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August 04, 2020; 95 (5) ArticleOpen Access

Twenty-seven-year time trends in dementia incidence in Europe and the United States

The Alzheimer Cohorts Consortium

View ORCID ProfileFrank J. Wolters, View ORCID ProfileLori B. Chibnik, Reem Waziry, Roy Anderson, Claudine Berr, Alexa Beiser, Joshua C. Bis, Deborah Blacker, Daniel Bos, Carol Brayne, Jean-François Dartigues, Sirwan K.L. Darweesh, Kendra L. Davis-Plourde, Frank de Wolf, Stephanie Debette, Carole Dufouil, Myriam Fornage, Jaap Goudsmit, Leslie Grasset, Vilmundur Gudnason, View ORCID ProfileChristoforos Hadjichrysanthou, Catherine Helmer, M. Arfan Ikram, M. Kamran Ikram, View ORCID ProfileErik Joas, Silke Kern, Lewis H. Kuller, Lenore Launer, Oscar L. Lopez, View ORCID ProfileFiona E. Matthews, Kevin McRae-McKee, Osorio Meirelles, Thomas H. Mosley, Matthew P. Pase, Bruce M. Psaty, View ORCID ProfileClaudia L. Satizabal, Sudha Seshadri, Ingmar Skoog, Blossom C.M. Stephan, Hanna Wetterberg, Mei Mei Wong, Anna Zettergren, View ORCID ProfileAlbert Hofman
First published July 1, 2020, DOI: https://doi.org/10.1212/WNL.0000000000010022
Frank J. Wolters
From the Department of Epidemiology (F.J.W., L.B.C., R.W., D. Blacker, D. Bos, J.G., A.H.), Harvard T.H. Chan School of Public Health, Boston, MA; Departments of Epidemiology (F.J.W., D. Bos, S.K.L.D., M.A.I., M.K.I., A.H.), Radiology and Nuclear Medicine (D. Bos), and Neurology (M.K.I.), Erasmus MC, Rotterdam, the Netherlands; Department of Neurology (L.B.C.), Massachusetts General Hospital, Boston; Department of Infectious Disease Epidemiology (R.A., F.d.W., C. Hadjichrysanthou, K.M.-M., M.M.W.), School of Public Health, Imperial College London, UK; Neuropsychiatry and Epidemiology and Clinical Research (C. Berr), INSERM, UMR 1061 Montpellier, Universite de Montpellier, France; Boston University School of Medicine (A.B., M.P.P., C.L.S., S.S.); Framingham Heart Study (A.B., M.P.P., C.L.S., S.S.), MA; Department of Biostatistics (A.B., K.L.D.-P.), Boston University School of Public Health, MA; Cardiovascular Health Research Unit, Departments of Medicine (J.C.B., B.M.P.) and Epidemiology and Health Services (B.M.P.), University of Washington, Seattle; Department of Psychiatry (D. Blacker), Massachusetts General Hospital, Charlestown; University of Cambridge (C. Brayne), UK; Bordeaux Population Health Research Center (J.-F.D., S.D., C.D., L.G., C. Helmer), INSERM, UMR 1219, University of Bordeaux; Department of Neurology (S.D.), Memory Clinic, Bordeaux University Hospital, France; McGovern Medical School (M.F.), University of Texas Health Science Center at Houston; Icelandic Heart Association (V.G.), Kopavogur; Faculty of Medicine (V.G.), University of Iceland, Reykjavik; Institute of Neuroscience and Physiology (E.J., S.K., I.S., H.W., A.Z.), Sahlgrenska Academy, University of Gothenburg, Sweden; Department of Epidemiology, Graduate School of Public Health (L.H.K.), and Departments of Neurology and Psychiatry (O.L.L.), University of Pittsburgh, PA; Laboratory of Epidemiology and Population Sciences (L.L., O.M.), National Institute on Aging, Bethesda, MD; Institute of Health and Society (F.E.M., B.C.M.S.), Newcastle University, Newcastle upon Tyne, UK; MIND Center (T.H.M.), University of Mississippi Medical Center, Jackson; Melbourne Dementia Research Centre (M.P.P.), The Florey Institute for Neuroscience and Mental Health, Melbourne, Australia; Kaiser Permanente Washington Health Research Institute (B.M.P.), Seattle; and The Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases (C.L.S., S.S.), UT Health San Antonio, TX.
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Lori B. Chibnik
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Reem Waziry
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Roy Anderson
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Claudine Berr
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Alexa Beiser
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Joshua C. Bis
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Deborah Blacker
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Daniel Bos
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Carol Brayne
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Jean-François Dartigues
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Sirwan K.L. Darweesh
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Kendra L. Davis-Plourde
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Frank de Wolf
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Stephanie Debette
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Carole Dufouil
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Myriam Fornage
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Jaap Goudsmit
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Leslie Grasset
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Vilmundur Gudnason
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Christoforos Hadjichrysanthou
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Catherine Helmer
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M. Arfan Ikram
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M. Kamran Ikram
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Erik Joas
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Silke Kern
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Lewis H. Kuller
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Lenore Launer
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Oscar L. Lopez
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Fiona E. Matthews
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Kevin McRae-McKee
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Osorio Meirelles
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Thomas H. Mosley Jr
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Matthew P. Pase
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Bruce M. Psaty
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Claudia L. Satizabal
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Sudha Seshadri
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Ingmar Skoog
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Blossom C.M. Stephan
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Hanna Wetterberg
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Mei Mei Wong
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Anna Zettergren
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Albert Hofman
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Twenty-seven-year time trends in dementia incidence in Europe and the United States
The Alzheimer Cohorts Consortium
Frank J. Wolters, Lori B. Chibnik, Reem Waziry, Roy Anderson, Claudine Berr, Alexa Beiser, Joshua C. Bis, Deborah Blacker, Daniel Bos, Carol Brayne, Jean-François Dartigues, Sirwan K.L. Darweesh, Kendra L. Davis-Plourde, Frank de Wolf, Stephanie Debette, Carole Dufouil, Myriam Fornage, Jaap Goudsmit, Leslie Grasset, Vilmundur Gudnason, Christoforos Hadjichrysanthou, Catherine Helmer, M. Arfan Ikram, M. Kamran Ikram, Erik Joas, Silke Kern, Lewis H. Kuller, Lenore Launer, Oscar L. Lopez, Fiona E. Matthews, Kevin McRae-McKee, Osorio Meirelles, Thomas H. Mosley, Matthew P. Pase, Bruce M. Psaty, Claudia L. Satizabal, Sudha Seshadri, Ingmar Skoog, Blossom C.M. Stephan, Hanna Wetterberg, Mei Mei Wong, Anna Zettergren, Albert Hofman
Neurology Aug 2020, 95 (5) e519-e531; DOI: 10.1212/WNL.0000000000010022

