Incidence of Dementia and Associated Factors in the EPIC-Spain Dementia Cohort

Abstract

Background: Dementia has become a public health priority as the number of cases continues to grow worldwide. Objective: To assess dementia incidence and determinants in the EPIC-Spain Dementia Cohort. Methods: 25,015 participants (57% women) were recruited from three Spanish regions between 1992-1996 and followed-up for over 20 years. Incident cases were ascertained through individual revision of medical records of potential cases. Crude and age-adjusted incidence rates (IR) of dementia and sub-types (Alzheimer’s disease (AD), and non-AD) were calculated by sex. Neelson-Aalen cumulative incidence estimates at 10, 15, and 20 years were obtained for each sex and age group. Multivariate Royston-Parmar models were used to assess independent determinants. Results: Global IR were higher in women for dementia and AD, and similar by sex for non-AD. IR ranged from 0.09 cases of dementia (95% confidence interval: 0.06–0.13) and 0.05 [0.03–0.09] of AD per 1000 person-years (py) in participants below 60 years, to 23.2 (15.9–33.8) cases of dementia and 14.6 (9.1–33.5) of AD (per 1000 py) in those ≥85 years. Adjusted IR were consistently higher in women than men for overall dementia and AD. Up to 12.5% of women and 9.1% of men 60–65 years-old developed dementia within 20 years. Low education, diabetes, and hyperlipidemia were the main independent predictors of dementia risk, whereas alcohol showed an inverse association. Conclusion: Dementia incidence increased with age and was higher among women, but showed no geographical pattern. Dementia risk was higher among subjects with lower education, not drinking alcohol, and presenting cardiovascular risk factors.

Association Between Egg Consumption and Dementia Risk in the EPIC-Spain Dementia Cohort

“…Dietary modifications in the years before dementia or after chronic disease ascertainment are probable, but the exclusions of either dementia cases that occurred in the first 5 years of the follow-up or prevalent cases of chronic diseases at recruitment did not modify our findings. In addition, there is the possibility of a sub-registration of dementia cases that may have not been considered in the public health system due to lack of consultation in public centers, emigration, or premature death for other reasons, although we estimate this probability as low ( 39 ). Finally, a misclassification of the cases might be possible; however, all incident dementia cases were validated by neurologists.…”

Dementia Risk Score for a Population in Southern Europe Calculated Using Competing Risk Models

“…Besides variables found to be statistically significant, we took into account those used previously in predictive models and recommended in the literature [ 17, 33 ]. As the target was a southern European population, Mediterranean diet assessed by the rMED score was also incorporated into the model [ 24 ]. The discriminatory power of the model was assessed using the modified C statistic and the Brier score [ 34 ].…”

The Analysis of Oxidative Stress Markers May Increase the Accuracy of the Differential Diagnosis of Alzheimer’s Disease with and without Depression

“…3 Alzheimer's disease is now considered the most common cause of dementia, accounting for about 70% of all dementias, not only to the high frequency of diagnosis of this disease but also to the relatively long survival of patients. [4][5][6][7] The prevalence of this type of dementia increases with age. [4][5][6][7] Depression is among the most common neuropsychiatric disorder affecting more than 50% of patients diagnosed with AD.…”

“…[4][5][6][7] The prevalence of this type of dementia increases with age. [4][5][6][7] Depression is among the most common neuropsychiatric disorder affecting more than 50% of patients diagnosed with AD. 8,9 The etiology of both conditions may be influenced by various factors: genetics, toxins (endogenous and exogenous), bacterial and viral infections.…”

“…1,18 Depression of the elderly is characterized, inter alia, by anhedonia and the coexistence of various cognitive dysfunctions: in terms of executive function, memory, processing speed, attention and visual-spatial skills 19 and it is associated with an increased risk of developing AD compared to healthy older adults. [4][5][6][7] Pathomechanism of the development of major depressive disorder (MDD) is still associated with many unknowns, but it is believed to have a multi-factorial origin, involving dysfunction of many areas of the brain, such as the hippocampus, prefrontal cortex, nucleus and amygdala. 20 In addition, MDD pathophysiology is associated with an inflammatory process due to microglial activation, increased cytokine release and increased oxidative stress, astrocyte atrophy and changes in glutamatergic regulation, which can lead to local damage.…”