University Hospital, Cheonan, Korea
| | - Jin Hyeong Jhoo
- 15Department of Neuropsychiatry, Kangwon National University Hospital, Korea
| | - Ki Woong Kim
- 1Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea.,2Department of Neuropsychiatry, Seoul National University Bundang Hospital, Gyeonggido, Korea.,16Department of Brain and Cognitive Science, Seoul National University College of Natural Sciences, Seoul, Korea
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Effects of task-specific rehabilitation training on tau modification in rat with photothrombotic cortical ischemic damage. Neurochem Int 2017; 108:309-317. [PMID: 28499951 DOI: 10.1016/j.neuint.2017.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 05/02/2017] [Accepted: 05/08/2017] [Indexed: 01/05/2023]
Abstract
Although stroke elicits progressive cognitive decline and is a leading cause of dementia, molecular interplay between stroke and Alzheimer's disease (AD) pathology has not been fully elucidated. Furthermore, studies on the effects of post-stroke rehabilitation on AD pathology are limited. We evaluated the acute effect of stroke on tau modification, and the molecular effects of task-specific training (TST) on tau modification using a model of photochemically-induced thrombosis (PIT)-induced cortical infarction. Following PIT in the dominant side of sensorimotor cortex, the rehabilitation group received 4-weeks of TST rehabilitation once daily by single pellet reaching training, whereas the sedentary control group did not received any type of training. Cortical expression levels of proteins related to tau modification were evaluated on post-stroke day 1 (PSD1) and 28; functional tests were also evaluated performed every week. The expression levels of acetyl-tau, phosphorylated-tau (p-tau), cyclooxygenase-2 and Akt-mTORC1-p70S6K pathway in infarcted cortices on PSD1 were significantly greater, whereas the expression levels of p-AMPK were significantly lower than in the paired contralateral sides. TST rehabilitation for 4 weeks greatly improved functional motor performance but not memory, which concurred with the down-regulations of ipsilateral p-AMPK, cyclooxygenase-2, Akt-mTORC1-p70S6K pathway, and p-tau in rehabilitation group. PIT-induced cortical infarction was found to induce cortical tau modification through the Akt-mTORC1-p70S6K activation, and to suppress the expression of AMPK-related proteins. TST rehabilitation greatly improved motor function, but not memory, and suppressed p-tau expression and neuroinflammation. Nevertheless, the role of TST-mediated regulation of tau hyperphosphorylation required further clarification.
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Nielsen RE, Lolk A, Valentin JB, Andersen K. Cumulative dosages of antipsychotic drugs are associated with increased mortality rate in patients with Alzheimer's dementia. Acta Psychiatr Scand 2016; 134:314-20. [PMID: 27357602 DOI: 10.1111/acps.12614] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/01/2016] [Indexed: 01/22/2023]
Abstract
OBJECTIVE We wished to investigate the effects of cumulative dosages of antipsychotic drug in Alzheimer's dementia, when controlling for known risk factors, including current antipsychotic exposure, on all-cause mortality. METHOD We utilized a nationwide, population-based, retrospective cohort study design with mortality as outcome in individual patients diagnosed with Alzheimer's dementia. RESULTS We included a total of 45 894 patients and followed them for 3 803 996 person-years in total, presenting 27 894 deaths in the study population. Cumulative antipsychotic exposure increased mortality: more than 0 Daily Defined Dosage (DDDs) but less than 90: HR 2.20, 95% CI (2.14-2.27), P < 0.001; more than or equal to 90 DDDs but less than 365: HR 1.81, 95% CI (1.74-1.89), P < 0.001; more than or equal to 365 DDDs but less than 730: HR 1.38, 95% CI (1.428-1.49), P < 0.001; and more than or equal to 730 DDDs: HR 1.06, 95% CI (0.95-1.18), P = 0.322, when controlling for proxy markers of severity, somatic and mental comorbid disorders. CONCLUSION In this nationwide cohort study of 45 894 patients diagnosed with Alzheimer's dementia, we found that cumulative dosages of antipsychotic drugs were associated with increased mortality rates.
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Affiliation(s)
- R E Nielsen
- Department of Psychiatry, Unit for Psychiatric Research, Aalborg University Hospital, Aalborg, Denmark. .,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
| | - A Lolk
- Department of Psychiatry, Institute of Clinical Health, University of Southern Denmark, Odense, Region of Southern Denmark, Denmark
| | - J B Valentin
- Department of Psychiatry, Unit for Psychiatric Research, Aalborg University Hospital, Aalborg, Denmark
| | - K Andersen
- Department of Psychiatry, Institute of Clinical Health, University of Southern Denmark, Odense, Region of Southern Denmark, Denmark
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Abstract
Care planning in dementia is made more complicated by the increasing prevalence of multiple chronic comorbidities, also termed 'frailty'. Consideration of the reciprocal impact of dementia and other health issues is critical to appropriate care planning. This may be best achieved through an ordered process whereby the clinician first considers medical evidence and its limitations to the medical, physical and social determinants of the patient's health trajectory and quality of life. The next step is to provide information and recommendations to the patient and a second decision maker (who will become increasingly involved as dementia progresses). The end point of care planning is an informed and empowered decision maker who is able to dynamically apply skills to measure any treatment option that may be proposed, while having access to the decisional support of a health professional familiar with the patient's health status.
