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Aging and the occurrence of dementia: Findings From a Population-Based Cohort With a Large Sample of Nonagenarians
Stockholm Gerontology Research Center, Division of Geriatric Medicine, Neurotec, Karolinska Institute, Stockholm.ORCID iD: 0000-0001-5800-6454
Stockholm Gerontology Research Center, Division of Geriatric Medicine, Neurotec, Karolinska Institute, Stockholm.
Stockholm Gerontology Research Center, Division of Geriatric Medicine, Neurotec, Karolinska Institute, Stockholm.
Stockholm Gerontology Research Center, Division of Geriatric Medicine, Neurotec, Karolinska Institute, Stockholm.
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1999 (English)In: Archives of Neurology, ISSN 0003-9942, E-ISSN 1538-3687, Vol. 56, no 5, 587-592 p.Article in journal (Refereed) Published
Abstract [en]

Context In spite of numerous studies on the occurrence of dementia, many questions remain, such as the relation between age, aging, and dementing disorders. This question is relevant both for understanding the pathogenetic mechanism of the dementias and for the public health prospective because of the increasing number of 85-year-old or older persons in our population.

Objective To estimate the occurrence of dementia in the very old, including nonagenarians, in relation to age, gender, and different dementia types.

Design An epidemiological survey where all participants were clinically examined by physicians, assessed by psychologists, and interviewed by nurses. The Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition (DSM-III-R) criteria for dementia were followed. A category of "questionable dementia" was added when all criteria were not fulfilled. A double diagnostic procedure was used for all subjects.

Setting Community-based population, including all inhabitants of 2 areas in central Stockholm, Sweden (N=1848).

Participants Of the 1848 subjects in the study population, 168 (9.1%) had died and 56 (3%) moved before examination. Of the remaining subjects, 1424 (87.7%) were examined, and the refusal rate was 12.3%.

Main Outcome Measures Age- and gender-specific prevalence figures, and gender- and education-adjusted odds ratios were used.

Results At the end of the diagnostic procedure, 358 clinically definite cases of dementia and 101 questionable cases of dementia were identified. Alzheimer disease (AD) contributed to 76.5%, and vascular dementia (VaD) to 17.9%. The prevalence of dementia increases from 13% in the 77- to 84-year-old subjects to 48% among persons 95 years and older (from 18% to 61% when questionable cases were included). The odds ratio for subjects 90 to 94 years and 95 years and older in comparison with 77- to 84-year-old subjects was 3.7 (95% confidence interval [CI], 2.7-5.1) and 6.5 (95% CI, 3.9-10.8) for dementia, 4.8 (95% CI, 3.3-7.0) and 8.0 (95% CI, 4.6-14.0) for persons with AD, 2.3 (95% CI, 1.3-4.2) and 4.6 (95% CI, 1.9-11.2) for VaD, respectively.

Conclusions Dementia prevalence continues to increase even in the most advanced ages. This increase is especially evident among women and is more clear for AD. We believe that our prevalence data reflect the differential distribution of dementia risk.

Place, publisher, year, edition, pages
American Medical Association , 1999. Vol. 56, no 5, 587-592 p.
Keyword [en]
aging, dementia
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:rkh:diva-615DOI: 10.1001/archneur.56.5.587PubMedID: 10328254OAI: oai:DiVA.org:rkh-615DiVA: diva2:610558
Available from: 2013-03-12 Created: 2013-03-12 Last updated: 2016-04-19Bibliographically approved
In thesis
1. Being old in our society: health, functional status, and effects of research
Open this publication in new window or tab >>Being old in our society: health, functional status, and effects of research
2000 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This thesis concerns health and functional status in old age, as well as older adults' attitudes towards research participation. Five studies were performed using data from the Kungsholmen Project, a population-based study on ageing and dementia ongoing in Stockholm since 1987.

Occurrence of dementia. Both prevalence and incidence of dementia were investigated. In the 75-79 age group the incidence rates for dementia were 19.6 for women and 12.4 for men per 1,000 person-years, whereas the corresponding figures were 86.7 and 15.0 among 90+ year old subjects. A prevalence study with an enlarged sample of nonagenarians showed that the probability of having dementia after the age of 75 increased by 10% each year and 90% every 5 years. AD contributed to 76. 5% and VaD to 17.9% of the prevalent cases.

Health and functional status. Higher morbidity prevalence in women than in men was detected only after the age of 85. 90+ year old women compared to men had an OR=2.2 (95% CI 1.1-4-3) for disability after adjustment for age, education, and number of diseases. Functionally independent men in the youngest age group had a higher risk of death than women (OR=0.4; 95% CI 0.3-0.7), whereas no gender difference was found among disabled subjects. Incidence of long term disability in women was higher than in men only in the 90+ years old subjects, although the difference was not statistically significant after adjustment.

Effects of research. In a postal questionnaire, 79% of the subjects reported advantages in research participation. Older elderly with impaired cognitive functioning and lower education showed the least positive attitude. The first contact and the cognitive testing were judged as the most stressful situations. Community-based longitudinal surveys also appear to have a social function, thus stressing ethical issues regarding the termination of contact when studies are completed.

Conclusions. The dementia incidence increases with age, even in the most advanced ages. This increase is especially evident among women, leading to an increased risk of dementia in the male gender. A large proportion of nonagenarians were functionally independent (73%) despite their advanced age, and 19% had no diseases at all. The gender distribution of morbidity, mortality and disability was modified by age. 90+ year old women were more disabled than men, partially due to the excess of dementia and other chronic diseases. We hypothesise that more women may be at higher risk of developing severe disability than men in the advanced ages due to a longer survival of women with slight disability in earlier ages.

Finally, this thesis provides empirical data concerning the impact of longitudinal research on participants that may help researchers in lowering the refusal rate in epidemiological studies, and might assist ethics committees in making their judgements.

Place, publisher, year, edition, pages
Stockholm: Norstedts Förlag, 2000. 51 p.
Keyword
ageing, attitude, dementia, functional status, morbidity, participation, population survey, nonagenarians
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:rkh:diva-561 (URN)91-628-4189-0 (ISBN)
Public defence
2000-05-25, Finskt Äldrecentrum, Sabbatsbergsområdet, Olivecronas väg 14, 00:00
Available from: 2014-09-17 Created: 2013-03-01 Last updated: 2016-04-19Bibliographically approved

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