Epidemiology of Dementia
Stefania Maggi
CNR-Institute of Neuroscience
Aging Branch
Padova, Italy
Worldwide population 65+
milion
1000
900
800
700
600
500
400
300
200
100
0
1000
The proportion of
Older people will
Increase from 7%
to 12%
420
2000
2030
Source: United Nation, Population Aging and Development, 2009
Projections population over 65 from 2010 to 2060
(EUROPOP, 2010)
Europe
Italy
56,3%
60
% Estimated frequency
51,7%
50
52,6%
45,5%
38,3%
40
30,8%
30
50,2%
56,7%
31,4%
41,1%
34,8&
25,9%
20
10
0
2010
2020
2030
Time
2040
2050
2060
Worldwide dementia: the
numbers will double every twenty
years!!
Million
81,1
80
60
42,3
40
24,3
20
0
2001
2020
Ferri et al., 2005, Lancet 366:2112-17
2040
Epidemiology studying dementia
Give the real size of dementia:
3.
Prevalence
Incidence
Risk factors
4.
Protective factors (biologic, behavioural, socio-economic)
1.
2.
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 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
0%
20%
40%
60%
80%
100%
Kuopio Study (Finland)
Kungsholmen Project (Sweden)
Odense Study (Denmark)
Rotterdam Study (Netherlands)
Melton Mowbray (UK)
AD
VaD
other
MCR-ALPHA (UK)
PAQUID (France)
Pamplona Study (Spain)
Zaragoza Study (Spain)
ZARADEMP (Spain)
ILSA (Italy)
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 studies
Worldwide dementia Incidence
Qiu et al., 2009, Dialogues. Clin. Neurosci. 11:111-128
Per 1000 persons-year
75
60
45
AD Male
AD Female
VaD Male
VaD Female
EURODEM
30
15
0
65-69
70-74
75-79
80-84
85-89
90+
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
factors for dementia
Risk Factors









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
Protective Factors







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
Survival of patients with
dementia
ILSA Study
ILSA coorte
ILSA coorte: dementia vs.non D
P<0.05
Survival in ILSA coorte: disability
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%)
Demented
Non demented
P<0.05
P<0.05
Hazard Ratio and 95% CI of
death in the ILSA cohort
Noale M et al. Dement geriatr Cogn Disord 2003
I 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:
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