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Affiliation(s)
- Paige Moorhouse
- Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Halifax, NS, Canada.
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Davies N, Maio L, van Riet Paap J, Mariani E, Jaspers B, Sommerbakk R, Grammatico D, Manthorpe J, Ahmedzai S, Vernooij-Dassen M, Iliffe S. Quality palliative care for cancer and dementia in five European countries: some common challenges. Aging Ment Health 2014; 18:400-10. [PMID: 24131061 PMCID: PMC3979441 DOI: 10.1080/13607863.2013.843157] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Accepted: 09/04/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVES There is a growing consensus worldwide that palliative care needs to be both more inclusive of conditions other than cancer and to improve. This paper explores some common challenges currently faced by professionals providing palliative care for patients with either cancer or dementia across five countries. METHOD One focus group (n=7) and 67 interviews were conducted in 2012 across five countries: England, Germany, Italy, the Netherlands and Norway, with professionals from dementia, cancer and palliative care settings. RESULTS The interviews revealed five common challenges faced across the five countries: communication difficulties (between services; and between professionals, and patients and their families); the variable extent of structural/functional integration of services; the difficulties in funding of palliative care services; problematic processes of care (boundaries, definitions, knowledge, skills and inclusiveness) and, finally, time constraints. CONCLUSION These are not problems distinct to palliative care, but they may have different origins and explanations compared to other areas of health care. This paper explored deeper themes hidden behind a discourse about barriers and facilitators to improving care.
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Affiliation(s)
- Nathan Davies
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Laura Maio
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Jasper van Riet Paap
- Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Elena Mariani
- Alma Mater Studiorum – Department of Psychology, University of Bologna, Bologna, Italy
| | - Birgit Jaspers
- Department of Palliative Medicine, University of Bonn, Bonn, Germany
- Palliative Care Centre, Malteser Hospital Bonn/Rhein-Sieg, Bonn, Germany
| | - Ragni Sommerbakk
- Department of Cancer Research and Molecular Medicine, Faculty of Medicine, NTNU, Trondheim, Norway
| | | | - Jill Manthorpe
- Social Care Workforce Unit, King's College London, London, UK
| | - Sam Ahmedzai
- Department of Oncology, The Medical School, Sheffield, UK
| | - Myrra Vernooij-Dassen
- Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Steve Iliffe
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - for the IMPACT research team
- Research Department of Primary Care and Population Health, University College London, London, UK
- Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
- Alma Mater Studiorum – Department of Psychology, University of Bologna, Bologna, Italy
- Department of Palliative Medicine, University of Bonn, Bonn, Germany
- Palliative Care Centre, Malteser Hospital Bonn/Rhein-Sieg, Bonn, Germany
- Department of Cancer Research and Molecular Medicine, Faculty of Medicine, NTNU, Trondheim, Norway
- Social Care Workforce Unit, King's College London, London, UK
- Department of Oncology, The Medical School, Sheffield, UK
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Todd S, Barr S, Roberts M, Passmore AP. Survival in dementia and predictors of mortality: a review. Int J Geriatr Psychiatry 2013; 28:1109-24. [PMID: 23526458 DOI: 10.1002/gps.3946] [Citation(s) in RCA: 151] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Accepted: 01/22/2013] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Dementia is an important cause of mortality and, with the ageing population and increasing prevalence of dementia, reliable data on prognosis and survival will be of interest to patients and caregivers as well as providers and commissioners of health and social care. A review of the literature was undertaken to determine the rates of survival in dementia and Alzheimer's disease (AD) and to identify factors that are or are not predictive of mortality in dementia and AD. METHODS Relevant articles on mortality in dementia were identified following a search of several electronic databases from 1990 to September 2012. Inclusion criteria were reports on prospective community or clinic based cohorts published in English since 1990, to reflect more recent recognition of possible predictors. RESULTS Median survival time from age of onset of dementia ranges from 3.3 to 11.7 years, with most studies in the 7 to 10-year period. Median survival time from age of disease diagnosis ranges from 3.2 to 6.6 years for dementia or AD cohorts as a whole. Age was consistently reported as a predictor of mortality, with male gender a less consistent predictor. Increased disease severity and functional impairment were often associated with mortality. CONCLUSIONS Substantial heterogeneity in the design of included studies limits the ability to prognosticate for individual patients. However, it is clear that dementia and AD are associated with significant mortality. Reasons for the increased mortality are not established.
