Age-Specific Incidence of Alzheimer's Disease in a Community Population

Hebert, Liesi E.; Scherr, Paul A.; Beckett, Laurel A.; Albert, Marilyn; Pilgrim, David; Chown, Marilyn J.; Funkenstein, H. Harris; Evans, Denis A.

doi:10.1001/jama.1995.03520410048025

Cited by 369 publications

(178 citation statements)

References 26 publications

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“…= biomarker untested; UC = biomarker uninformative or conflicting. (Braak and Braak, 1991), and those on the prevalence of AD dementia from three epidemiological studies (Hebert et al, 1995;Ganguli et al, 2000;Kukull et al, 2002). Adapted from Sperling et al, 2011. scientific knowledge and propose the recognition of three stages of AD of increasing cognitive and functional severity: the preclinical, the MCI, and the dementia stage (Table 1).…”

Section: The Conceptual Frameworkmentioning

confidence: 99%

Revised NIA-AA criteria for the diagnosis of Alzheimer's disease: a step forward but not yet ready for widespread clinical use

Frisoni¹,

Winblad

O’Brien

2011

Int. Psychogeriatr.

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In clinical medicine, diagnostic criteria are not only useful everyday tools for the practicing physician, but also represent a conceptual concentrate of the understanding of the etiology and pathophysiology of diseases at a given point in time. Although different sets of diagnostic criteria for Alzheimer's disease (AD) have been developed, the most widely used and best validated by clinico-pathological study to date are the NINCDS-ADRDA (National Institute of Neurological and Communicative Disorders and Stroke – Alzheimer's Disease and Related Disorders Association) criteria which were published in 1984 (McKhann et al., 1984). These criteria are largely based on the exclusion of other conditions that may cause dementia and can be succinctly but fairly summarized as defining AD as an “acquired progressive cognitive, behavioral, and functional impairment with no other obvious cause”. Clearly, the NINCDS-ADRDA criteria were etiology- and pathophysiology-agnostic in that they failed to point at any specific etiology, not even a degenerative one. They were also developed before other important causes of dementia, such as dementia with Lewy bodies, fronto-temporal dementia and subcortical vascular dementia had been fully described and characterized. The recent publication of a substantially revised version of these criteria (Sperling et al. 2011; Albert et al., 2011; McKhann et al., 2011), heralded by a largely European initiative four years ago (Dubois et al., 2007) has been greeted with great interest by the field. The newly proposed criteria reflect the substantial insights on disease pathophysiology gained over the last decades, especially regarding the molecular pathology of AD and the time course of such pathology in relation to clinical symptoms and disease.

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Section: The Conceptual Frameworkmentioning

confidence: 99%

Revised NIA-AA criteria for the diagnosis of Alzheimer's disease: a step forward but not yet ready for widespread clinical use

Frisoni¹,

Winblad

O’Brien

2011

Int. Psychogeriatr.

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“…[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] Despite methodologic differences in these studies, most have shown a consistent rise in the frequency of AD with increasing age. Women appear to have a higher frequency of AD than men in some, but not all studies.…”

mentioning

confidence: 99%

Incidence of AD in African-Americans, Caribbean Hispanics, and Caucasians in northern Manhattan

Tang¹,

Cross²,

Andrews³

et al. 2001

Neurology

641

579

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Article abstract-Objective: To compare the incidence rates for AD among elderly African-American, Caribbean Hispanic, and white individuals and to determine whether coincident cerebrovascular disease contributes to the inconsistency in reported differences among ethnic groups. Methods: This was a population-based, longitudinal study over a 7-year period in the Washington Heights and Inwood communities of New York City. Annual incidence rates for AD were calculated and compared by ethnic group, and cumulative incidence adjusted for differences in education, diabetes, cardiovascular risk factors, and stroke was calculated. Results: The age-specific incidence rate for probable and possible AD was 1.3% (95% CI, 0.8 to 1.7) per person-year between the ages of 65 and 74 years, 4.0% (95% CI, 3.2 to 4.8) per person-year between ages 75 and 84 years, and 7.9% (95% CI, 5.5 to 10.5) per person-year for ages 85 and older. Compared to white individuals, the cumulative incidence of AD to age 90 years was increased twofold among African-American and Caribbean Hispanic individuals. Adjustment for differences in number of years of education, illiteracy, or a history of stroke, hypertension, heart disease, or diabetes did not change the disproportionate risks among the three ethnic groups. Conclusion: The incidence rate for AD was significantly higher among African-American and Caribbean Hispanic elderly individuals compared white individuals. The presence of clinically apparent cardiovascular or cerebrovascular disease did not contribute to the increased risk of disease. Because the proportion of African-American and Caribbean Hispanic individuals reaching ages 65 and older in the United States is increasing more rapidly than the proportion of white individuals, it is imperative that this disparity in health among the elderly be understood. NEUROLOGY 2001;56:49 -56 Prevalence and incidence rates for AD have been studied extensively throughout the world.1-20 Despite methodologic differences in these studies, most have shown a consistent rise in the frequency of AD with increasing age. Women appear to have a higher frequency of AD than men in some, but not all studies. 17,19,[21][22][23] Although the prevalence and incidence rates for dementia in Asia, China, Europe, and the United States are comparable, the types of dementia can vary. For example, the frequency of vascular dementia is reported to be higher than that of AD among East Asians 13 and JapaneseAmericans 18 compared with most populations in the United States and Europe.Only a few studies in the United States have compared the frequency of AD or other forms of dementia among major ethnic groups. No differences in the prevalence and incidence rates of AD were reported among African-American and white individuals in the Piedmont area of North Carolina participating in the Duke Established Populations for Epidemiologic Studies of the Elderly.5 However, Gurland et al. 8 reported a higher prevalence of all types of dementia, including AD, among African-American and Hispani...

