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Lanctôt KL, Hviid Hahn-Pedersen J, Eichinger CS, Freeman C, Clark A, Tarazona LRS, Cummings J. Burden of Illness in People with Alzheimer's Disease: A Systematic Review of Epidemiology, Comorbidities and Mortality. J Prev Alzheimers Dis 2024; 11:97-107. [PMID: 38230722 PMCID: PMC10225771 DOI: 10.14283/jpad.2023.61] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 04/05/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Alzheimer's disease (AD) is the most common neurodegenerative disease worldwide, and an updated quantification of its impact on morbidity, disability, and mortality is warranted. We conducted a systematic literature review, focusing on the past decade, to characterize AD and assess its impact on affected individuals. METHODS Searches of Embase, MEDLINE, and the Cochrane Library were conducted on August 7, 2020 and updated on November 10, 2021. Observational studies from any country reporting incidence, prevalence, comorbidities, and/or outcomes related to disability and mortality/life expectancy, in people with mild cognitive impairment (MCI) due to AD, or mild, moderate, or severe AD dementia, were considered relevant. RESULTS Data were extracted from 88 studies (46 incidence/prevalence; 44 comorbidities; 25 mortality-/disability-related outcomes), mostly from Europe, the USA, and Asia. AD dementia diagnosis was confirmed using biomarkers in only 6 studies. Estimated 5-year mortality in AD was 35%, and comorbidity prevalence estimates varied widely (hypertension: 30.2-73.9%; diabetes: 6.0-24.3%; stroke: 2.7-13.7%). Overall, people with AD dementia were more likely to have cardiovascular disease or diabetes than controls, and 5-year mortality in people with AD dementia was double that in the age- and year-matched general population (115.0 vs 60.6 per 1,000 person-years). CONCLUSIONS AD is associated with excess morbidity and mortality. Future longitudinal studies of population aging, incorporating biomarker assessment to confirm AD diagnoses, are needed to better characterize the course of MCI due to AD and AD dementia.
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Affiliation(s)
- K L Lanctôt
- Krista L. Lanctôt, Hurvitz Brain Sciences Program, Sunnybrook Research Institute; and Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada, Email address: Telephone: +1 416 480-6100; Ext: 2241
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Hendriks S, Peetoom K, Bakker C, Koopmans R, van der Flier W, Papma J, Verhey F, de Vugt M, Köhler S. Global incidence of young-onset dementia: A systematic review and meta-analysis. Alzheimers Dement 2023; 19:831-843. [PMID: 35715891 DOI: 10.1002/alz.12695] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 03/19/2022] [Accepted: 04/27/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Reliable data on the incidence rates for young-onset dementia (YOD) are lacking, but are necessary for research on disease etiology and to raise awareness among health care professionals. METHODS We performed a systematic review and meta-analysis on population-based studies on the incidence of YOD, published between January 1, 1990 and February 1, 2022, according to Meta-analyses of Observational Studies in Epidemiology (MOOSE) guidelines. Data were analyzed using random-effects meta-analyses. Results were age-standardized, and heterogeneity was assessed by subgroup analyses and meta-regression. RESULTS Sixty-one articles were included. Global age-standardized incidence rates increased from 0.17/100,000 in age 30 to 34 years, to 5.14/100,000 in age 60 to 64 years, giving a global total age-standardized incidence rate of 11 per 100,000 in age 30 to 64. This corresponds to 370,000 new YOD cases annually worldwide. Heterogeneity was high and meta-regression showed geographic location significantly influenced this heterogeneity. DISCUSSION This meta-analysis shows the current best estimate of YOD incidence. New prospective cohort studies are needed.