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Affiliation(s)
- Stephen Todd
- Care of the Elderly Medicine, Altnagelvin Hospital, Western Health and Social Care Trust, Londonderry, UK
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Abstract
BACKGROUND Reporting of cause of death in patients with Alzheimer's disease (AD) has changed over the past few decades but concerns persist over the accuracy of death certificate completion in this setting. OBJECTIVES To examine the causes of death in AD and examine how this compares with those affecting the normal population. METHODS Death certificates were obtained for 85 AD patients and 52 control subjects from a cohort of 396 participants. Underlying causes of death and other conditions mentioned on the death certificates of the AD patients were analysed and compared with the Northern Ireland population age-and-sex adjusted mortality rates and subsequently to the death certificates of control subjects. RESULTS AD and pneumonia were causes of significant excess mortality and the most common underlying causes of death in the AD patient group (23.53 and 17.65%, respectively). When compared with the control subjects, AD and gastrointestinal diseases were found to be more prevalent. AD was recorded on 63.5% of death certificates of AD subjects who died during follow-up. CONCLUSION The cause of death documented for AD patients may be affected by the physician's knowledge of the patient or reflects the approach to management of patients with end-stage dementia.
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Affiliation(s)
- S Todd
- Centre for Public Health, School of Medicine Dentistry and Biomedical Sciences, Queen’s University of Belfast, Belfast BT7 9BL, UK.
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Flaherty JH, Dong B, Wu H, Zhang Y, Guralnik JM, Malmstrom TK, Morley JE. Observational study of 1-year mortality rates before and after a major earthquake among Chinese nonagenarians. J Gerontol A Biol Sci Med Sci 2011; 66:355-61. [PMID: 21310809 DOI: 10.1093/gerona/glq229] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Little is known about mortality among nonagenarians after an earthquake. METHODS Using secondary data analyses from the 2005 study called the Project of Longevity and Aging in Dujiangyan(n = 870), 1-year mortality rates were compared among a pre-earthquake group and a post-earthquake group of nonagenarians. All participants were from Dujiangyan, 50 km from the epicenter of the May 12, 2008 earthquake, in China. The pre-earthquake group was a subset of the 870 Project of Longevity and Aging in Dujiangyan participants, ages 93-95 years at the beginning of "Time Frame 1" (July 2005 through June 2006; n = 228). The post-earthquake group was a different subset of the 870 Project of Longevity and Aging in Dujiangyan participants, ages 93-95 years and alive at the beginning of Time Frame 2 (July 2008 through June 2009; n = 235). Time Frame 2 excluded a 7-week period following the earthquake in order to account for deaths due to trauma. Pre-earthquake health assessment data from the 2005 Project of Longevity and Aging in Dujiangyan study were used to calculate unadjusted/adjusted hazard ratios (HRs) for mortality. RESULTS One-year mortality rates were 8.3% (19/228) and 16.2% (38/235) in the pre-earthquake group and the post-earthquake group, respectively (p =.01). In unadjusted analyses, only "being in the post-earthquake group" was associated with death (HR = 2.04; 95% confidence interval [CI], 1.17-3.53; p = .011). In the multivariable Cox regression model, being in the post-earthquake group continued to be the strongest risk factor associated with mortality (HR = 2.47; 95% CI, 1.39-4.40; p = .002). Other significant risk factors included impaired cognition (HR = 1.97; 95% CI, 1.10-3.53; p = .024), serum albumin (HR = 0.90; 95% CI, 0.82-0.98; p < .015), and serum triglycerides (HR = 1.51; 95% CI, 1.15-1.99; p = .003). CONCLUSION The May 12, 2008 earthquake in Wenchuan, China, was associated with a twofold increase in the 1-year mortality among a group of nonagenarians who lived nearby.
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Affiliation(s)
- Joseph H Flaherty
- Department of Internal Medicine, Division of Geriatrics, Saint Louis University School of Medicine, Missouri 1402 S. Grand Blvd., Room M238, St. Louis, MO 63104, USA.
