4 Worldwide dementia: the numbers will double every twenty years!! MillionFerri et al., 2005, Lancet 366:
5 Epidemiology studying dementia Give the real size of dementia:PrevalenceIncidenceRisk factorsProtective factors (biologic, behavioural, socio-economic)Dementia diagnosis!
6 Diagnosis: Revised criteria NINDS-ADRDA (McKhann, 2011) for all-cause dementia Cognitive or behavioural (neuropsychiatric) symptomsInterfere with work or usual activitiesRepresent a decline from previous functioning levelsAre not explained by deliriumCognitive impairment established by objective cognitive assessment, self- and proxy-reported, and finally confirmed by neuropsychological testingDeficits in at least two following domains:Acquire and remember new informationReasoning and handling complex taskPoor judgmentVisuospatial abilitiesLanguageChanges in personality, behaviour, or comportment
8 Worldwide Prevalence of dementia Qiu et al., 2009, Dialogues. Clin. Neurosci. 11:
9 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
10 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)
11 General Conclusions on Dementia prevalence studies AD prevalence increases with age doubling every 5 years from age 65Prevalence of AD is higher than prevalence of VaDNeed to better define the “mixed” form of dementiaTrends in prevalence reflects the influence of the incidence of disease and survivalPrevalence and incidence studies based on either hospital records or volunteers underestimate the ADPoor sensitivity of screening test
15 General Conclusions on Dementia Incidence studies Incidence increases by 2 times about every 5 yearsFemale population has an increased risk of ADIncidence is influenced by applied diagnostic criteriaDifferences among countries are more pronounced for AD and VaD comparison respect to other forms of dementia
19 ILSA S tudyILSA coorte: dementia vs.non DILSA coorteP<0.05
20 Survival in ILSA coorte: disability According to the Global Burden of Disease estimates, dementiaContributes 11.2% of years lived with disability in people 60+, more than stroke (9.5%), musculoskeletal ds (8.9%), CVD (5%), cancer (2.4%)DementedNon dementedP<0.05P<0.05
21 Hazard Ratio and 95% CI of death in the ILSA cohort Noale M et al. Dement geriatr Cogn Disord 2003
22 I COSTI DELLA MALATTIA DI ALZHEIMER COSTO MEDIO ANNUO : circa 43, 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%.
24 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 +) worldwideTake into account Risk and Protective factorsIn patients with dementia, a comprehensive approach including any comorbidities may improve the prognosis quoad vitam e quoad valetudinem