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Abstract

Objective To determine changes in the incidence of dementia between 1988 and 2015.

Methods This analysis was performed in aggregated data from individuals >65 years of age in 7 population-based cohort studies in the United States and Europe from the Alzheimer Cohort Consortium. First, we calculated age- and sex-specific incidence rates for all-cause dementia, and then defined nonoverlapping 5-year epochs within each study to determine trends in incidence. Estimates of change per 10-year interval were pooled and results are presented combined and stratified by sex.

Results Of 49,202 individuals, 4,253 (8.6%) developed dementia. The incidence rate of dementia increased with age, similarly for women and men, ranging from about 4 per 1,000 person-years in individuals aged 65–69 years to 65 per 1,000 person-years for those aged 85–89 years. The incidence rate of dementia declined by 13% per calendar decade (95% confidence interval [CI], 7%–19%), consistently across studies, and somewhat more pronouncedly in men than in women (24% [95% CI 14%–32%] vs 8% [0%–15%]).

Conclusion The incidence rate of dementia in Europe and North America has declined by 13% per decade over the past 25 years, consistently across studies. Incidence is similar for men and women, although declines were somewhat more profound in men. These observations call for sustained efforts to finding the causes for this decline, as well as determining their validity in geographically and ethnically diverse populations.

Glossary

3C=
Three-City Study;
ACC=
Alzheimer Cohorts Consortium;
AD=
Alzheimer disease;
AGES–Reykjavik Study=
Age, Gene/Environment Susceptibility–Reykjavik Study;
ARIC=
Atherosclerosis Risk in Communities;
CFAS=
Cognitive Function and Ageing Studies;
CHS=
Cardiovascular Health Study;
CI=
confidence interval;
DSM-III-R=
Diagnostic and Statistical Manual of Mental Disorders, 3rd edition, revised;
DSM-IV=
Diagnostic and Statistical Manual of Mental Disorders, 4th edition;
FHS=
Framingham Heart Study;
HR=
hazard ratio;
IR=
incidence rate;
PAQUID=
Personnes Agées QUID;
RS=
Rotterdam Study

Footnotes

  • Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • ↵The Article Processing Charge was funded by Association of Universities in the Netherlands (VSNU) Association of Universities in the Netherlands (VSNU).

  • * These authors contributed equally to this work.

  • Received July 11, 2019.
  • Accepted in final form January 31, 2020.
  • Copyright © 2020 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.

This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License 4.0 (CC BY-NC-ND), which permits downloading and sharing the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

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Letters: Rapid online correspondence

  • Author response: Twenty-seven-year time trends in dementia incidence in Europe and the United States: The Alzheimer Cohorts Consortium
    • Frank J. Wolters, Postdoctoral Research Fellow, Erasmus MC Rotterdam
    • Lori B. Chibnik, Assistant Professor, Harvard T.H. Chan School of Public Health
    • Albert Hofman, Professor of Epidemiology, Harvard T.H. Chan School of Public Health
    Submitted September 02, 2020
  • Reader response: Twenty-seven-year time trends in dementia incidence in Europe and the United States: The Alzheimer Cohorts Consortium
    • Jonathan Spiegel, Medical Student, Brown University's Warren Alpert School of Medicine
    • Mony de Leon, Director Brain Health Imaging Institute, Brain Health Imaging Institute at Weill Cornell Medicine Department of Radiology
    Submitted August 26, 2020
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