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Vazzana R, Bandinelli S, Lauretani F, Volpato S, Lauretani F, Di Iorio A, Abate M, Corsi AM, Milaneschi Y, Guralnik JM, Ferrucci L. Trail Making Test predicts physical impairment and mortality in older persons. J Am Geriatr Soc 2010; 58:719-23. [PMID: 20398153 DOI: 10.1111/j.1532-5415.2010.02780.x] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To examine whether performance in the Trail Making Test (TMT) predicts mobility impairment and mortality in older persons. DESIGN Prospective cohort study. SETTING Community-dwelling older persons enrolled in the Invecchiare in Chianti (InCHIANTI) Study. PARTICIPANTS Five hundred eighty-three participants aged 65 and older and free of major cognitive impairment (Mini-Mental State Examination score >21) with baseline data on TMT performance. Of these, 427 performed the Short Physical Performance Battery (SPPB) for the assessment of lower extremity function at baseline and after 6 years. Of the initial 583 participants, 106 died during a 9-year follow-up. MEASUREMENTS The TMT Parts A and B (TMT-A and TMT-B) and SPPB were administered at baseline and 6-year follow-up. Impaired mobility was defined as an SPPB score less than 10. Vital status was ascertained over a 9-year follow-up. RESULTS InCHIANTI participants in the fourth quartile of the time to complete TMT-B minus time to complete TMT-A (TMT (B-A)) were significantly more likely to develop an SPPB score less than 10 during the 6-year follow-up than those in the first quartile (relative risk (RR)=2.4, 95% confidence interval (CI)=1.4-3.9, P=.001). After adjusting for potential confounders, these findings were substantially unchanged (RR=2.2, 95% CI=1.4-3.6, P=.001). Worse performance on the TMT was associated with significantly greater decline in SPPB score over the 6-year follow-up, after adjusting for age, sex, and baseline SPPB scores (beta=-0.01, standard error=0.003, P=.004). During the 9-year follow-up, 18.2% of the participants died. After adjustment for age and sex, the proportion of participants who died was higher in participants in the worst than the best performance quartile of TMT (B-A) scores (hazard ratio (HR)=1.7, 95% CI=1.0-2.9, P=.048). Results were similar in a parsimonious adjusted model (HR=1.8, 95% CI=1.0-3.2, P=.04). CONCLUSION Performance on the TMT is a strong, independent predictor of mobility impairment, accelerated decline in lower extremity function, and death in older adults living in the community. The TMT could be a useful addition to geriatric assessment.
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Affiliation(s)
- Rosamaria Vazzana
- Department of Medicine and Sciences of Aging, Laboratory of Clinical Epidemiology, University G. D'Annunzio, Chieti, Italy
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Venkitachalam L, Spertus JA. Stepping Outside of the Heart. J Am Coll Cardiol 2010; 55:317-9. [DOI: 10.1016/j.jacc.2009.09.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2009] [Accepted: 09/14/2009] [Indexed: 10/19/2022]
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Mura T, Dartigues JF, Berr C. How many dementia cases in France and Europe? Alternative projections and scenarios 2010-2050. Eur J Neurol 2009; 17:252-9. [PMID: 19796284 DOI: 10.1111/j.1468-1331.2009.02783.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE The objective of this study is to estimate the number of dementia cases expected to occur in France and Europe over the next few decades until 2050. METHODS Our estimates are based on a model using the European incidence data for dementia by age and sex, the relative mortality risks related to dementia stratified by age classes, and the projections of mortality coefficients in the French and European general population. RESULTS In France, in 2010, the number of dementia cases should reach 754000, i.e., 1.2% of the general population or 2.8% of the active population. By 2050 this number should be multiplied by 2.4, i.e., 1813000 cases, which will be 2.6% of the total population and 6.2% of the active population. In Europe this number could reach more than 6 millions in 2010 and 14 millions in 2050. The sensitivity analysis performed on French data showed that our projections were robust to the use of alternative data for incidence and relative mortality risk (variation of 5.5% and 6.5%), but very sensitive to hypotheses of evolution of mortality (variation of -22% to 29%). CONCLUSIONS The approach used in our study, integrating both the dementia incidence and the mortality in the calculations, allowed us to refine the projections and stress the great sensitivity of the demographic hypotheses forecasts on the evolution of life expectancy. The likely increase is particularly important and confirms that French and European health systems must take this into account when making future plans.
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Affiliation(s)
- T Mura
- INSERM, U888, Pathologies du Système Nerveux, Recherche Epidémiologique et Clinique, Université MontpellierI, Montpellier, France
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Eaton WW, Martins SS, Nestadt G, Bienvenu OJ, Clarke D, Alexandre P. The burden of mental disorders. Epidemiol Rev 2008; 30:1-14. [PMID: 18806255 DOI: 10.1093/epirev/mxn011] [Citation(s) in RCA: 292] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
In the last decade, there has been an increase in interest in the burden of chronic and disabling health conditions that are not necessarily fatal, such as the mental disorders. This review systematically summarizes data on the burden associated with 11 major mental disorders of adults. The measures of burden include estimates of prevalence, mortality associated with the disorders, disabilities and impairments related to the disorders, and costs. This review expands the range of mental disorders considered in a report on the global burden of disease, updates the literature, presents information on the range and depth of sources of information on burden, and adds estimates of costs. The purpose is to provide an accessible guide to the burden of mental disorders, especially for researchers and policy makers who may not be familiar with this subfield of epidemiology.
