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. 2017 Nov 1;74(11):1345-1351.
doi: 10.1001/jamaneurol.2017.1964.

Trends in Dementia Incidence in a Birth Cohort Analysis of the Einstein Aging Study

Carol A Derby  1   2 , Mindy J Katz  1 , Richard B Lipton  1   2 , Charles B Hall  1   2
Affiliations

Trends in Dementia Incidence in a Birth Cohort Analysis of the Einstein Aging Study

Carol A Derby et al. JAMA Neurol. .

Abstract

Importance: Trends in dementia incidence rates have important implications for planning and prevention. To better understand incidence trends over time requires separation of age and cohort effects, and few prior studies have used this approach.

Objectives: To examine trends in dementia incidence and concomitant trends in cardiovascular comorbidities among individuals aged 70 years or older who were enrolled in the Einstein Aging Study between 1993 and 2015.

Design, setting, and participants: In this birth cohort analysis of all-cause dementia incidence in persons enrolled in the Einstein Aging Study from October 20, 1993, through November 17, 2015, a systematically recruited, population-based sample of 1348 participants from Bronx County, New York, who were 70 years or older without dementia at enrollment and at least one annual follow-up was studied. Poisson regression was used to model dementia incidence as a function of age, sex, educational level, race, and birth cohort, with profile likelihood used to identify the timing of significant increases or decreases in incidence.

Exposures: Birth year and age.

Main outcomes and measures: Incident dementia defined by consensus case conference based on annual, standardized neuropsychological and neurologic examination findings, using criteria from the DSM-IV.

Results: Among 1348 individuals (mean [SD] baseline age, 78.5 [5.4] years; 830 [61.6%] female; 915 [67.9%] non-Hispanic white), 150 incident dementia cases developed during 5932 person-years (mean [SD] follow-up, 4.4 [3.4] years). Dementia incidence decreased in successive birth cohorts. Incidence per 100 person-years was 5.09 in birth cohorts before 1920, 3.11 in the 1920 through 1924 birth cohorts, 1.73 in the 1925 through 1929 birth cohorts, and 0.23 in cohorts born after 1929. Change point analyses identified a significant decrease in dementia incidence among those born after July 1929 (95% CI, June 1929 to January 1930). The relative rate for birth cohorts before July 1929 vs after was 0.13 (95% CI, 0.04-0.41). Prevalence of stroke and myocardial infarction decreased across successive birth cohorts, whereas diabetes prevalence increased. Adjustment for these cardiovascular comorbidities did not explain the decreased dementia incidence rates for more recent birth cohorts.

Conclusions and relevance: Analyses confirm decreasing dementia incidence in this population-based sample. Whether decreasing incidence will contribute to reduced burden of dementia given the aging of the population is not known.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Derby reported receiving grants from the National Institute on Aging during the conduct of the study and personal fees from the National Institutes of Health for reviewing proposals outside the submitted work. Ms Katz reported receiving grant support from Eli Lilly and Company outside the submitted work. Dr Lipton reported receiving grants from the National Institutes of Health during the conduct of the study and from the National Headache Foundation and Boston Scientific; serving on the editorial board of Neurology and as a senior adviser to Headache; reviewing for the National Institute on Aging and the National Institute of Neurological Disorders and Stroke; holding stock options in eNeura Therapeutics; serving as a consultant or advisory board member or receiving honoraria from Alder, Allergan, the American Headache Society, Amgen, Autonomic Technologies, Avanir, Boehringer Ingelheim, Boston Scientific, Bristol-Myers Squibb, CoLucid, Dr. Reddy’s, ElectroCore, Eli Lilly and Company, eNeura Therapeutics, Merck, Novartis, Pfizer, Teva, and Vedanta; and receiving royalties from Wolff’s Headache and Other Head Pain, 8th Edition and Informa. Dr Hall reported conducting data analyses for this project and receiving grants from the National Institute on Aging during the conduct of the study, personal fees from the National Institutes of Health, personal fees from Washington University, St Louis, personal fees from University of Cincinnati, grants from the National Institute on Aging, grants and other support from the National Institute for Occupational Safety and Health, grants from the National Cancer Institute, and grants from National Center for Advancing Translational Sciences outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Crude Dementia Incidence in the Einstein Aging Study Cohort as a Function of Date of Birth and Age
Data were smoothed using locally weighted scatterplot smoothing (LOESS) methods.
Figure 2.
Figure 2.. Prevalence of Myocardial Infarction, Stroke, and Diabetes at the Age of 80 Years by Year of Birth, Einstein Aging Study Cohort
Locally weighted scatterplot smoothing (LOESS) curves of prevalence as a function of date of birth are shown.
See this image and copyright information in PMC

References

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