Future Dementia Prevalence Research Articles

Future projections of the prevalence of dementia in Japan: results from the Toyama Dementia Survey

BackgroundThis study aimed to make future projections of the nationwide prevalence of dementia in Japan using the prevalence of dementia from the Toyama Dementia Survey and population projections.MethodsWe performed linear regression analysis using the prevalence of dementia by sex and age in 1985, 1990, 1996, 2001, and 2014 from the Toyama Dementia Survey to calculate the estimated future prevalence by sex and age. The estimated prevalence was then multiplied by the estimated future population of people aged 65 years and older by sex and age in each of the 47 prefectures from 2020 to 2045 and added together to calculate the total number of people with dementia. The estimated future prevalence of dementia was calculated by dividing the calculated number of people with dementia by the estimated future population of people aged 65 years and older in each of the 47 prefectures. In addition, the estimated future prevalence of dementia in each of the 47 prefectures from 2020 to 2045 was presented on a map of Japan and grayscale-coded in four levels.ResultsIn 2020, the estimated future prevalence of dementia did not exceed 20% in any prefecture, but in 2025, five prefectures, mainly rural prefectures, had projected rates exceeding 20%. In 2030, the prevalence rate is projected to exceed 20% nationwide, and by 2035, the rate will exceed 25% in 42 prefectures. In 2045, all prefectures excluding Tokyo are projected to have a dementia prevalence rate exceeding 25%, and the rate will exceed 30% in 12 of 47 prefectures.ConclusionsOver the next 25 years, the prevalence of dementia in people older than 65 years is projected to exceed 25% nationwide, including metropolitan areas.

1491Impact of COVID19 on years of life lost with and without disability across 18 European-countries

Abstract Background To accurately assess the impact of COVID19 on life-expectancy, years of life lost, and prevalence of dementia and disability, a model integrating calendar-trends in cardiovascular-disease, dementia, disability and mortality is required. We estimated these impacts in Austria, Belgium, Czech-Republic, Denmark, Estonia, France, Germany, Greece, Hungary, Italy, The Netherlands, Poland, Portugal, Slovenia, Spain, Sweden, Switzerland, and the UK. Methods Data to inform the ten-state Monte-Carlo Markov-model for the 18 European countries were derived from official-statistics for population-numbers and mortality-rates (age&sex-specific) and from Survey for Health, Ageing and Retirement in Europe for prevalence-estimates and transition-probabilities. Impact of COVID19 was measured comparing the estimates derived from incorporating expected mortality rates assuming calendar-trends in mortality and incidence of dementia, disability, and cardiovascular-disease continue those of the past two-decades, and those incorporating excess COVID19 mortality. Results Assuming COVID-19 vaccination and termination of the pandemic will be accomplished by the end of 2021, the pandemic will have resulted in a loss of 9.3M (95% Uncertainty-Interval 1.3M-29.8M) person-years of life, including 7.1M person-years of dementia-free life and 5.2M person-years of disability-free life among the 289M population (as of 2019) above age-35. The effects on prevalence of dementia, disability and life-expectancy will be presented. Conclusions The impact of the pandemic on disability-free person-years of life lost are devastating, marking a need for more rapid actions to halt the spread of epidemics. Key messages Accurate estimation of future prevalence of dementia and disability to quantify the impact of the pandemic on years of life lost needs to simultaneously account for the declining trends in incidence of dementia and the decline in cardiovascular disease incidence and mortality resulting in increased life-expectancy and a larger pool susceptible to dementia and disability. The COVID19 pandemic is estimated to result in 9.3million person-years of life lost in 18 European countries including a loss of 7.1M person-years of dementia-free life and 5.2M person-years of disability-free life.