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Affiliation(s)
- William W Eaton
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
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Xie J, Brayne C, Matthews FE. Survival times in people with dementia: analysis from population based cohort study with 14 year follow-up. BMJ 2008; 336:258-62. [PMID: 18187696 PMCID: PMC2223023 DOI: 10.1136/bmj.39433.616678.25] [Citation(s) in RCA: 269] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To provide estimates of survival after onset of dementia by age, sex, self reported health, disability, and severity of cognitive impairment. DESIGN Analysis of participants from prospective population based cohort study in 1991-2003, with follow-up of dementia status in all individuals after two and six years (in one centre) and 10 years and in subsamples additionally at six and eight years and mortality until 2005. SETTING Multicentre population based study in England and Wales: two rural and three urban centres. PARTICIPANTS 438 participants who developed dementia from a population based study of 13 004 individuals aged 65 years and over drawn from primary care population registers. MAIN OUTCOME MEASURES Sociodemographic factors, cognitive function, specific health conditions, and self reported health collected at each interview. Cox's proportional hazards regression models were used to identify predictors of mortality from the selected variables in people who received diagnosis of dementia according the study's criteria. RESULTS By December 2005, 356 of the 438 (81%) participants who developed dementia during the study had died. Estimated median survival time from onset of dementia to death was 4.1 years (interquartile range 2.5-7.6) for men and 4.6 years (2.9-7.0) for women. There was a difference of nearly seven years in survival between the younger old and the oldest people with dementia: 10.7 (25th centile 5.6) for ages 65-69; 5.4 (interquartile range 3.4-8.3) for ages 70-79; 4.3 (2.8-7.0) for ages 80-89, and 3.8 (2.3-5.2) years for ages > or =90. Significant factors that predicted mortality in the presence of dementia during the follow-up included sex, age of onset, and disability. CONCLUSION These analyses give a population based estimated median survival for incident dementia of 4.5 years. Such estimates can be used for prognosis and planning for patients, carers, service providers, and policy makers.
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Affiliation(s)
- Jing Xie
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge CB2 0SR
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Sund-Levander M, Grodzinsky E, Wahren LK. Gender differences in predictors of survival in elderly nursing-home residents: a 3-year follow up. Scand J Caring Sci 2007; 21:18-24. [PMID: 17428210 DOI: 10.1111/j.1471-6712.2007.00431.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This study focus on predicting factors of survival possible to modify by nursing care, and the incidence and mortality rate of nursing-home-acquired pneumonia, allocated to 1, 2 and 3 years of follow ups. The residents consisted of 156 women and 78 men living in special housing for the elderly. Data on chronic disease and medication were obtained at baseline, and activities of daily living (ADL) status, nutritional status and body temperature were assessed. The incidence of pneumonia was noted prospectively for 1 year and retrospectively for the following 2 years. Predictive factors for survival were explored by Cox hazard regression analysis. The results showed that age, functional and cognitive impairment were predictors of mortality irrespective of gender, while poor nutritional status in women and chronic obstructive pulmonary disease, heart disease and medication with sedatives in men were gender-specific predictors. ADL correlated positively with dementia and negatively with S-albumin irrespective of gender, while malnutrition correlated positively with ADL in women and positively with chronic obstructive pulmonary disease in men. To promote the quality of daily living in elderly individuals, it is of importance to improve the capabilities in daily functions and nutritional status, especially in women with functional impairment, and to prevent anxiety particularly in men. The findings also clarify that pneumonia is as common as cerebral vascular insult and heart failure as cause of death in this population.
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Affiliation(s)
- Märtha Sund-Levander
- Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden.
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Regal-Ramos R, Salinero Fort M, Cruz-Jentoft A. [Mortality predictive factors of a clinical cohort of elderly patients]. Aten Primaria 2006; 36:480-6. [PMID: 16324504 PMCID: PMC7676102 DOI: 10.1016/s0212-6567(05)70548-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To study the association between the main variables collected in the comprehensive geriatric assessment (CGA) and mortality, in a clinical cohort of elderly people referred from primary care, following standardised criteria, to a geriatric unit. Design. Retrospective cohort study. SETTING Outpatient department of a geriatric unit of a hospital in Madrid, Spain. PARTICIPANTS A total of 140 patients older than 65 years were followed up for 70 months. MAIN MEASUREMENTS We collected demographic, clinical, functional, and social variables during the CGA carried out by a multidisciplinary team. After 70 months we measured this cohort survival and we analysed the predictive factors for mortality using Cox hazard ratio analysis. RESULTS. Sixty three patients died after the 70 months of the study, and the survival median was 37 months. In the univariate analysis, age, male gender, diagnosed cancer, COPD, the Katz and Lawton indices, and the Mini-Mental State Examination (MMSE) score of 35 items, were significantly associated with mortality. In the multivariate analysis we found, as predictive factors for mortality: MMSE-35 (HR=0.965; 95% CI, 0.934-0.998; P=.037); male gender (HR=2.75; 95% CI, 1.6-4.74; P=.001); Katz score (HR=1.22; 95% CI, 1.04-1.43; P=.017); Lawton score (HR=0.93; 95% CI, 0.82-1.07; P=.30). CONCLUSION Cognitive impairment is a mortality predictive factor (HR=0.65), for each point less in the MMSE-35, we observed an increase in mortality risk of 3.5% (1-HR) at 70 months, after adjustment for Katz and Lawton index and gender.
