Epidemiology of Dementia Stefania Maggi CNR-Institute of Neuroscience Aging Branch Padova, Italy

Worldwide population 65+ milion The proportion of Older people will Increase from 7% to 12% Source: United Nation, Population Aging and Development, 2009

Worldwide dementia: the numbers will double every twenty years!! Million Ferri et al., 2005, Lancet 366:2112-17

Epidemiology studying dementia Give the real size of dementia: Prevalence Incidence Risk factors Protective factors (biologic, behavioural, socio-economic) Dementia diagnosis!

Diagnosis: Revised criteria NINDS-ADRDA (McKhann, 2011) for all-cause dementia Cognitive or behavioural (neuropsychiatric) symptoms Interfere with work or usual activities Represent a decline from previous functioning levels Are not explained by delirium Cognitive impairment established by objective cognitive assessment, self- and proxy-reported, and finally confirmed by neuropsychological testing Deficits in at least two following domains: Acquire and remember new information Reasoning and handling complex task Poor judgment Visuospatial abilities Language Changes in personality, behaviour, or comportment

Prevalence studies

Worldwide Prevalence of dementia Qiu et al., 2009, Dialogues. Clin. Neurosci. 11:111-128

EURODEM STUDY Mean prevalence of dementia: 6,4 % 65+ years old Kuopio Study (Finland) Kungsholmen Project (Sweden) Odense Study (Denmark) Rotterdam Study (Netherlands) Melton Mowbray (UK) MCR-ALPHA (UK) PAQUID (France) Pamplona Study (Spain) Zaragoza Study (Spain) ZARADEMP (Spain) ILSA (Italy) Mean prevalence of dementia: 6,4 % 65+ years old

EURODEM STUDY Kuopio Study (Finland) Kungsholmen Project (Sweden) Odense Study (Denmark) Rotterdam Study (Netherlands) Melton Mowbray (UK) MCR-ALPHA (UK) PAQUID (France) Pamplona Study (Spain) Zaragoza Study (Spain) ZARADEMP (Spain) ILSA (Italy)

General Conclusions on Dementia prevalence studies AD prevalence increases with age doubling every 5 years from age 65 Prevalence of AD is higher than prevalence of VaD Need to better define the “mixed” form of dementia Trends in prevalence reflects the influence of the incidence of disease and survival Prevalence and incidence studies based on either hospital records or volunteers underestimate the AD Poor sensitivity of screening test

Incidence studies

Worldwide dementia Incidence Qiu et al., 2009, Dialogues. Clin. Neurosci. 11:111-128

Per 1000 persons-year EURODEM

General Conclusions on Dementia Incidence studies Incidence increases by 2 times about every 5 years Female population has an increased risk of AD Incidence is influenced by applied diagnostic criteria Differences among countries are more pronounced for AD and VaD comparison respect to other forms of dementia

Risk and Protective factors for dementia

Risk Factors Protective Factors APOE-4 allele: susceptibility gene Vascular RF (obesity, high cholesterol) Vascular disease (diabetes, hypertension, TIA, WM lesion) Lifestyle (heavy alcohol intake, smoking) High serum Homocysteine Inflammation Toxic exposure (aluminium, mercury) Traumatic brain injury Depression Antioxidant (Vitam E and C) High serum levels of folate and Vitamin B12 Polyunsaturated fatty acid (Omega 3) High education level Social network and engagement Regular physical activity Active mind

Survival of patients with dementia

ILSA S tudy ILSA coorte: dementia vs.non D ILSA coorte P<0.05

Survival in ILSA coorte: disability According to the Global Burden of Disease estimates, dementia Contributes 11.2% of years lived with disability in people 60+, more than stroke (9.5%), musculoskeletal ds (8.9%), CVD (5%), cancer (2.4%) Demented Non demented P<0.05 P<0.05

Hazard Ratio and 95% CI of death in the ILSA cohort Noale M et al. Dement geriatr Cogn Disord 2003

I COSTI DELLA MALATTIA DI ALZHEIMER COSTO MEDIO ANNUO : circa 43,000.00 Euro (Gambina, et al, 2010) Due studi italiani precedenti (Co.Dem., Bianchetti 1998; Cavallo e Fattore 1997) calcolavano un valore medio tra i 93 e i 98 milioni. In tutti questi studi i costi indiretti, sostenuti in massima parte dalle famiglie, incidono per circa 80% sul totale. I costi associati alla gestione della Demenza di Alzheimer incidono sul PIL, di nazioni diverse, dal 0,6% al 4% circa. Gli studi italiani (Cavallo, Fattore 1997 e Trabucchi 1994) stimavano in Italia una percentuale pari a 1,16% sul PIL, che oggi sono stimati intorno al 4,5%.

Epidemiologia della Demenze: conclusioni

Dementia is a devastating neurodegenerative disorder that will grow up overtime. Multidisciplinary approches to assess dementia (genetic, epidemiologist, clinicians) Prevalence and Incidence increase exponentially with age (65 +) worldwide Take into account Risk and Protective factors In patients with dementia, a comprehensive approach including any comorbidities may improve the prognosis quoad vitam e quoad valetudinem