Construction of Essential Care Service Package for People Living with Dementia in Smoke-free Environment under Disease Pandemic in China

Objectives: In recent years, the harm of smoking has attracted more and more public attention. Creating a healthy smoke-free environment has been widely favored and supported by the public. Smokeless environment has a certain positive effect on the rehabilitation of dementia patients. Sustained smoking cessation is associated with significantly decreased the future prevalence of dementia. Therefore, hospitals often establish a special organizational structure and management model for tobacco control, and carry out training and assessment for all staff. The nursing group also took it as the basic nursing standard. The 2019 disease pandemic has posed unique health threats to people living with dementia (PLWD). Therefore, a strict smoke-free environment is more necessary for the nursing group. One of the key challenges is scaling up long-term care services to meet the needs of the rapidly growing population of PLWD in developing countries. The aim of the study is to explore the care service needs, utilization and build an essential care service package (ECSP) for PLWD under the disease pandemic in China. Methods: From July 2018 to October 2019, a total of 1255 elderly with dementia in six cities in China by a cluster sampling were investigated with the self-designed questionnaire. Care service needs and utilization for PLWD with different levels of cognitive impairment were summarized. Results: The ECSP for PLWD was composed of 30 service items (7 for core care) in order to guarantee that all PLWD enjoy equal care services, basing on public financing and implementing strategies and taking China's situations into account. The selection plan for ECSP at different levels is designed as 'General Care Services + Selective Care Services ', in which respective service items for low, mid, and high-level care for PLWD are 7+3, 7+6, and 7+10, and requires 151.41 hours, 201.88 hours, and 252.35 hours per month, respectively. Conclusion: The present study provides the first large-scale data on care service needs and utilization for PLWD in mainland China. The ECSP for PLWD based on the needs advanced in the paper was a practicable and effective quantitative management means that deserves a large-scale application. Some safeguard mechanisms and operational implementing pathways of ECSP for PLWD during and after the disease pandemic in China are proposed.

The Contribution of Eight Modifiable Risk Factors to Dementia Prevalence in Jamaica

The number and proportion of dementia cases in Jamaica attributable to eight modifiable lifestyle factors was calculated using factor analysis in Stata and Levin’s Attributable Risk formula (hypertension, diabetes mellitus, depression, low educational attainment, smoking, overweight, obesity and vision problems). Four sources of data were used: (1) risk factor prevalence data were obtained from the Jamaica Health and Lifestyle Survey, 2008, (2) relative risk data were sourced from published meta-analyses, (3) factor analysis in Stata version 15 was performed to estimate shared variance among risk factors utilising data from the Health and Social Status of Older Persons in Jamaica Study and, (4) estimated prevalence of dementia in Jamaica in 2012 was obtained from a 2018 publication by Shearer et al. Obesity was found to be responsible for the largest proportion of dementia cases (13.94%; 2508 cases) followed by hypertension (10.64%; 1917 cases), low educational attainment (7.21%; 1299 cases), overweight (6.42%; 1156 cases), smoking (3.90%; 702 cases), diabetes (3.38%; 608 cases), depression (1.00%; 181 cases) and impaired vision (0.002%; 34 cases%). Using this largely theoretical model, the eight factors examined account for approximately 46.0% of dementia cases. Dementia risk reduction programs that target even one of these factors has the potential to result in significant reduction in future dementia prevalence as they are all interrelated. In future work, as these data become available, the contribution of mid-life obesity, mid-life hypertension and physical inactivity will also be taken into consideration.

Cognitive reserve and resilience: Possible mechanisms of dementia prevention

AbstractBackgroundPredictions about future dementia prevalence vary but usually suggest large increases in numbers of people with dementia as the population ages. However, in some countries, for example, the US, UK and Netherlands, while overall numbers of people with dementia are growing as predicted, the age‐specific incidence rates of dementia have decreased substantially. This is probably due to educational, socio‐economic, health and lifestyle changes.MethodWe reviewed known risk factors listed in the 2017 Lancet commission: education, hypertension, hearing impairment, smoking, obesity, depression, exercise, diabetes and social contact; literature about cognitive reserve and considered effective interventions for these risks.ResultCognitive reserve is the brain resilience which allows for cognition maintenance despite neuropathological damage. Early, mid and late life factors are all important. Early‐life factors, such as education, are important for cognitive reserve and those with more education build greater cognitive reserve. Lifelong higher educational attainment also reduces dementia risk. Cognitive reserve is not static and is affected by a number of factors. Quantifying it uses proxy measures such as education, residual approaches (the variance of cognition not explained by demographic variables and brain measures) or identifying underlying brain functional. People in more cognitively demanding jobs tend to show less cognitive deterioration before, and sometimes after retirement than those in less demanding jobs. Hypertension and obesity in mid‐life are risk factors for dementia, as is hearing impairment. More frequent social contacts at age 60 years is associated with lower dementia risk over 15 years of follow‐up. Smoking in late life increases the risk of dementia. In later life people’s physical health may moderate the susceptibility to neuropathology. Those who are frail may develop Alzheimer’s disease with a lesser burden of neuropathology. Older people otherwise in good physical health can sustain a higher burden of neuropathology without cognitive impairment. There are however relatively few evidence based interventions and we will discuss what interventions we found in systematic review and what developments are still needed.ConclusionThere are clinically and economically effective interventions. It is important to consider the stage of the life course when thinking about possible effective interventions to prevent dementia.

