Incidence of dementia and cognitive impairment, not dementia in the united states

Objective: Estimates of incident dementia, and cognitive impairment, not dementia (CIND) (or the related mild cognitive impairment) are important for public health and clinical care policy. In this paper, we report US national incidence rates for dementia and CIND. Methods: Participants in the Aging, Demographic, and Memory Study (ADAMS) were evaluated for cognitive impairment using a comprehensive in‐home assessment. A total of 456 individuals aged 72 years and older, who were not demented at baseline, were followed longitudinally from August 2001 to December 2009. An expert consensus panel assigned a diagnosis of normal cognition, CIND, or dementia and its subtypes. Using a population‐weighted sample, we estimated the incidence of dementia, Alzheimer disease (AD), vascular dementia (VaD), and CIND by age. We also estimated the incidence of progression from CIND to dementia. Results: The incidence of dementia was 33.3 (standard error [SE], 4.2) per 1,000 person‐years and 22.9 (SE, 2.9) per 1,000 person‐years for AD. The incidence of CIND was 60.4 (SE, 7.2) cases per 1,000 person‐years. An estimated 120.3 (SE, 16.9) individuals per 1,000 person‐years progressed from CIND to dementia. Over a 5.9‐year period, about 3.4 million individuals aged 72 and older in the United States developed incident dementia, of whom approximately 2.3 million developed AD, and about 637,000 developed VaD. Over this same period, almost 4.8 million individuals developed incident CIND. Interpretation: The incidence of CIND is greater than the incidence of dementia, and those with CIND are at high risk of progressing to dementia, making CIND a potentially valuable target for treatments aimed at slowing cognitive decline. ANN NEUROL 2011;Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/86941/1/22362_ftp.pd

Frequency and Course of Mild Cognitive Impairment in a Multiethnic Community

Objective To examine incidence rates and antecedents of mild cognitive impairment (MCI) and Alzheimer's disease (AD) among diverse elders without dementia at the initial visit, and to examine the characteristics of elders with MCI who reverted to normal on follow-up examination. Methods A total of 2,364 Caribbean Hispanic, black, or non-Hispanic white subjects, aged 65 or older, who were free of dementia at initial evaluation were followed up every 18 to 24 months. Incidence rate of MCI and AD was determined by examination of neurological, medical, psychiatric, and neuropsychological function. Results Over 10,517 person-years, 21% of normal elderly subjects progressed to MCI (annual incidence rate, 5.1%; 95% confidence interval, 4.6–5.6%). Of those with MCI initially, 21.8% were subsequently diagnosed with AD (annual incidence rate, 5.4%; 95% confidence interval, 4.7–6.3%), 47% remained unchanged, and 31% reverted to normal. Those with MCI were 2.8 times more likely to experience development of AD than normal elderly subjects. MCI with impairment in memory and at least one other cognitive domain was associated with greatest risk for progression to AD and was also least likely to revert to normal at follow-up. Consistent diagnosis of MCI or incident probable or possible AD was 60% sensitive and 94% specific for the pathological diagnosis of AD. Interpretation Impaired memory and language were useful predictors of transition to AD. Reversion to normal from MCI was frequent, but those with impairment in more than one cognitive domain were more likely to progress or remain impaired than those with single-domain impairment. Clinical diagnosis of MCI does not always predict AD neuropathology. Ann Neurol 200

Apolipoprotein E Genotype and Mortality: Findings From The Cache County Study

Objectives: To evaluate the association between apolipoprotein E (apo E) ɛ4 and mortality, the population attributable risk for mortality with ɛ4, and relative contributions of cardiovascular disease (CVD) and Alzheimer\u27s disease (AD). Design: Population-based cohort study. Setting: Community-based. Participants: Permanent residents of Cache County, Utah, aged 65 and older as of January 1, 1995. Measurements: Participants were genotyped at the apo E locus using buccal-swab deoxyribonucleic acid. Cardiovascular health was ascertained using self- or proxy-report interviews at participants\u27 residences. AD was diagnosed according to Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised, and National Institute of Neurological and Communicative Disorders and Stroke—Alzheimer\u27s Disease and Related Disorders criteria. Utah Department of Vital Statistics quarterly reports were reviewed to identify participants who died. Results: Crude evaluations showed nonsignificantly greater risk of death for ɛ2/2 (hazard ratio (HR)=1.66, 95% confidence interval (CI)=0.92–2.76) and ɛ3/4 (HR=1.11, 95% CI=0.97–1.26) genotypes and significantly greater risk for ɛ4/4 (HR=1.48, 95% CI=1.09–1.96). After adjustment for age, age2, sex, and education, risks increased to 1.98 (95% CI=1.08–3.35), 1.28 (95% CI=1.12–1.46), and 2.02 (95% CI=1.47–2.71), respectively, compared with ɛ3/3 genotypes. Adjustment for presence of any CVD did not change the risk of death for ɛ3/4 and ɛ4/4. Adjustment for AD reduced the risk of death for ɛ3/4 (HR=1.13, 95% CI=0.99–1.30) and ɛ4/4 (HR=1.59, 95% CI=1.15–2.14). The population attributable risk of death for ɛ3/4 and ɛ4/4 genotypes combined is estimated at 9.6%. Conclusion: These findings suggested that the ɛ2/2, ɛ3/4, and ɛ4/4 genotypes have greater early mortality risks. Further analyses showed that AD partially mediates the association between ɛ3/4, ɛ4/4, and death

Early parental death and remarriage of widowed parents as risk factors for alzheimer disease: The cache county study

10.1097/JGP.0b013e3182011b38American Journal of Geriatric Psychiatry199814-824AJGP