Trends in the incidence of dementia: design and methods in the Alzheimer Cohorts Consortium.

Several studies have reported a decline in incidence of dementia which may have large implications for the projected burden of disease, and provide important guidance to preventive efforts. However, reports are conflicting or inconclusive with regard to the impact of gender and education with underlying causes of a presumed declining trend remaining largely unidentified. The Alzheimer Cohorts Consortium aggregates data from nine international population-based cohorts to determine changes in the incidence of dementia since 1990. We will employ Poisson regression models to calculate incidence rates in each cohort and Cox proportional hazard regression to compare 5-year cumulative hazards across study-specific epochs. Finally, we will meta-analyse changes per decade across cohorts, and repeat all analysis stratified by sex, education and APOE genotype. In all cohorts combined, there are data on almost 69,000 people at risk of dementia with the range of follow-up years between 2 and 27. The average age at baseline is similar across cohorts ranging between 72 and 77. Uniting a wide range of disease-specific and methodological expertise in research teams, the first analyses within the Alzheimer Cohorts Consortium are underway to tackle outstanding challenges in the assessment of time-trends in dementia occurrence

Chronic obstructive pulmonary disease and cerebral microbleeds: the Rotterdam study

Rationale: Chronic obstructive pulmonary disease (COPD) is a common, complex multisystem disease in the elderly with multiple comorbidities that significantly impact morbidity and mortality. Although cerebral small-vessel disease is an important cause of cognitive decline and age-related disability, it is a poorly investigated potential systemic manifestation of patients with COPD. Objectives: To examine whether COPD relates to the development and location of cerebral microbleeds, a novel marker of cerebral small-vessel disease. Methods: Cross-sectional and longitudinal analyses were part of the Rotterdam Study, a prospective population-based cohort study in subjects aged ≥55 years. Diagnosis of COPD was confirmed by spirometry. Cerebral microbleeds were detected using high-resolution Magnetic Resonance Imaging (MRI). Main Results: Subjects with COPD (n = 165) had a higher prevalence of cerebral microbleeds compared to subjects with normal lung function (n = 645) independent of age, sex, smoking status, atherosclerotic macroangiopathy, antithrombotic use, total cholesterol, triglycerides, and serum creatinin (OR 1.7, 95%CI 1.15-2.47, p=0.007). Regarding the specific microbleed location, COPD subjects had a significantly higher prevalence of microbleeds in deep or infratentorial locations (OR 3.3, 95%CI 1.97-5.53, p<0.001), which increased with severity of airflow limitation and are suggestive of hypertensive or arteriolosclerotic microangiopathy. Furthermore, in longitudinal analysis restricted to subjects without microbleed at baseline, COPD was an independent predictor of incident cerebral microbleeds in deep or infratentorial locations (OR 7.1, 95%CI: 2.1-24.5, p=0.002). Conclusions: Our findings are compatible with an increased risk of COPD on the development of cerebral microbleeds in deep or infratentorial locations

Sarcopenia and its clinical correlates in the general population : the Rotterdam study

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