Proportion of Dementia Explained by Five Key Factors in Jamaica.

Background:Dementia has no known cure and age is its strongest predictor. Given that populations in the Caribbean are aging, a focus on policies and programs that reduce the risk of dementia and its risk factors is required.Objective:To estimate the proportion of dementia in the Jamaican setting attributable to key factors.Methods:We analyzed the contribution of five modifiable risk factors to dementia prevalence in Jamaica using a modified Levin’s Attributable Risk formula (low educational attainment, diabetes, smoking status, depression, and physical inactivity). Four sources of data were used: risk factor prevalence was obtained from the Jamaica Health and Lifestyle Survey, 2008, relative risk data were sourced from published meta-analyses, shared variance among risk factors was determined using cross-sectional data from the Health and Social Status of Older Persons in Jamaica Study. Estimated future prevalence of dementia in Jamaica was sourced from a published ADI/BUPA report which focused on dementia in the Americas. We computed the number of dementia cases attributable to each risk factor and estimated the effect of a reduction in these risk factors on future dementia prevalence.Results:Accounting for the overlapping of risk factors, 34.46% of dementia cases in Jamaica (6548 cases) were attributable to the five risk factors under study. We determined that if each risk factor were to be reduced by 5% –10% per decade from 2010–2050, dementia prevalence could be reduced by up to 14.0%.Conclusion:As the risk factors for dementia are shared with several of the main causes of death in Jamaica, a reduction in risk factors by even 5% can result in considerable public health benefit.

Decline in the Incidence of All-Cause and Alzheimer's Disease Dementia: a 12-Year-Later Rural Cohort Study in Korea.

BackgroundThere has been no study on the time trends of dementia incidence in Korea. We report the 5-year incidence and its correlates of all-cause and Alzheimer's disease (AD) dementia, and compared our results with those of a 12-year-prior cohort study conducted in the same area.MethodsA total of 751 community-dwelling older adults were followed up for a mean duration of 5.4 years. The age-, gender-, and educational attainment-specific incidence of all-cause and AD dementia were reported as cases per 1,000 person-years. We performed univariate and multivariate cox proportional hazard regression analyses to determine whether baseline sociodemographic, lifestyle, and clinical variables were associated with the risk of all-cause and AD dementia. A 12-year-prior cohort study was used for descriptive comparison to indicate the time trends of dementia incidence.ResultsThe incidence rates were 16.2 and 13.0 cases per 1,000 person-years for all-cause and AD dementia, respectively. The baseline diagnosis of mild cognitive impairment increased the 5-year incidence of all-cause dementia by more than 4-fold. Old age and low baseline global cognitive function were noted as risk factors for both all-cause and AD dementia.ConclusionUpon comparing the results with those from the earlier cohort study in Yeoncheon, the incidence of all-cause and AD dementia decreased by approximately 40% over 12 years; it has been mainly driven by the increase in the educational level of older adults. The declining time trends of incidence should be taken into account for estimating the future prevalence of dementia in Korea.

