Incidence and prevalence of dementia in the cardiovascular health study

被引:296
作者
Fitzpatrick, AL
Kuller, LH
Ives, DG
Lopez, OL
Jagust, W
Breitner, JCS
Jones, B
Lyketsos, C
Dulberg, C
机构
[1] Univ Washington, Dept Epidemiol, Seattle, WA 98115 USA
[2] Univ Washington, Dept Biostat, Seattle, WA 98115 USA
[3] Univ Pittsburgh, Sch Med, Dept Neurol, Pittsburgh, PA USA
[4] Univ Pittsburgh, Sch Med, Dept Psychiat, Pittsburgh, PA USA
[5] Univ Pittsburgh, Grad Sch Publ Hlth, Dept Epidemiol, Pittsburgh, PA USA
[6] Univ Calif Davis, Dept Neurol, Davis, CA 95616 USA
[7] VA Puget Sound Hlth Care Syst, Seattle, WA USA
[8] Univ Washington, Sch Med, Dept Psychiat & Behav Sci, Div Geriatr Psychait, Seattle, WA 98195 USA
[9] Wake Forest Univ, Bowman Gray Sch Med, Dept Psychiat, Winston Salem, NC USA
[10] Johns Hopkins Univ, Sch Publ Hlth, Dept Mental Hyg, Baltimore, MD USA
[11] Johns Hopkins Univ, Sch Med, Dept Psychiat & Behav Sci, Baltimore, MD 21205 USA
关键词
Alzheimer's disease; dementia; education; incidence; prevalence; race; vascular dementia;
D O I
10.1111/j.1532-5415.2004.52058.x
中图分类号
R592 [老年病学]; C [社会科学总论];
学科分类号
03 ; 0303 ; 100203 ;
摘要
OBJECTIVES: To estimate the incidence and prevalence of dementia, Alzheimer's disease (AD), and vascular dementia (VaD) in the Cardiovascular Health Study (CHS) cohort. DESIGN: Longitudinal cohort study using prospectively and retrospectively collected data to evaluate dementia. SETTING: Four U.S. communities. PARTICIPANTS: There were 3,602 CHS participants, including 2,865 white and 492 African-American participants free of dementia, who completed a cranial magnetic resonance image between 1992 and 1994 and were followed for an average of 5.4 years. MEASUREMENTS: Dementia was classified by neurologist/psychiatrist committee review using neuropsychological tests, neurological examinations, medical records, physician questionnaires, and proxy/informant interviews. Demographics and apolipoprotein E (APOE) genotype were collected at baseline. Incidence by type of dementia was determined using National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association criteria for AD and Alzheimer's Disease Diagnostic and Treatment Center's State of California criteria for VaD. RESULTS: Classification resulted in 227 persons with prevalent dementia at entry into the study and 480 incident cases during follow-up. Incidence rates of dementia scaled to age 80 were 34.7 per 1,000 person-years for white women, 35.3 for white men, 58.8 for African-American women, and 53.0 for African-American men. Sex differences were not significant within race. Adjusted for age and education, racial differences were only of borderline significance and may have been influenced by ascertainment methodology. Rates differed substantially by educational attainment but were only significant for whites. Those with the APOE epsilon4 allele had an incidence rate at age 80 of 56.4, compared with 29.6 for those without this allele (P<.001). In whites, type-specific incidence at age 80 was 19.2 for AD versus 14.6 for VaD. These rates were 34.7 and 27.2 for African Americans. At termination of observation, women had only a slightly higher prevalence of dementia (16.0%) than men (14.7%). CONCLUSION: Sex and racial differences were not found, and VaD was higher than reported in other studies. These data provide new estimates of dementia incidence in a community sample for projection of future burden.
引用
收藏
页码:195 / 204
页数:10
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