epidemiology of dementia stefania maggi cnr-institute of neuroscience aging branch padova, italy

Epidemiology of DementiaEpidemiology of DementiaEpidemiology of DementiaEpidemiology of Dementia

Stefania MaggiCNR-Institute of Neuroscience

Aging BranchPadova, Italy

Worldwide population 65+

1000

420

0100200300400500600700800900

1000

2000 2030

milion

Source: United Nation, Population Aging and Development, 2009

The proportion ofOlder people willIncrease from 7% to 12%

Projections population over 65 from 2010 to 2060 (EUROPOP, 2010)

25,9%

31,4%

38,3%

45,5%

50,2%52,6%

30,8%34,8&

41,1%

51,7%

56,3% 56,7%

0

10

20

30

40

50

60

2010 2020 2030 2040 2050 2060Time

% E

stim

ated

fre

qu

ency

Europe Italy

Worldwide dementia: the numbers will double every twenty

years!!

42,3

81,1

24,3

0

20

40

60

80

2001 2020 2040

Ferri et al., 2005, Lancet 366:2112-17

Million

Epidemiology studying dementia

Give the real size of dementia:1. Prevalence

2. Incidence

3. Risk factors

4. Protective factors (biologic, behavioural, socio-economic)

Dementia diagnosis!

Diagnosis: Revised criteria NINDS-ADRDA (McKhann, 2011) for all-cause dementia

Cognitive or behavioural (neuropsychiatric) symptoms Interfere with work or usual activities Represent a decline from previous functioning levels Are not explained by delirium

Cognitive impairment established by objective cognitive assessment, self- and proxy-reported, and finally confirmed by neuropsychological testing

Deficits in at least two following domains: Acquire and remember new information Reasoning and handling complex task Poor judgment Visuospatial abilities Language Changes in personality, behaviour, or comportment

Prevalence studiesPrevalence studies

Worldwide Prevalence of dementia

Qiu et al., 2009, Dialogues. Clin. Neurosci. 11:111-128

EURODEM STUDY

Kuopio Study (Finland)

Kungsholmen Project (Sweden)

Odense Study (Denmark)

Rotterdam Study (Netherlands)

Melton Mowbray (UK)

MCR-ALPHA (UK)

PAQUID (France)

Pamplona Study (Spain)

Zaragoza Study (Spain)

ZARADEMP (Spain)

ILSA (Italy)

Mean prevalence of dementia: 6,4 % 65+ years old

EURODEM STUDY

Kuopio Study (Finland)

Kungsholmen Project (Sweden)

Odense Study (Denmark)

Rotterdam Study (Netherlands)

Melton Mowbray (UK)

MCR-ALPHA (UK)

PAQUID (France)

Pamplona Study (Spain)

Zaragoza Study (Spain)

ZARADEMP (Spain)

ILSA (Italy)

0% 20% 40% 60% 80% 100%

AD VaD other

General Conclusions on Dementia prevalence studies

AD prevalence increases with age doubling every 5 years from age 65

Prevalence of AD is higher than prevalence of VaD

Need to better define the “mixed” form of dementia

Trends in prevalence reflects the influence of the incidence of disease and survival

Prevalence and incidence studies based on either hospital records or volunteers underestimate the AD

Poor sensitivity of screening test

Incidence studiesIncidence studies

Worldwide dementia Incidence

Qiu et al., 2009, Dialogues. Clin. Neurosci. 11:111-128

0

15

30

45

60

75

65-69 70-74 75-79 80-84 85-89 90+

AD Male

AD Female

VaD Male

VaD Female

Per 1000 persons-year

EURODEM

General Conclusions on Dementia Incidence studies

Incidence increases by 2 times about every 5 years

Female population has an increased risk of AD

Incidence is influenced by applied diagnostic criteria

Differences among countries are more pronounced for AD and VaD comparison respect to other forms of dementia

Risk and Protective Risk and Protective factors for dementiafactors for dementia

APOE-4 allele: susceptibility gene Vascular RF (obesity, high

cholesterol) Vascular disease (diabetes,

hypertension, TIA, WM lesion) Lifestyle (heavy alcohol intake,

smoking) High serum Homocysteine Inflammation Toxic exposure (aluminium,

mercury) Traumatic brain injury Depression

Antioxidant (Vitam E and C) High serum levels of folate

and Vitamin B12 Polyunsaturated fatty acid

(Omega 3) High education level Social network and

engagement Regular physical activity Active mind

Risk Factors Protective Factors

Survival of patients with Survival of patients with dementiadementia

ILSA SILSA Studytudy

P<0.05

ILSA coorte ILSA coorte: dementia vs.non D

Survival in ILSA coorte: disabilitySurvival in ILSA coorte: disability

P<0.05P<0.05

Demented Non demented

According to the Global Burden of Disease estimates, dementia Contributes 11.2% of years lived with disability in people 60+, more than stroke (9.5%), musculoskeletal ds (8.9%), CVD (5%), cancer (2.4%)

Hazard Ratio and 95% CI of Hazard Ratio and 95% CI of death in the ILSA cohortdeath in the ILSA cohort

Noale M et al. Dement geriatr Cogn Disord 2003

I COSTI DELLA MALATTIA DI ALZHEIMERI COSTI DELLA MALATTIA DI ALZHEIMER

COSTO MEDIO ANNUO : circa 43,000.00 Euro (Gambina, et al, 2010)Due studi italiani precedenti (Co.Dem., Bianchetti 1998; Cavallo e Fattore 1997) calcolavano un valore medio tra i 93 e i 98 milioni.

In tutti questi studi i costi indiretti, sostenuti in massima parte dalle famiglie, incidono per circa 80% sul totale.I costi associati alla gestione della Demenza di Alzheimer incidono sul PIL, di nazioni diverse, dal 0,6% al 4% circa.Gli studi italiani (Cavallo, Fattore 1997 e Trabucchi 1994) stimavano in Italia una percentuale pari a 1,16% sul PIL, che oggi sono stimati intorno al 4,5%.

Epidemiologia della Demenze:Epidemiologia della Demenze:conclusioni conclusioni

Dementia is a devastating neurodegenerative disorder that will grow up overtime.

Multidisciplinary approches to assess dementia (genetic, epidemiologist, clinicians)

Prevalence and Incidence increase exponentially with age (65 +) worldwide

Take into account Risk and Protective factors

In patients with dementia, a comprehensive approach including any comorbidities may improve the prognosis quoad vitam e quoad valetudinem