Gender and incidence of dementia in the Framingham Heart Study from mid‐adult life

Abstract

Background Gender-specific risks for dementia and Alzheimer's Disease (AD) starting in midlife remain largely unknown. Methods Prospectively ascertained dementia/AD and cause-specific mortality in Framingham Heart Study (FHS) participants was used to generate 10- to 50-year risk estimates of dementia/AD, based on the Kaplan-Meier method (Cumulative Incidence) or accounting for competing risk of death (lifetime risk, LTR). Results Overall, 777 incident dementia (601 AD) occurred in 7,901 participants (4,333 women) over 136,266 person-years. Whereas cumulative incidences were similar in women and men, LTRs were higher in women >85. LTR of dementia/AD at age 45 was 1 in 5 in women, 1 in 10 in men. Cardiovascular mortality was higher in men with rate ratios decreasing from ~6 at 45-54 to <2 after age 65. Conclusion Selective survival of men with a healthier cardiovascular risk profile and hence lower propensity to dementia might partly explain the higher LTR of dementia/AD in women.

A Risk Score for the Prediction of Neurocognitive Disorders among Community-Dwelling Chinese Older Adults

“…The alternative risk score performed similarly well in our sample. Our risk scores perform within a range consistent with previously reported risk scores for cognition (C statistic 0.54-0.81) [2,4,18,19] and with medical risk scores; the Framingham Risk Score is widely used by medical practitioners to predict the risk of coronary heart disease, and it is considered to perform well, with reported C statistics of 0.75-0.80 [24]. This will suffice for general public education and for close surveillance and management of risk factors in primary care.…”

“…There is no difference in model diagnostics between models A and B. However, due to biological differences between males and females and existing evidence suggesting increased risk of dementia among females [16,17,18], it is best to include gender as a variable. Therefore, the risk score from model B was chosen to be the tool for risk prediction of NCD in the community.…”

Neuropsychological Criteria for Mild Cognitive Impairment in the Framingham Heart Study’s Old-Old

“…Diagnosis of dementia in the FHS has been previously described [16]. Individuals with clear or questionable cognitive deficits are discussed in a dementia diagnostic review meeting during which a team, including at least one neurologist and one neuropsychologist, reviews all available information for the participants to reach a consensus diagnosis.…”

Ascertainment of Dementia Cases in the Spanish European Prospective Investigation into Cancer and Nutrition-Murcia Cohort

“…Nevertheless, the project was later extended to evaluate additional endpoints, such as stroke and acute myocardial infarction (as part of the EPIC-Heart and EPIC-CVD projects) [4], diabetes (EPIC-Interact) [5] or Parkinson Disease (NeuroEPIC) [6], taking advantage of the vast amount of data and research infrastructure of the EPIC project in an efficient way. Similarly, other studies, such as the Framingham Cohort Study [7][8][9] or the Cardiovascular Health study [10,11], initially focused on a primary outcome (cardiovascular disease), were later successfully used to assess other outcomes such as dementia.…”

“…By contrast, ascertainment of dementia is more difficult in those studies without cognitive screenings at baseline. In some cases, such as the above-mentioned examples [7,8,10], a random sample of the overall cohort was obtained, and the neuropsychological assessment was performed on this subcohort. However, this is still expensive and not always possible.…”