A simulation of dementia epidemiology and resource use in Australia

Objectives:The number of people in the developed world who have dementia is predicted to rise markedly. This study presents a validated predictive model to assist decision‐makers to determine this population's future resource requirements and target scarce health and welfare resources appropriately. Methods:A novel individual patient discrete event simulation was developed to estimate the future prevalence of dementia and related health and welfare resource use in Australia. Results:When compared to other published results, the simulation generated valid estimates of dementia prevalence and resource use. The analysis predicted 298,000, 387,000 and 928,000 persons in Australia will have dementia in 2011, 2020 and 2050, respectively. Health and welfare resource use increased markedly over the simulated time‐horizon and was affected by capacity constraints. Conclusions:This simulation provides useful estimates of future demands on dementia‐related services allowing the exploration of the effects of capacity constraints. Implications for public health:The model demonstrates that under‐resourcing of residential aged care may lead to inappropriate and inefficient use of hospital resources. To avoid these capacity constraints it is predicted that the number of aged care beds for persons with dementia will need to increase more than threefold from 2011 to 2050.

The proportion of dementia attributable to common modifiable lifestyle factors in Barbados.

ABSTRACTObjectiveTo understand what number and proportion of dementia cases in Barbados are attributable to modifiable lifestyle factors and what effect a reduction in these risk factors would have on future dementia prevalence.MethodsThis was an observational study using Levin's Attributable Risk formula, which assumes independence of risk factors, to calculate the population attributable risk (PAR) of dementia (all-cause) for six risk factors: midlife obesity, physical inactivity, smoking, low educational attainment, diabetes mellitus, and midlife hypertension in Barbados. A recently-published, modified formula was utilized to account for non-independence of risk factors using secondary data for Barbados. The number and proportion of dementia cases attributable to each risk factor and to all risk factors combined were computed, as was the effect that any reduction in these risk factors might have on future dementia prevalence.ResultsAccounting for the fact that risk factors do not operate independently, 50.9% (1 526 cases) were attributable to the combined effect of the six risk factors under study. According to the analysis, if each risk factor were reduced by 5% – 20% per decade, dementia prevalence could be 3.3% – 31.8% lower by 2050.ConclusionUsing a largely theoretical model, the six modifiable lifestyle factors were estimated to be attributable to 50.9% of dementia cases in Barbados. Since the risk factors have much in common, any intervention that targets one of them could significantly reduce future dementia prevalence.

Temporal trend in dementia incidence since 2002 and projections for prevalence in England and Wales to 2040: modelling study

Objective To forecast dementia prevalence with a dynamic modelling approach that integrates calendar trends in dementia incidence with those for mortality and cardiovascular disease.Design Modelling study.Setting General adult population of...

A NATIONAL DEMENTIA REGISTER FOR IRELAND: THE RIGHT APPROACH TO MEETING OUR DEMENTIA DATA NEEDS?

With dementia prevalence set to increase as our population ages, there is an urgent need to gather valid epidemiological data in Ireland that provides accurate and reliable estimates of current and future dementia prevalence and facilitates the development of effective dementia health and social policy. This study examined the feasibility of developing a national dementia register for Ireland. A rapid review of national and international patient registry literature was undertaken to identify registry functions, underlying design and process models, best-practice guidelines for their development, and the legal, ethical, clinical, technology, and financial issues relevant to the creation of an Irish dementia registry. Following ethical approval, we also conducted two focus groups with people with dementia and twenty-one expert stakeholder interviews with clinicians, and representatives from research, health, and social care organisations in Ireland and the UK, existing Irish patient registries, and international dementia registries. Discussions followed an agreed structure, were audio-recorded, transcribed, and analysed using inductive content analysis. Common themes that emerged from the literature review and stakeholder discussions were: registry function; registry data; benefits and risks; governance; legislation; barriers and facilitators; lessons learned; best practice; and complexities within the Irish system. Given the government strategy of addressing research and information systems as part of the 2014 National Dementia Strategy, it is opportune to examine the best approach to improving dementia data recording in Ireland. These results provide an evidence-base on which to progress this debate.