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“…[1][2][3][4][5][6][7] Familial aggregation of disease alters the lifetime risk, with the presence of an affected first-degree relative producing a two-to threefold increase in risk. 8 -13 Initial efforts to understand the role of genetics in AD focused on extremely rare, multigenerational families where disease onset occurs in the fourth or fifth decade of life (earlyonset AD).…”

mentioning

confidence: 99%

Physicians' propensity to offer genetic testing for Alzheimer's disease: Results from a survey

Chase

Geller

Havstad

et al. 2002

Genetics in Medicine

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Purpose: Examine physician knowledge, preferences, and use of genetic tests for Alzheimer's disease (AD). Alzheimer's disease (AD) is one of the most common threats to the elderly with a risk of approximately 12% to 15% that a 65-year-old would become affected during his or her remaining lifetime; this risk is steeply concentrated toward the end of the lifespan. 1-7 Familial aggregation of disease alters the lifetime risk, with the presence of an affected first-degree relative producing a two-to threefold increase in risk. 8 -13 Initial efforts to understand the role of genetics in AD focused on extremely rare, multigenerational families where disease onset occurs in the fourth or fifth decade of life (earlyonset AD). These autosomal dominant forms of the disease account for no more than 5% to 10% of all AD cases. At present, three gene loci are linked to early-onset AD, 14 -16 with the presenilin 1 gene on chromosome 14 appearing to be the major early-onset locus. 16 Mutations of these three genes are virtually 100% penetrant in the approximately 100 families studied thus far and explain approximately half of the earlyonset cases. 17 In the vast majority of AD cases, in which disease onset occurs after the age of 65, only the APOE gene located on chromosome 19 has been shown to be associated with increased disease risk, with a significantly higher frequency of the ⑀4 allele found in cases compared with controls. 18 -21 Although the presence of one ⑀4 allele appears to double the risk of AD at age 65, 1,22,23 a substantial proportion of ⑀4-positive persons never experience the onset of AD. In addition, it appears that roughly 35% to 50% of those suffering from AD do not have the ⑀4 allele, that the frequency of this allele may be similar in other dementing conditions, and that the association of ⑀4 with AD may vary with ethnic background, 24 -26 prompting medical geneticists and others to recommend against the use of APOE genotyping for prediction of risk in asymptomatic individuals. 24,27 Continuing advances in molecular genetics will identify other genes that may play a role in AD, further increasing the expectations of the public regarding the predictive accuracy of genetic susceptibility tests and the prospects for effective intervention. Studies indicate the majority of physicians have insufficient training for the understanding of genetic probabilities, penetrance, the notion of competing risk or calculation of positive predictive value. 28,29 A survey of 50 physicians found less than half had accurate knowledge of the baseline risk of AD and Ͻ5% understood the alteration in risk associated with the presence of the ⑀4 allele. 1 At the present time, genetic testing for the APOE gene as well as the PS1 gene is available and being marketed directly to physicians for use in appropriate circumstances as defined by the manufacturer. 30 Effective physician patient communication may be hampered by two factors: physician uncertainty regarding the meaning of predictive test results, and physician inability to id...

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Age-Specific Incidence of Alzheimer's Disease in a Community Population

Abstract: The incidence of Alzheimer's disease is substantial and is approximately 14 times higher among persons older than 85 years compared with those between 65 and 69 years of age.

Cited by 369 publications

References 26 publications

Revised NIA-AA criteria for the diagnosis of Alzheimer's disease: a step forward but not yet ready for widespread clinical use

Revised NIA-AA criteria for the diagnosis of Alzheimer's disease: a step forward but not yet ready for widespread clinical use

Incidence of AD in African-Americans, Caribbean Hispanics, and Caucasians in northern Manhattan

Physicians' propensity to offer genetic testing for Alzheimer's disease: Results from a survey

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