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Affiliation(s)
| | - M.A. Salinero Fort
- Unidad de Formación e Investigación de Atención Primaria. Área 4. Servicio Madrileño de Salud. Madrid. España
- Correspondencia: M.A. Salinero Fort. Unidad de Formación e Investigación de Atención Primaria. Área 4. Servicio Madrileño de Salud. José Arcones Gil, 11. 28017 Madrid. España.
| | - A.J. Cruz-Jentoft
- Hospital Ramón y Cajal.Unidad de Geriatría. Servicio Madrileño de Salud. Madrid. España
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Sampson EL, Gould V, Lee D, Blanchard MR. Differences in care received by patients with and without dementia who died during acute hospital admission: a retrospective case note study. Age Ageing 2006; 35:187-9. [PMID: 16407434 DOI: 10.1093/ageing/afj025] [Citation(s) in RCA: 120] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Elizabeth L Sampson
- Department of Mental Health Sciences, Royal Free & University College Medical School, Rowland Hill Street, London NW3 2PF, UK.
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Zaccai J, Ince P, Brayne C. Population-based neuropathological studies of dementia: design, methods and areas of investigation--a systematic review. BMC Neurol 2006; 6:2. [PMID: 16401346 PMCID: PMC1397861 DOI: 10.1186/1471-2377-6-2] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2005] [Accepted: 01/09/2006] [Indexed: 11/25/2022] Open
Abstract
Background Prospective population-based neuropathological studies have a special place in dementia research which is under emphasised. Methods A systematic review of the methods of population-based neuropathological studies of dementia was carried out. These studies were assessed in relation to their representativeness of underlying populations and the clinical, neuropsychological and neuropathological approaches adopted. Results Six studies were found to be true population-based neuropathological studies of dementia in the older people: the Hisayama study (Japan); Vantaa 85+ study (Finland); CC75C study (Cambridge, UK); CFAS (multicentre, UK); Cache County study (Utah, USA); HAAS (Hawaï, USA). These differ in the core characteristics of their populations. The studies used standardised neuropathological methods which facilitate analyses on: clinicopathological associations and confirmation of diagnosis, assessing the validity of hierarchical models of neuropathological lesion burden; investigating the associations between neuropathological burden and risk factors including genetic factors. Examples of findings are given although there is too little overlap in the areas investigated amongst these studies to form the basis of a systematic review of the results. Conclusion Clinicopathological studies based on true population samples can provide unique insights in dementia. Individually they are limited in power and scope; together they represent a powerful source to translate findings from laboratory to populations.
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Affiliation(s)
- Julia Zaccai
- Department of Public Health and Primary Care, University of Cambridge, Robinson Way, Cambridge CB2 2SR, UK
| | - Paul Ince
- Academic Unit of Neuropathology, University of Sheffield, 'E' Floor, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, UK
| | - Carol Brayne
- Department of Public Health and Primary Care, University of Cambridge, Robinson Way, Cambridge CB2 2SR, UK
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Abstract
Dementia is one of the major causes of dependency after stroke. The prevalence of poststroke dementia (PSD)-defined as any dementia occurring after stroke-is likely to increase in the future. In community-based studies, the prevalence of PSD in stroke survivors is about 30% and the incidence of new onset dementia after stroke increases from 7% after 1 year 48% after 25 years. Having a stroke doubles the risk of dementia. Patient-related variables associated with an increased risk of PSD are increasing age, low education level, dependency before stroke, prestroke cognitive decline without dementia, diabetes mellitus, atrial fibrillation, myocardial infarction, epileptic seizures, sepsis, cardiac arrhythmias, congestive heart failure, silent cerebral infarcts, global and medial-temporal-lobe atrophy, and white-matter changes. Stroke-related variables associated with an increased risk of PSD are stroke severity, cause, location, and recurrence. PSD might be the result of vascular lesions, Alzheimer pathology, white-matter changes, or combinations of these. The cause of PSD differs among studies in relation to the mean age of patients, ethnicity, criteria used, and time after stroke. In developed countries, the proportion of patients with presumed Alzheimer's disease among those with PSD is between 19% and 61%. Patients with PSD have high mortality rates and are likely to be functionally impaired. These patients should be treated according to the current guidelines for stroke prevention.
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Affiliation(s)
- Didier Leys
- Stroke department, Department of Neurology, University of Lille II, EA 2691, Rue Emile Laine, Lille, France.