Proportion of dementia in Australia explained by common modifiable risk factors

BackgroundAt present, dementia has no known cure. Interventions to delay onset and reduce prevalence of the disease are therefore focused on risk factor reduction. Previous population attributable risk estimates for western countries may have been underestimated as a result of the relatively low rates of midlife obesity and the lower weighting given to that variable in statistical models.MethodsLevin’s Attributable Risk which assumes independence of risk factors was used to calculate the proportion of dementia attributable to seven modifiable risk factors (midlife obesity, physical inactivity, smoking, low educational attainment, diabetes mellitus, midlife hypertension and depression) in Australia. Using a recently published modified formula and survey data from the Australia Diabetes, Obesity and Lifestyle Study, a more realistic population attributable risk estimate which accounts for non-independence of risk factors was calculated. Finally, the effect of a 5–20% reduction in each risk factor per decade on future dementia prevalence was computed.ResultsTaking into consideration that risk factors do not operate independently, a more conservative estimate of 48.4% of dementia cases (117,294 of 242,500 cases) was found to be attributable to the seven modifiable lifestyle factors under study. We calculated that if each risk factor was to be reduced by 5%, 10%, 15% and 20% per decade, dementia prevalence would be reduced by between 1.6 and 7.2% in 2020, 3.3–14.9% in 2030, 4.9–22.8% in 2040 and 6.6–30.7% in 2050.ConclusionOur largely theory-based findings suggest a strong case for greater investment in risk factor reduction programmes that target modifiable lifestyle factors, particularly increased engagement in physical activity. However, further data on risk factor treatment and dementia risk reduction from population-based studies are needed to investigate whether our estimates of potential dementia prevention are indeed realistic.

Future policy directions for planning of national responsibility for dementia care

Dementia is one of the biggest global public health challenges facing our generation today. By 2030, Korea is projected to have the highest life expectancy in the world. The government's new plans regarding national responsibility for dementia care are well-timed strategies for patients and family members suffering from dementia and should be welcomed. The newly designed national dementia strategy of Korea may set new standards for dementia welfare policies. However, these plans should be modified after careful consideration of following aspects: financial sustainability, issues related with long-term care systems for other critical diseases, and instantaneous nationwide implementation without a period of trial-and-error learning. More gradual and steady policy initiatives is preferred. Through consensus we should strategically develop the optimal quality control system for dementia care and education program for training physicians, dementia-care professionals, and workers to be deployed in both specialized 72 public dementia care hospitals and nationwide 252 regional dementia centers. In addition, these care plans should also include health policy aiming the primary prevention to reduce future dementia prevalence while creating dementia-friendly communities and emphasizing clinical and basic research for dementia. Modifying the current plans for the Korean national dementia strategy using stepwise, well-integrated, and systematic approaches will lead to successful dementia welfare policy.

055 THE FEASIBILITY OF A NATIONAL DEMENTIA REGISTER FOR IRELAND

Background: There is an acknowledged lack of information about dementia in Ireland, including very poor coding of dementia across all care settings. Yet with dementia prevalence set to increase as our population ages, there is an urgent need to gather valid epidemiological data that provides accurate and reliable national estimates of current and future dementia prevalence, and facilitates the development of robust and effective dementia health and social policy (Cahill, O’Shea, & Pierce, 2012). This study, commissioned as part of the Alzheimer Society of Ireland evidence-based policy series, examined the feasibility of developing a national dementia register for Ireland. Methods: A rapid review of national and international patient registry literature was undertaken to identify registry functions, underlying design and process models, and best-practice guidelines for their development. A ‘landscape analysis’ identified the legal, ethical, clinical, technology, and financial issues relevant to the creation of an Irish dementia register. Following ethical approval, we conducted two focus groups with people with dementia and twenty-one expert stakeholder interviews with clinicians and with representatives from research, health, and social care organisations in Ireland and the UK, existing Irish patient registries, and international dementia registries. Discussions followed an agreed structure, were audio-recorded, transcribed, and analysed using inductive content analysis. Results: Common themes emerged from the literature and stakeholder discussions with regard to: registry function; benefits and risks; data collection; data management; governance; legislation; barriers and facilitators; Irish complexities; and best-practice. Conclusions: The results provide an evidence-base on which to progress the issue of improved recording structures for dementia in Ireland. Given the strategic approach the government is now taking to address research and information systems as part of the 2014 National Dementia Strategy, it is opportune to examine the potential for a framework to collect information in a reliable, accurate, valid, complete, and timely way

