Dementia incidence continues to increase with age in the oldest old: The 90+ study

Corrada, María M.; Brookmeyer, Ron; Paganini‐Hill, Annlia; Berlau, Daniel J.; Kawas, Claudia H.

doi:10.1002/ana.21915

Cited by 428 publications

(380 citation statements)

References 33 publications

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“…This is consistent with the increased prevalence and incidence of dementia in individuals age 85 or older. 29,30 Progression from normal cognition to MCI, or from normal to MCI to dementia, was not linear in 20% of the subjects, which has important implications for the study and diagnosis of MCI and dementia. First, only 1 of the unstable individuals was an APOE4 allele carrier, suggesting that the absence of the APOE4 allele may attenuate the rate of progression and decrease mortality.…”

Section: Discussionmentioning

confidence: 95%

Incidence of mild cognitive impairment in the Pittsburgh Cardiovascular Health Study–Cognition Study

et al. 2012

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Objectives and Methods:The purpose of this study was to examine the incidence of mild cognitive impairment (MCI) and patterns of progression from incident MCI to dementia in 285 cognitively normal subjects (mean age, 78.9 years) in the Cardiovascular Health Study-Cognition Study from 1998-1999 to 2010-2011. Results: Two hundred (70%) of the participants progressed to MCI; the age-adjusted incidence of MCI was 111.09 (95% confidence interval, 88.13-142.95) per 1,000 person-years. A total of 107 (53.5%) of the incident MCI subjects progressed to dementia. The mean time from MCI to dementia was 2.8 Ϯ 1.8 years. Forty (20%) of the incident MCI cases had an "unstable" course: 19 (9.5%) converted to MCI and later returned to normal; 10 (5%) converted to MCI, to normal, and later back to MCI; 7 (3.5%) converted to MCI, to normal, to MCI, and later to dementia; and 4 (2%) converted to MCI, to normal, and later to dementia. There was an increased mortality rate among the cognitively normal group (110.10 per 1,000 person-years) compared to those with incident MCI who converted to dementia (41.32 per 1,000 person-years). Conclusions:The majority of the subjects aged Ͼ80 years developed an MCI syndrome, and half of them progressed to dementia. Once the MCI syndrome was present, the symptoms of dementia appeared within 2 to 3 years. Progression from normal to MCI or from normal to MCI to dementia is not always linear; subjects who developed MCI and later returned to normal can subsequently progress to dementia. Competing mortality and morbidity influence the study of incident MCI and dementia in population cohorts. Neurology Older persons with mild cognitive impairment (MCI) have an increased risk of developing dementia, especially Alzheimer disease (AD).1-4 The prevalence rates of MCI range from 3% to more than 20%, depending on the classification methods (e.g., amnestic vs multiple cognitive domain), 5,6 and although there are extensive data on the incidence of dementia in subjects with MCI, there are few data on the incidence of MCI in cognitively normal subjects. 3,[7][8][9][10][11][12][13][14][15][16] The existing data show an incidence in the range of 37 to 77 per 1,000 person-years (py). Individuals with MCI progress to dementia at a rate of 5% to 15% per year, 1,4 although as many as 40% to 50% of the subjects can return to cognitive normality (normal) 3,9 ; thus, the natural history of MCI could be very unstable. If so, this makes the determination of its incidence a challenge, because individuals who have normal cognition at one point in time may

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Section: Discussionmentioning

confidence: 95%

Incidence of mild cognitive impairment in the Pittsburgh Cardiovascular Health Study–Cognition Study

et al. 2012

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“…On the one hand, evidence linking certain comorbidities in heart failure to increased mortality [6][7][8][9][10] suggests that persons who survive to very old age with heart failure are less likely to have those comorbidities. On the other hand, the increase in prevalence with advancing age of several chronic diseases unrelated to heart failure, such as dementia [13][14][15][16] , suggests that older adults with heart failure may accumulate comorbidity as they survive into old age. An existing framework developed by Piette and Kerr (2006) characterizes comorbid conditions as either concordant with the primary disease-related in pathophysiology or management and on the same treatment pathway-or discor-dant with the primary disease-unrelated in pathophysiology or management and not likely to be part of the same treatment plan 17,18 .…”