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Affiliation(s)
- Stevie Hendriks
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Centre Limburg, Maastricht University, Maastricht, The Netherlands
| | - Kirsten Peetoom
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Centre Limburg, Maastricht University, Maastricht, The Netherlands
| | - Christian Bakker
- Department of Primary and Community Care, Radboud UMC Alzheimer Center, Radboud University Medical Center, Nijmegen, The Netherlands
- Groenhuysen, Center for Specialized Geriatric Care, Roosendaal, The Netherlands
| | - Raymond Koopmans
- Department of Primary and Community Care, Radboud UMC Alzheimer Center, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Wiesje van der Flier
- Department of Neurology, Department of Epidemiology and Data Science, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Janne Papma
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Frans Verhey
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Centre Limburg, Maastricht University, Maastricht, The Netherlands
| | - Marjolein de Vugt
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Centre Limburg, Maastricht University, Maastricht, The Netherlands
| | - Sebastian Köhler
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Centre Limburg, Maastricht University, Maastricht, The Netherlands
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Johansen M, Joensen S, Restorff M, Stórá T, Christy D, Gustavsson EK, Bian J, Guo Y, Farrer MJ, Petersen MS. Polygenic risk of Alzheimer's disease in the Faroe Islands. Eur J Neurol 2022; 29:2192-2200. [PMID: 35384166 DOI: 10.1111/ene.15351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 04/01/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The Faroe Islands are a geographically isolated population in the North Atlantic with a similar prevalence Alzheimer's disease (AD) and all cause dementia as other European nations. However, the genetic risk underlying Alzheimer's disease and other dementia susceptibility has yet to be elucidated. METHODS Forty-nine single nucleotide polymorphisms (SNPs) were genotyped in 174 patients with AD and other dementias and 159 healthy controls. Single variant and polygenic risk score (PRS) associations, with/without APOE variability, were assessed by logistic regression. Performance was examined using receiver operating characteristics 'area under the curve' analysis (ROC AUC). RESULTS APOE rs429358 was associated with AD in the Faroese cohort after correction for multiple testing (OR=6.32, CI[3.98-10.05], p=6.31e-15 ), with suggestive evidence for three other variants: NECTIN2 rs41289512 (OR 2.05, CI[1.20-3.51], p=0.01), HLA-DRB1 rs6931277 (OR 0.67, CI[0.48-0.94], p=0.02), and APOE rs7412 [ε2] (OR 0.28, CI[0.11-0.73], p=0.01). PRS were associated with AD with or without the inclusion of APOE (PRS+APOE OR=4.5. CI[2.90-5.85, p=4.56e-15 and PRS-APOE OR=1.53, CI[1.21-1.98], p=6.82e-4 ). AD ROC AUC analyses demonstrated a PRS+APOE AUC=80.3% and PRS-APOE AUC=63.4%. However, PRS+APOE was also significantly associated with all cause dementia (OR=3.39, CI[2.51-4.71], p= 2.50e-14 ) with an AUC=76.9%, i.e. all cause dementia did show similar results albeit less significant. DISCUSSION In the Faroe Islands, SNP analyses highlighted APOE and immunogenomic variability in AD and dementia risk. PRS+APOE , based on 25 SNPs/loci, had excellent sensitivity and specificity for Alzheimer's disease with AUC of 80.3%. High PRS were also associated with an earlier onset of late-onset AD.
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Affiliation(s)
- Malan Johansen
- Center of Health Science, University of the Faroe Islands, Vestarabryggja 15, Tórshavn, Faroe Islands.,Department of Occupational Medicine and Public Health, The Faroese Hospital System, Sigmundargøta 5, Tórshavn, Faroe Islands
| | - Sofus Joensen
- The Dementia Clinic, Psychiatric Center, National Hospital of the Faroe Islands, J. C. Svabos gøta 41-49, Tórshavn, Faroe Islands
| | - Marjun Restorff
- The Dementia Clinic, Psychiatric Center, National Hospital of the Faroe Islands, J. C. Svabos gøta 41-49, Tórshavn, Faroe Islands
| | - Tórmóður Stórá
- The Dementia Clinic, Psychiatric Center, National Hospital of the Faroe Islands, J. C. Svabos gøta 41-49, Tórshavn, Faroe Islands
| | - Darren Christy
- Centre for Applied Neurogenetics, University of British Columbia, C201-4500 Oak Street, Vancouver, BC, Canada
| | - Emil K Gustavsson
- Genetics and Genomic Medicine, Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London, UK.,Department of Neurodegenerative Disease, Institute of Neurology, University College London, Queen Square, London, UK
| | - Jiang Bian
- Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, 2004 Mowry RD, Gainesville, FL, USA
| | - Yi Guo
- Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, 2004 Mowry RD, Gainesville, FL, USA
| | - Matthew J Farrer
- Centre for Applied Neurogenetics, University of British Columbia, C201-4500 Oak Street, Vancouver, BC, Canada.,McKnight Brain Institute, Department of Neurology, University of Florida, 1149 Newell Drive, Gainesville, FL, USA
| | - Maria Skaalum Petersen
- Center of Health Science, University of the Faroe Islands, Vestarabryggja 15, Tórshavn, Faroe Islands.,Department of Occupational Medicine and Public Health, The Faroese Hospital System, Sigmundargøta 5, Tórshavn, Faroe Islands
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Yuan M, Wu Z, Luo B, Sha Y, Zhang H, Bi M, Fang Y. Gender-specified mediation of depression between sleep quality and short-term memory in older adults: Study in a semi-closed Island of Xiamen, China. Int J Geriatr Psychiatry 2021; 36:1514-1523. [PMID: 33899959 DOI: 10.1002/gps.5559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 04/09/2021] [Accepted: 04/17/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND Both the quality of sleep and depression impact short-term memory (STM) while they influence each other. However, the underlying mechanisms are not yet clear. Herein, we aimed to explore the mediating effect of depression between sleep quality and STM in older adults and further test the gender differences in this relationship. METHODS A cluster sampling survey was carried out among 903 residents that were aged 60+ years in a semi-closed island of Xiamen, China, in 2019. The subjects' sleep quality and depression were measured using the Pittsburgh Sleep Quality Index (PSQI) and the 15-item Geriatric Depression Scale (GDS-15), respectively. The three-item recall test was utilized to measure STM function. Mediation analyses were performed using the structural equation model and bias-corrected bootstrap method. Next, the Wald-test was utilized to determine gender differences in the pathway. RESULTS Overall, 355 men and 508 women, with a mean age of 69.55 and 70.97, respectively, had valid data on the main variables. Depression was found to mediate the effect of sleep quality on STM (a*b = -0.076, p < 0.05). Interestingly, while this indirect effect existed in the female group (af *bf = -0.126, p < 0.05), it did not in the male group (am *bm = 0.017, p = 0.677). The Wald-test indicated no gender differences in the pathway from sleep quality to depression (p = 0.303). However, the pathway from depression to STM function was found to be significantly stronger for females than males (p = 0.0198). CONCLUSION Higher sleep quality was found to be associated with improved STM function. Furthermore, the association was found to be regulate indirectly by lower depressive symptoms for females, but directly for males. Therefore, appropriate psychological interventions may be beneficial to the maintenance of STM for older adults, particularly for women.
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Affiliation(s)
- Manqiong Yuan
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, China.,Department of Preventive Medicine, Key Laboratory of Health Technology Assessment of Fujian Province, School of Public Health, Xiamen University, Xiamen, China
| | - Zhilin Wu
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, China
| | - Bei Luo
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, China
| | - Yude Sha
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, China
| | - Hemin Zhang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, China
| | - Min Bi
- Department of Neurology, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian, China.,Graduate School of Fujian Medical University, Fuzhou, Fujian, China
| | - Ya Fang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, China.,Department of Preventive Medicine, Key Laboratory of Health Technology Assessment of Fujian Province, School of Public Health, Xiamen University, Xiamen, China
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Hendriks S, Peetoom K, Bakker C, van der Flier WM, Papma JM, Koopmans R, Verhey FRJ, de Vugt M, Köhler S. Global Prevalence of Young-Onset Dementia: A Systematic Review and Meta-analysis. JAMA Neurol 2021; 78:1080-1090. [PMID: 34279544 PMCID: PMC8290331 DOI: 10.1001/jamaneurol.2021.2161] [Citation(s) in RCA: 147] [Impact Index Per Article: 49.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 04/24/2021] [Indexed: 12/22/2022]
Abstract