A commentary on studies presenting projections of the future prevalence of dementia

BackgroundPopulation ageing over the first half of this century is likely to lead to dramatic increases in the prevalence of dementia. This will affect all regions of the world, but particularly developing regions. Dementia projections have been used extensively to support policy. It is therefore important these projections are as accurate as possible.DiscussionIn this paper we provide a commentary on studies projecting the future prevalence of dementia for the world or for individual continents. We identify some important limitations of the methods used in published projections and provide recommendations to improve the accuracy of future projections, and allow for the checking of the accuracy of the predictions.SummaryAccurate projections of dementia incidence, at both the global and local level, are essential for healthcare planners.

Midlife obesity and dementia: Meta‐analysis and adjusted forecast of dementia prevalence in the united states and china

Obesity is a risk factor of dementia. Current forecasts of dementia prevalence fail to take the rising obesity prevalence into account. Embase and Medline were searched for observational studies on the association between overweight (BMI 25-30 kg/m(2)) or obesity (BMI > 30 kg/m(2)) and dementia and pooled the effect sizes by meta-analysis. The population attributable risk (PAR) was calculated for different time points and adjusted them for confounders. Based on current prevalence rates of dementia and demographic forecasts, patient numbers were calculated and adjusted by the growth rates of PAR. Compared to normal weight, midlife obesity increases the risk of dementia later in life (BMI 25-30: RR = 1.34 [95% CI 1.08, 1.66], BMI > 30: RR = 1.91 [1.4, 2.62]). If obesity is included into forecast models, the prevalence of dementia is estimated to be 7.1 million (6.9, 7.3) and 11.3 million (10.9, 11.7) for the United States in 2030 and 2050, respectively. In China, the estimate is 13.1 million (12.8, 13.3) in 2030 and 26.2 million (25.1, 27.4) in 2050. These figures are 9% and 19% higher for the United States and China, respectively, than forecasts that rely solely on the demographic change. The past and ongoing increase in midlife obesity prevalence will contribute significantly to the future prevalence of dementia and public health measures to reduce midlife obesity are simultaneously primary prevention measures to reduce the risk of dementia.

An Estimate of the Worldwide Prevalence and Direct Costs of Dementia in 2003

Dementia disorders are today considered to be a major driver of costs in health care and social systems and worrying estimates of future dementia prevalence have been presented. It is of great interest for policy makers to have an estimate of dementia disorders’ contribution to global social and health care costs, particularly in light of the demographic prognoses. The worldwide costs of dementia were estimated from prevalence figures for different regions, and cost-of-illness studies from key countries using a model based on the relationship between direct costs of care per demented and the gross domestic product per capita in each country. The worldwide direct costs for dementia in 2003 are estimated at 156 billion USD in the main scenario based on a worldwide prevalence of 27.7 million demented persons (sensitivity analysis: 129–159 billion USD). Ninety-two percent of the costs are found in the advanced economies with 38% of the prevalence. Although there are several sources of uncertainty, it is obvious that the worldwide costs are substantial and the expected increase in elderly people in the developing countries presents a great challenge.

Dementia and age at death.

The objective of this paper is to investigate changes in dementia mortality, as recorded on death certificates in Canada. Use is made of data available at Statistics Canada for the period 1990-1991. During this period there have been appreciable changes over time in the ages at death and in the percentage of death certificates that mention dementia. This increase in mortality associated with dementia can be explained, in large part, by an increased tendency for dementia to be listed as an underlying cause of death on the death certificate. Also, the median ages at death of persons in Canada for the period 1990-1991, for whom dementia is recorded as the underlying cause of death, are similar to or greater than the ages at death reported for all other causes of death but excluding dementia. Because those who have dementia are living longer, there is an increase in the number of people with dementia (prevalence of dementia); this has important implications concerning public policy on health and aging. We discuss the significance of these changes with respect to the future prevalence of dementia.