Section: Introductionmentioning

confidence: 99%

Change in Comorbidity Prevalence with Advancing Age Among Persons with Heart Failure

et al. 2011

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BACKGROUND: Comorbidity-a condition that co-exists with a primary illness-is common among older persons with heart failure and can complicate the overall management of this population. OBJECTIVES: To determine the relationship between advancing age and the prevalence and patterns of comorbidity among older persons with heart failure. DESIGN: Retrospective longitudinal cohort study PARTICIPANTS: A total of 201,130 Medicare beneficiaries with heart failure stratified into three age strata in 2001: 66-75, 76-85, and 86+ years, and followed over 5 years. MEASUREMENTS: (1) Prevalence of 19 conditions as identified by the Chronic Conditions Warehouse fromMedicare claims data, characterized as concordant (related to heart failure) or discordant (unrelated to heart failure), and (2) overall comorbidity burden, defined as count of conditions. RESULTS: The median number of comorbidities rose from four (IQR: 2-5) to five (IQR: 4-7) among the youngold, and from 4 (IQR: 3-6) to 6 (IQR: 5-8) among the middle-old and oldest-old between 2001 and 2006. In 2001, the majority of concordant conditions were more prevalent among the youngest than oldest beneficiaries (e.g., diabetes 46.2% vs 26.9%; kidney disease 21.8% vs 18.4%), while the majority of discordant conditions were more prevalent among the oldest-old than youngest-old beneficiaries (e.g., dementia 39.6% vs 9.9%; hip fracture 9.5% vs 1.9%). Discordant conditions increased in prevalence faster among the oldest than youngest beneficiaries (e.g., dementia 13% points versus 9% points). CONCLUSION: Among older Medicare beneficiaries with heart failure, there is a higher overall burden of comorbidity and greater prevalence of discordant comorbidity among the oldest old. Comorbidity prevalence increases over time, with discordant comorbidity increasing at the fastest rate among the oldest old. This comorbidity burden highlights the challenge of effectively treating heart failure while simultaneously managing co-existing and unrelated conditions.

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“…1,2 Although the prevalence of Alzheimer disease (AD), Lewy bodies, and other brain pathologies appears to plateau in the tenth decade and beyond, 3 the risk of dementia continues to double with every 5 years of age reaching a staggering 40% per year in centenarians. 2 The causes of dementia and cognitive loss in extreme aging have been difficult to discern. Although AD continues to be the most frequent pathology in the oldest-old, many clinical pathologic studies have suggested a weakening of the association between dementia in this age group and individual pathologies including AD, vascular disease, and Lewy bodies.…”

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confidence: 99%

Multiple pathologies are common and related to dementia in the oldest-old

et al. 2015

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Objective: The purpose of this study was to examine the role of multiple pathologies in the expression of dementia in the oldest-old.Methods: A total of 183 participants of The 901 Study with longitudinal follow-up and autopsy were included in this clinical-pathologic investigation. Eight pathologic diagnoses (Alzheimer disease [AD], microinfarcts, hippocampal sclerosis, macroinfarcts, Lewy body disease, cerebral amyloid angiopathy, white matter disease, and others) were dichotomized. We estimated the odds of dementia in relation to each individual pathologic diagnosis and to the total number of diagnoses. We also examined dementia severity in relation to number of pathologic diagnoses.Results: The presence of multiple pathologic diagnoses was common and occurred more frequently in those with dementia compared with those without dementia (45% vs 14%). Higher numbers of pathologic diagnoses were also associated with greater dementia severity. Participants with intermediate/high AD pathology alone were 3 times more likely to have dementia (odds ratio 5 3.5), but those with single non-AD pathologies were 12 times more likely to have dementia (odds ratio 5 12.4). When a second pathology was present, the likelihood of dementia increased 4-fold in those with intermediate/high AD pathology but did not change in those with non-AD pathologies, suggesting that pathologies may interrelate in different ways. Conclusions:In the oldest-old, the presence of multiple pathologies is associated with increased likelihood and severity of dementia. The effect of the individual pathologies may be additive or perhaps synergistic and requires further research. Multiple pathologies will need to be targeted to reduce the burden of dementia in the population. Neurology ® 2015;85:535-542

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Dementia incidence continues to increase with age in the oldest old: The 90+ study

Cited by 428 publications

References 33 publications

Incidence of mild cognitive impairment in the Pittsburgh Cardiovascular Health Study–Cognition Study

Incidence of mild cognitive impairment in the Pittsburgh Cardiovascular Health Study–Cognition Study

Change in Comorbidity Prevalence with Advancing Age Among Persons with Heart Failure

Multiple pathologies are common and related to dementia in the oldest-old

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