Importance Reliable prevalence estimates are lacking for young-onset dementia (YOD), in which symptoms of dementia start before the age of 65 years. Such estimates are needed for policy makers to organize appropriate health care. Objective To determine the global prevalence of YOD. Data Sources The PubMed, Embase, CINAHL, and PsycInfo databases were systematically searched for population-based studies on the prevalence of YOD published between January 1, 1990, and March 31, 2020. Study Selection Studies containing data on the prevalence of dementia in individuals younger than 65 years were screened by 2 researchers for inclusion in a systematic review and meta-analysis. Data Extraction and Synthesis Prevalence estimates on 5-year age bands, from 30 to 34 years to 60 to 64 years, were extracted. Random-effects meta-analyses were conducted to pool prevalence estimates. Results were age standardized for the World Standard Population. Heterogeneity was assessed by subgroup analyses for sex, dementia subtype, study design, and economic status based on the World Bank classification and by meta-regression. Main Outcomes and Measures Prevalence estimates of YOD for 5-year age bands. Results A total of 95 unique studies were included in this systematic review, of which 74 with 2 760 379 unique patients were also included in 5-year age band meta-analyses. Studies were mostly conducted in Europe and in older groups in Asia, North America, and Oceania. Age-standardized prevalence estimates increased from 1.1 per 100 000 population in the group aged 30 to 34 years to 77.4 per 100 000 population in the group aged 60 to 64 years. This gives an overall global age-standardized prevalence of 119.0 per 100 000 population in the age range of 30 to 64 years, corresponding to 3.9 million people aged 30 to 64 years living with YOD in the world. Subgroup analyses showed prevalence between men and women to be similar (crude estimates for men, 216.5 per 100 000 population; for women, 293.1 per 100 000 population), whereas prevalence was lower in high-income countries (crude estimate, 663.9 per 100 000 population) compared with upper-middle-income (crude estimate, 1873.6 per 100 000 population) and lower-middle-income (crude estimate, 764.2 per 100 000 population) countries. Meta-regression showed that age range (P < .001), sample size (P < .001), and study methodology (P = .02) significantly influenced heterogeneity between studies. Conclusions and Relevance This systematic review and meta-analysis found an age-standardized prevalence of YOD of 119.0 per 100 000 population, although estimates of the prevalence in low-income countries and younger age ranges remain scarce. These results should help policy makers organize sufficient health care for this subgroup of individuals with dementia. Study Registration PROSPERO CRD42019119288.
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Affiliation(s)
- Stevie Hendriks
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Centre Limburg, Maastricht University, Maastricht, the Netherlands
| | - Kirsten Peetoom
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Centre Limburg, Maastricht University, Maastricht, the Netherlands
| | - Christian Bakker
- Department of Primary and Community Care, Radboud University Medical Center, Radboud, the Netherlands
- Groenhuysen, Center for Specialized Geriatric Care, Roosendaal, the Netherlands
- Radboudumc Alzheimer Center, Nijmegen, the Netherlands
| | - Wiesje M. van der Flier
- Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC (University Medical Center), Amsterdam, the Netherlands
- Department of Epidemiology and Data Science, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Janne M. Papma
- Department of Neurology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Raymond Koopmans
- Department of Primary and Community Care, Radboud University Medical Center, Radboud, the Netherlands
- Radboudumc Alzheimer Center, Nijmegen, the Netherlands
| | - Frans R. J. Verhey
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Centre Limburg, Maastricht University, Maastricht, the Netherlands
| | - Marjolein de Vugt
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Centre Limburg, Maastricht University, Maastricht, the Netherlands
| | - Sebastian Köhler
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Centre Limburg, Maastricht University, Maastricht, the Netherlands