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Nitrini R, Caramelli P, Herrera E, de Castro I, Bahia VS, Anghinah R, Caixeta LF, Radanovic M, Charchat-Fichman H, Porto CS, Teresa Carthery M, Hartmann APJ, Huang N, Smid J, Lima EP, Takahashi DY, Takada LT. Mortality from dementia in a community-dwelling Brazilian population. Int J Geriatr Psychiatry 2005; 20:247-53. [PMID: 15717343 DOI: 10.1002/gps.1274] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The influence of dementia on mortality has not yet been reported for a Latin American country. OBJECTIVES To evaluate the influence of dementia on mortality of a community-dwelling elderly population in Brazil, and to verify the extent to which the diagnosis of dementia is reported on death certificates. METHODS A cohort of 1,656 individuals, aged 65 and over, was screened for dementia at their domiciles, in 1997. The same population was re-evaluated in 2000, and information on deaths was obtained from relatives and from the municipal obituary service. Kaplan-Meier curves were used for the survival analysis, and the mortality risk ratio (MMR) was calculated using Cox proportional hazards models. RESULTS We obtained data from 1,393 subjects, corresponding to 84.1% of the target population. The number of deaths was 58 (51.3%) among the patients with dementia and 163 (12.7%) among those without dementia in 1997 (p <0.0001). Dementia and Alzheimer's disease (AD) decreased survival, with hazards ratios of 5.16 [95% Confidence Interval (CI): 3.74-7.12] for dementia and 4.76 (95% CI: 3.16-7.18) for AD. The Cox proportional hazards model identified dementia (MMR=3.92, 95% CI: 2.80-5.48) as the most significant predictor of death, followed by age, history of stroke, complaints of visual impairment and heart failure and by severe arterial hypertension in the baseline evaluation. Dementia and/or AD were mentioned in only 12.5% of the death certificates of individuals with dementia. CONCLUSIONS Dementia causes a significant decrease in survival, and the diagnosis of dementia is rarely reported on death certificates in Brazil.
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Affiliation(s)
- Ricardo Nitrini
- Behavioral and Cognitive Neurology Unit, Department of Neurology, University of São Paulo School of Medicine, Brazil.
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Mussi C, Foroni M, Valli A, Ascari S, Tolve I, Salvioli G. The "time and change" test: an appropriate method to detect cognitive decline in the elderly. J Geriatr Psychiatry Neurol 2002; 15:12-5. [PMID: 11936237 DOI: 10.1177/089198870201500103] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The Time and Change (T&C) test is an easy and time-saving test validated for the detection of dementia. Our aim was to determine how geriatric features like depression, disability, and comorbidity are able to influence the result of the T&C and, consequently, to decide whether it could be a reliable screening test for cognitive impairment in the elderly. A total of 220 participants (mean age = 75.8+/-9.6 years, 63.7% females) underwent the T&C, Mini-Mental State Examination, and the Clock Drawing Test; Activities of Daily Living, Instrumental Activities of Daily Living, comorbidity, and depression were also evaluated. Time and Change-positive participants were older, had poorer cognitive tests, and had higher levels of disability and comorbidity than participants testing negative. Multivariate analysis showed that cognitive impairment and comorbidity were the only features that influenced the T&C, regardless of age, education, disability, and depression. We conclude that the T&C should be implemented in primary care because it quickly identifies elderly patients with cognitive impairment who need a more accurate evaluation.
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Affiliation(s)
- Chiara Mussi
- Department of Geriatrics and Gerontology, University of Modena and Reggio Emilia, Italy
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Perkins AJ, Hui SL, Ogunniyi A, Gureje O, Baiyewu O, Unverzagt FW, Gao S, Hall KS, Musick BS, Hendrie HC. Risk of mortality for dementia in a developing country: the Yoruba in Nigeria. Int J Geriatr Psychiatry 2002; 17:566-73. [PMID: 12112181 DOI: 10.1002/gps.643] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Limited data exist on the impact of dementia in developing nations, including its association with mortality. OBJECTIVE The purpose of this paper is to assess the relationship between dementia and five-year mortality on a community dwelling elderly Yoruba population in the developing country of Nigeria and to compare those results with those from an elderly African-American community in Indianapolis. METHODS A two-phase design was used to ascertain dementia status in two sites. In the first phase, the Community Screening Instrument for Dementia (CSI-D) was administered. In the second phase, subjects were sampled for the clinical assessment according to their CSI-D performance category. Proportional hazards regression was used to assess the relationship between mortality and cognitive status at both sites after adjusting for demographics and chronic disease conditions. RESULTS For the entire screened population, poor and intermediate performance on the CSI-D is associated with increased mortality at both sites; however the effect of CSI-D performance did not significantly differ between the two sites. For the clinically assessed sample, dementia was significantly associated with increased mortality at both sites (Ibadan RR = 2.83, Indianapolis RR = 2.05), but the effect was not significantly different across the two sites. CONCLUSION Dementia resulted in an increased risk of mortality for Yoruba of a magnitude similar to African-Americans suggesting that the impact of dementia on mortality risk may be similar for developing and developed countries.
