epidemiology of dementia in canada: information from the canadian study of health and aging
TRANSCRIPT
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Epidemiology of Dementia in Canada:
Information from the Canadian Study of
Health and Aging
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Prevalence of DementiaCanada 1991-92
0
50
100
150
200
250
300
350
400
65-74 75-84 85 +
Women
Men
Total
Rate per 1,000
Source: Can Med Assoc J 1994;150:899-913
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Prevalence of Cognitive Disorderby severity and gender, ages 65+
Cognitively Cog. Dementia normal Impaired Mild Mod. Severe
Male % 72.6 21.3 2.1 2.6 1.4
Female % 77.1 13.5 2.4 3.6 3.5
M + F % 75.2 16.8 2.3 3.1 2.6
Source: Lancet 1997;349:1793
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Prevalence of Cognitive Disorderby severity and age
Cognitively Impaired Dementia normal Mild Mod. Severe
65-74 % 86.6 11.0 1.0 0.9 0.5
75-84 % 64.7 24.0 3.4 4.6 3.2
85+ % 35.0 30.3 7.2 12.9 14.6
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Estimated Numbers of Canadians, 65+, with Dementia, 1991
010,00020,00030,00040,00050,00060,00070,00080,00090,000
100,000
Community Institution
Male
Female
Source: Can Med Assoc J 1994;150:899-913
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Projected Prevalence of Dementia (x 1,000)Canada, 1991 - 2031
0
100
200
300
400
500
600
700
800
1991 2001 2011 2021 2031
All Dementias
AD
Vascularx 2
x 3
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Age-Specific Incidence of Dementia in Canada, per thousand (whole population)
0
10
20
30
40
50
60
70
80
65-69 70-74 75-79 80-84 85+
WomenMen
Source: Neurology 2000; 55: 66-73
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Annual Numbers of New Cases of DementiaCanada, 1991
19,770
25,840
14,540
65 - 74
85+
75 - 84
All Ages: 60,150
Source: Neurology 2000; 55: 66-73
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Probability of Becoming DementedCanada, 1991
0
10
20
30
40
50
60
65 70 75 80 85 90 95
Women
Men
Undemented at age
% probability
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Annual Incidence of Dementia in selected studies, by age,
per thousand (whole population)
0
20
40
60
80
100
120
65-69 70-74 75-79 80-84 85+ 90+
CSHA
Rochester
Turku
Bordeaux
FramighamNew York
Mannheim
Rotterdam
Kungsholmen
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Age-Specific Incidence of Alzheimer’s Disease, per thousand
0
10
20
30
40
50
60
70
80
90
65-69 70-74 75-79 80-84 85-89 90+
CSHA
E. Boston
Bordeaux
Baltimore
Lund
Framingham
Rotterdam
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Age-Specific Incidence of Alzheimer’s Disease, per thousand
0
10
20
30
40
50
60
70
65-69 70-74 75-79 80-84 85-89 90+
Canada
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CSHA Incidence of Alzheimer’s Disease, per thousand (log scale)
0.1
1
10
100
65-69 70-74 75-79 80-84 85-89 90+
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Expectation of Life With and Without Dementia: Canadian Women
0
5
10
15
20
25
65 70 75 80 85 90 95
Age
Years
undemented
demented
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Expectation of Life With and Without Dementia: Canadian Men
0
5
10
15
20
25
65 70 75 80 85 90 95
Age
Years
undemented
demented
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Age-adjusted Mortality Ratios Mortality Ratio
Residence Cognitive status Women Men
Community Normal 1 1 Impaired 2.17 1.95Demented 2.67 2.84
Institution Normal 3.06 2.11Impaired 3.52 3.09Demented 6.03 5.02
(reference group)
Source: Can. J. Public Health 1997;88:303
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Progression of Dementia:Survival by Age Category
00.10.20.30.40.50.60.70.80.9
1
0 1 2 3 4 5 6
64-74 yrs
75-84 yrs
85+ yrs
years of survival
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Net Annual Costs of Dementia, 1991cost per No. of Annual net
Source patient, $ patients cost x 1,000$
Community 10,100 123,900 1,250,900 - paid services 4,970 123,900 615,200 - unpaid services 5,130 123,900 635,700Institutions 19,100 114,000 2,177,500Drugs 240 252,600 60,600Hospital 0 252,600 0Diagnosis 250 54,100 13,500People < 65 yrs 28,100 389,200Total 3,901,500
Source: CanMedAssocJ 1994;151:1457-64
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Dementia and Functional AbilityCommunity Institutions
Normal Demented Normal Demented % % % %
Good function 65.8 6.6 7.1 0.0
Mild disability 20.2 14.8 10.8 0.3
Moderate 12.1 30.8 39.5 2.5
Severe 1.3 21.2 27.3 12.3
Total disability 0.6 26.5 15.3 84.9
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Risk Factors for AD(CSHA-1 Case-Control Study)
• One or more relatives with AD: One or more relatives with AD: O.R. O.R. 2.62.6
• 0-6 yrs education: 0-6 yrs education: O.R. O.R. 4.04.0
• Occupational exposure to glues: Occupational exposure to glues: O.RO.R. 2.2. 2.2
• Head injury:Head injury: O.R. O.R. 1.71.7
• Arthritis: Arthritis: O.R. O.R. 0.50.5
• Use of NSAID drugs: Use of NSAID drugs: O.R. O.R. 0.50.5
• Age of onset for smokers 80 yrs; nonsmokers 84 Age of onset for smokers 80 yrs; nonsmokers 84 yrs.yrs.
Source: Neurology 1994;44:2073-80
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Risk Factors for Alzheimer’s Disease (Cohort Study)
OR OR 95% CI95% CI
• Any Apolipoprotein E4Any Apolipoprotein E4 3.33.3 2.0 – 5.4 2.0 – 5.4
• 0-8 yrs. education0-8 yrs. education 1.91.9 1.3 - 2.9 1.3 - 2.9
• Head injury Head injury 0.60.6 0.3 - 1.2 0.3 - 1.2
• Family history of dementiaFamily history of dementia 1.1.00 0.6 – 1.8 0.6 – 1.8
• DepressionDepression 2.82.8 1.3 - 6.1 1.3 - 6.1
• SmokingSmoking 1.041.04 0.6 - 1.8 0.6 - 1.8
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Risk Factors for Alzheimer’s Disease (continued)
OR OR 95% CI 95% CI
• Vigorous exercise x3 / wk Vigorous exercise x3 / wk 0.70.7 0.5 - 1.0 0.5 - 1.0
• Use of NSAID drugsUse of NSAID drugs 0.70.7 0.4 – 1.0 0.4 – 1.0
• UlcerUlcer 1.81.8 0.9 - 3.3 0.9 - 3.3
• History of hypertensionHistory of hypertension 0.80.8 0.5 - 0.5 - 1.31.3