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Paul KC, Debes F, Eliasen E, Weihe P, Petersen MS. Incidence, gender influence, and neuropsychological predictors of all cause dementia in the Faroe Islands-the Faroese Septuagenarian cohort. Aging Clin Exp Res 2021; 33:105-114. [PMID: 32207093 PMCID: PMC7508821 DOI: 10.1007/s40520-020-01520-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 02/18/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Using the Faroese Septuagenarian cohort, we aimed to describe the incidence of dementia and assess the validity of neurocognitive tests to predict subsequent dementia diagnosis. METHODS In this population-based cohort, 713 Faroese septuagenarians aged 70-74 years without dementia, underwent clinical and neuropsychological examinations. After 10-years of follow-up, information was collected on all participants referred for cognitive evaluations and diagnosed with dementia. Incidence rates were calculated and presented with 95% confidence intervals (CIs), assuming a Poisson distribution. We then performed discriminant analysis to determine the best set of neuropsychological tests to identify those who would develop dementia. RESULTS Over the 10-years, 65 participants (9.1%) were diagnosed with dementia, with a 10-year incidence rate of 1063 cases per 100,000 person years (95% CI 825, 1343). Women had a greater incidence than men (incidence rate ratio (IRR) = 1.58; 95% CI 0.93, 2.71). After stepwise selection, gender and six neuropsychological measures were selected to discriminate between those who would and would not develop dementia. Overall, the model was able to correctly identify 82% of those who would not develop dementia (specificity) and 71% of those who would (sensitivity). CONCLUSIONS These results indicate that among a greater number of tests covering a broad range of cognitive abilities, tests reflecting verbal and visual learning and recall, visuospatial function, attention, and encoding into and retrieval from long-term memory may be helpful in identifying patients in the pre-symptomatic phase of dementia. Thus, helping care-givers identify patients at a higher risk of developing dementia and adjusting management of care accordingly.
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Affiliation(s)
- Kimberly C Paul
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Fróði Debes
- Department of Occupational Medicine and Public Health, The Faroese Hospital System, Tórshavn, Faroe Islands
| | - Eina Eliasen
- Department of Occupational Medicine and Public Health, The Faroese Hospital System, Tórshavn, Faroe Islands
| | - Pál Weihe
- Department of Occupational Medicine and Public Health, The Faroese Hospital System, Tórshavn, Faroe Islands
- Faculty of Health Sciences, Centre of Health Science, University of the Faroe Islands, Tórshavn, Faroe Islands
| | - Maria Skaalum Petersen
- Department of Occupational Medicine and Public Health, The Faroese Hospital System, Tórshavn, Faroe Islands.
- Faculty of Health Sciences, Centre of Health Science, University of the Faroe Islands, Tórshavn, Faroe Islands.
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Petersen MS, Lophaven SN, Weihe P, Lynge E. High incidence of dementia in Faroese-born female residents in Denmark. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2020; 6:e12022. [PMID: 32346600 PMCID: PMC7185209 DOI: 10.1002/trc2.12022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 03/11/2020] [Indexed: 11/18/2022]
Abstract
INTRODUCTION To assess whether the incidence of dementia among immigrants in Denmark from the Faroe Islands is similar to that of the inhabitants of their new country. METHODS Data on Faroese-born immigrants in Denmark were retrieved from the Danish Central Population Register. Incident dementia cases were identified from the Danish National Patient Register. Standardized incidence ratios (SIRs) were used to compare the dementia incidence in immigrants with the general Danish population. RESULTS Female, first-generation Faroese immigrants had double the risk of dementia compared with Danes (SIR 2.1, 95% confidence interval [CI] 1.8-2.5); the excess risk prevailed even beyond 10 years in Denmark, and it affected all sub-types of dementia. In male immigrants, only a modest, statistically non-significant excess risk was seen (SIR 1.2, 95% CI 0.9-1.6). DISCUSSION The observation of an excess risk of dementia in women only but not in men of Faroese origin living in Denmark underscores the complexity of the etiology of dementia.
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Affiliation(s)
- Maria Skaalum Petersen
- Department of Occupational Medicine and Public HealthThe Faroese Hospital SystemTórshavnFaroe Islands
- Faculty of Health SciencesCentre of Health ScienceUniversity of the Faroe IslandsTórshavnFaroe Islands
| | | | - Pál Weihe
- Department of Occupational Medicine and Public HealthThe Faroese Hospital SystemTórshavnFaroe Islands
- Faculty of Health SciencesCentre of Health ScienceUniversity of the Faroe IslandsTórshavnFaroe Islands
| | - Elsebeth Lynge
- Nykøbing Falster HospitalUniversity of CopenhagenCopenhagenDenmark
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