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