Is the risk of Alzheimer’s disease and dementia declining?

Abstract Background The number of older adults with dementia will increase around the world in the decades ahead as populations age. Current estimates suggest that about 4.2 million adults in the US have dementia and that the attributable economic cost of their care is about $200 billion per year. The worldwide dementia prevalence is estimated at 44.3 million people and the total cost at$604 billion per year. It is expected that the worldwide prevalence will triple to 135.5 million by 2050. However, a number of recent population-based studies from countries around the world suggest that the age-specific risk of dementia may be declining, which could help moderate the expected increase in dementia cases that will accompany the growing number of older adults. Discussion At least nine recent population-based studies of dementia incidence or prevalence have shown a declining age-specific risk in the US, England, The Netherlands, Sweden, and Denmark. A number of factors, especially rising levels of education and more aggressive treatment of key cardiovascular risk factors such as hypertension and hypercholesterolemia, may be leading to improving ‘brain health’ and declining age-specific risk of Alzheimer’s disease and dementia in countries around the world. Summary Multiple epidemiological studies from around the world suggest an optimistic trend of declining population dementia risk in high-income countries over the past 25 years. Rising levels of education and more widespread and successful treatment of key cardiovascular risk factors may be the driving factors accounting for this decline in dementia risk. Whether this optimistic trend will continue in the face of rising worldwide levels of obesity and diabetes and whether this trend is also occurring in low- and middle-income countries are key unanswered questions which will have enormous implications for the extent of the future worldwide impact of Alzheimer’s disease and dementia on patients, families, and societies in the decades ahead.http://deepblue.lib.umich.edu/bitstream/2027.42/110799/1/13195_2015_Article_118.pd

Opportunities for New Insights on the Life-Course Risks and Outcomes of Cognitive Decline in the Kavli HUMAN Project

The Kavli HUMAN Project (KHP) will provide groundbreaking insights into how biological, medical, and social factors interact and impact the risks for cognitive decline from birth through older age. It will richly measure the effect of cognitive decline on the ability to perform key activities of daily living. In addition, due to its family focus, the KHP will measure the impact on family members, including the amount of time that family members spend providing care to older adults with dementia. It will also clarify the division of caregiving duties among family members and the effects on caregivers' work, family life, and balance thereof. At the same time, for care that the family cannot provide, it will clarify the extent to which cognitive decline impacts healthcare utilization and end-of-life decision making.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140315/1/big.2015.0015.pd

P3‐114: The association of executive function with limitations in instrumental activities of daily living among older adults in the United States: The aging, demographics, and memory study

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/152613/1/alzjjalz2010051611.pd

Net Worth Predicts Symptom Burden at the End of Life

Objectives: To explore the predictors of symptom burden at the end of life. Design: Observational, secondary analysis of Health and Retirement Study (HRS) data. Setting: USA. Participants: Two thousand six hundred four deceased, older adults. Methods: Multivariate Poisson and logistic regression to explore the relationship between sociodemographic and clinical factors with symptoms. Results: Fatigue, pain, dyspnea, depression, and anorexia were common and severe; 58% of participants experienced more than 3 of these during their last year of life. Sociodemographic and clinical factors were associated with the number of symptoms as well as the presence of pain, depression, and dyspnea alone. Decedents in the highest quartile of net worth had fewer symptoms (incident rate ratio [IRR] 0.90, confidence interval [CI] 0.85–0.96) and less pain (odds ratio [OR] 0.66, CI 0.51–0.85) than comparisons did. Patients with cancer experienced more pain (OR 2.02, CI 1.62–2.53) and depression (OR 1.31, CI 1.07–1.61). Patients experienced more depression (OR 2.37, CI 1.85–3.03) and dyspnea (OR 1.40, CI 1.09–1.78). Limitation: Use of proxy reports for primary data. Conclusion: Older Americans experience a large symptom burden in the last year of life, largely with treatable symptoms such as pain, dyspnea, and depression. The adequacy of symptom control relates to clinical factors as well as net worth. This association between symptoms and wealth suggests that access to health care and other social services beyond those covered by Medicare may be important in decreasing symptom burden at the end of life.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/63106/1/jpm.2005.8.827.pd

Racial and ethnic differences in cognitive function among older adults in the USA

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/134204/1/gps4410.pd

Geographic Variation in Out‐of‐Pocket Expenditures of Elderly Medicare Beneficiaries

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/107567/1/jgs12834.pd

The Impact of Poor Health Behaviors on Workforce Disability

The effects of poor health habits on mortality have been studied extensively. However, few studies have examined the impact of these health behaviors on workforce disability. In the Health and Retirement Study, a nationally representative cohort of 6044 Americans who were between the ages of 51 and 61 and who were working in 1992, we found that both baseline smoking status and a sedentary lifestyle predict workforce disability six years later. If this relationship is causal, cost-benefit analyses of health behavior intervention that neglect workforce disability may substantially underestimate the benefits of such interventions.

Adapted Langa-Weir probable dementia classification outperforms other algorithms in 26 European countries without clinical dementia assessments.

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