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Affiliation(s)
- Anthony J Perkins
- Regenstrief Institute for Health Care, 1050 Wishard Boulevard, RG6, Indianapolis, IN 46202-2872, USA.
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Di Carlo A, Baldereschi M, Amaducci L, Lepore V, Bracco L, Maggi S, Bonaiuto S, Perissinotto E, Scarlato G, Farchi G, Inzitari D. Incidence of dementia, Alzheimer's disease, and vascular dementia in Italy. The ILSA Study. J Am Geriatr Soc 2002; 50:41-8. [PMID: 12028245 DOI: 10.1046/j.1532-5415.2002.50006.x] [Citation(s) in RCA: 143] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To estimate the incidence of dementia, Alzheimer's disease (AD), and vascular dementia (VaD) in older Italians and evaluate the relationship of age, gender, and education to developing dementia. DESIGN Cohort incidence study in the context of the Italian Longitudinal Study on Aging. SETTING Population sample from eight Italian municipalities. PARTICIPANTS A dementia-free cohort of 3,208 individuals (aged 65-84), individuated after a baseline evaluation performed in 1992 / 93, aimed at detecting prevalent cases. MEASUREMENTS The dementia-free cohort was reexamined in 1995 to identify incident cases. The Mini-Mental State Examination (cutoff 23 / 24) was employed to screen for dementia. Trained neurologists evaluated the individuals who screened positive. Final diagnoses had to meet Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised criteria for dementia, National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association criteria for AD, and International Classification of Diseases, Tenth Revision criteria for VaD. RESULTS Before the follow-up examination, 382 individuals had died (232 had reliable information). Of the 2,826 survivors, 2,266 completed the study. Overall, 127 new dementia cases were identified. Average incidence rates per 1,000 person-years were 12.47 (95% confidence interval (CI)=10.23-14.72) for dementia, 6.55 (95% CI=4.92-8.17) for AD, and 3.30 (95% CI=2.14-4.45) for VaD. Both AD and VaD showed age-dependent patterns. Education was protective against dementia and AD. Women carried a significantly higher risk of developing AD (hazard ratio=1.67, 95% CI=1.02-2.75), and men of developing VaD (hazard ratio=2.23, 95% CI=1.06-4.71). CONCLUSIONS Incidence of dementia in Italy paralleled that in most industrialized countries. About 150,000 new cases per year are expected. A significant gender effect was evidenced for major dementia subtypes. The burden of VaD, especially in men, offers opportunities for prevention.
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Affiliation(s)
- Antonio Di Carlo
- National Research Council of Italy (CNR-CSFET), Italian Longitudinal Study on Aging, Florence, Italy
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Dewey ME, Saz P. Dementia, cognitive impairment and mortality in persons aged 65 and over living in the community: a systematic review of the literature. Int J Geriatr Psychiatry 2001; 16:751-61. [PMID: 11536341 DOI: 10.1002/gps.397] [Citation(s) in RCA: 201] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND No recent attempt has been made to synthesise information on mortality and dementia despite the theoretical and practical interest in the topic. Our objective was to estimate the influence on mortality of cognitive impairment and dementia. METHODS Data sources were Medline, Embase, personal files and colleagues' records. Studies were considered if they included a majority of persons aged 65 and over at baseline either drawn from a total community sample or drawn from a random sample from the community. Samples from health care facilities were excluded. The search located 68 community studies. Effect sizes were extracted from the studies and if they were not included in the published studies, effect sizes were calculated where possible: this was possible for 23 studies of cognitive impairment and 32 of dementia. No attempt was made to contact authors for missing data. RESULTS For the studies of cognitive impairment Fisher's method (a vote counting method), gave a p-value (from eight studies) of 0.00001. For studies of dementia, age-adjusted confidence intervals (CI) were pooled (odds ratio (OR) 2.63 with 95% CI 2.17 to 3.21 from six studies). CONCLUSIONS Levels of cognitive impairment commonly found in community studies give rise to an increased risk of mortality, and this appears to be true even for quite mild levels of impairment. The analysis confirms the increased risk of mortality for dementia, but reveals a dearth of information on the causes of the excess mortality and on possible effect modification by age, dementia subtype or other variables.
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Affiliation(s)
- M E Dewey
- Trent Institute for Health Services Research, Medical School, University Hospital, Nottingham, NG7 2UH, UK.
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Abstract
Alzheimer's disease (AD) is the most common of the dementing disorders. AD begins insidiously and progresses gradually; it is characterized clinically not only by an impairment in cognition, but also by a decline in global function, a deterioration in the ability to perform activities of daily living, and the appearance of behavioral disturbances. No definitive tests for the diagnosis are available, and AD is a diagnosis of inclusion based on patient history, physical examination, neuropsychological testing, and laboratory studies. Disease progression is highly variable, and median survival after the onset of dementia ranges from 5 to 9.3 years. Early recognition of AD allows time to plan for the future, and to treat patients before marked deterioration occurs.
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