New Cases Of Dementia Research Articles

Epigenetic Determinants of Healthy and Diseased Brain Aging and Cognition

A better understanding of normal and diseased brain aging and cognition will have a significant public health impact, given that the oldest-old persons older than 85 years of age represent the fastest-growing segment in the population in developed countries, with more than 30 million new cases of dementia predicted to occur worldwide each year by 2040. Dysregulation of gene expression and, more generally, genome organization and function are thought to contribute to age-related declines in cognition. Remarkably, nearly all neuronal nuclei that reside in an aged brain had permanently exited from the cell cycle during prenatal development, and DNA methylation and histone modifications and other molecular constituents of the epigenome are likely to play a critical role in the maintenance of neuronal health and function throughout the entire lifespan. Here, we provide an overview of age-related changes in the brain's chromatin structures, highlight potential epigenetic drug targets for cognitive decline and age-related neurodegenerative disease, and discuss opportunities and challenges when studying epigenetic biomarkers in aging research.

Ascertainment bias in dementias: a secondary to tertiary centre analysis in Central Italy and conceptual review

Ascertainment bias (AB) indicates a bias of an evaluation centre in estimating the prevalence/incidence of a disease due to the specific expertise of the centre. The aim of our study was to evaluate classification of different types of dementia in new cases appearing in secondary and tertiary centres, in order to evidence possible occurrence of AB in the various (secondary to tertiary) dementia centres. To assess the mechanism of AB, the rates of new cases of the different forms of dementia reported by different centres were compared. The centres involved in the study were 11 hospital-based centres including a tertiary centre, located in the University Department of Clinical Neurology. The tertiary centre is endowed with state-of-the-art diagnostic facilities and its scientific production is prominently focused on dementia with Lewy bodies (DLB) thus suggesting the possible occurrence of a bias. Four main categories of dementia were identified: Alzheimer's disease (AD), DLB, fronto-temporal dementia (FTD), vascular dementia (VaD), with other forms in a category apart. The classification rate of new cases of dementia in the tertiary centre was compared with rates reported by secondary centres and rates of recoding were calculated during a follow-up of 2years. The study classified 2,042 newly diagnosed cases of dementia in a population of 1,370,000 inhabitants of which 315,000 were older than 65. AD was categorized in 48-52% of cases, DLB in 25-28%, FTD in 2-4% and VaD in 17-28%. During the 2-year follow-up the diagnosis was re-classified in 40 patients (3%). The rate of recoding was 5% in the tertiary centre, 2-8% in referrals from secondary to tertiary centre, 2-10% in recodings performed in secondary centres and addressed to tertiary centre. Recoding or percentages of new cases of AD or DLB were not different in the comparison between secondary or between secondary and tertiary centres. FTD and VaD were instead significantly recoded. The results of the study suggest that in a homogeneous area, AB is not interfering with diagnosis of AD or DLB.

Alzheimer’s Disease: is the Clue in the eyes?

The statistical projection on dementia is becoming increasingly familiar, largely through media coverage and increasing awareness of its future impact on society. In the UK, dementia affects one individual in 20 over the age of 65 years, increasing to one in six over the age of 80 years [101]. According to Alzheimer’s Research UK, 163,000 new cases of dementia occur every year. By 2021, there will be close to 1 million people with dementia in the UK [102]. International governments now recognize that there will be a dramatic rise in the prevalence of age-related disorders such as dementia. The economic cost in the UK is estimated to be £23 billion [102]; however, globally, the greatest costs will probably occur in societies with insufficient resources. If dementia is discovered and treated early, the onset of the worst symptoms may be delayed, allowing sufferers to have a better quality of life. However, the current diagnostic procedures for Alzheimer’s disease (AD) do not appear to be suitable for the global challenges that lie ahead. There is an urgent need for the development of diagnostic tests for AD that can be used universally, irrespective of culture or ethnicity. The current diagnosis process is plagued by various problems, one of the most pressing being the difficulty in detecting the disease in its early stages; this is due to the difficulty in distinguishing between normal age-related changes in memory function and the early cognitive impairment that signals the trajectory of AD. The diagnostic process is protracted as it proceeds by the careful exclusion of other causes, which would lead to a delay in the diagnosis of probable AD. The Mini Mental State Examination test [1] is widely used in the assessment and monitoring of patients with dementia but it is widely recognized that the test lacks sensitivity in patients with mild cognitive impairment or in highly educated individuals. Functional brain imaging with PET to detect amyloid deposits in the brain is very promising, but the high costs make this technique very unlikely to be suitable as a general diagnostic procedure. For many older patients, the detailed and long psycho logical test batteries pose a problem of compliance if patients are not able to fully comprehend the tests, sustain their attention or lose motivation. Some cognitive assessments will not be suitable for older patients with motor or

Body Adiposity in Later Life and the Incidence of Dementia: The Health in Men Study

ObjectiveTo determine if adiposity in later life increases dementia hazard.MethodsCohort study of 12,047 men aged 65–84 years living in Perth, Australia. Adiposity exposures were baseline body mass index (BMI), waist circumference (WC) and waist-to-hip ratio (WHR). We used the Western Australian Data Linkage System (WADLS) to establish the presence of new cases of dementia between 1996 and 2009 according to the International Classification of Diseases (ICD). Crude and adjusted hazard ratio (HR, 95% confidence interval, 95%CI) of dementia for each adiposity marker was calculated using Cox regression models. Other measured factors included age, marital status, education, alcohol use, smoking, diet, physical activity, and prevalent hypertension, diabetes, dyslipidaemia and cardiovascular disease.ResultsCompared with men with BMI<25, participants with BMI between 25–30 had lower adjusted HR of dementia (HR = 0.82, 95% CI = 0.70–0.95). The HR of dementia for men with BMI≥30 was comparable to men with BMI<25 (HR = 0.82, 95%CI = 0.67–1.01). Waist circumference showed no obvious association with dementia hazard. Men with WHR≥0.9 had lower adjusted HR of dementia than men with WHR <0.9 (HR = 0.82, 95%CI = 0.69–0.98). We found a “J” shape association between measures of obesity and the hazard of dementia, with the nadir of risk being in the overweight range of BMI and about 1 for WHR.ConclusionsHigher adiposity is not associated with incident dementia in this Australian cohort of older men. Overweight men and those with WHR≥0.9 have lower hazard of dementia than men with normal weight and with WHR<0.9.

Very Mild to Severe Dementia and Mortality: A 14-Year Follow-Up – The Odense Study

Background/Aims: To examine the mortality of very mildly to severely demented persons compared to nondemented persons. Methods: Participants in a randomly drawn population-based cohort study on dementia were followed for 14 years from 1992 to 2006. Participants were examined at baseline (3,065 nondemented and 234 prevalent demented), after 2 years (2,286 nondemented and 145 incident demented) and again after 5 years (1,669 nondemented and 124 new cases of dementia). Causes of death were ascertained in 884 nondemented and 286 demented participants. Survival for demented compared to nondemented persons was analyzed with the Cox proportional hazards model with time-dependent covariates adjusted for gender and age. Results: The hazard ratio of death (95% confidence interval) increased from 1.82 (1.55–2.14) for the very mildly demented to 9.52 (6.60–13.74) for the severely demented subjects. The demented participants died significantly more often of neurological causes other than dementia and of pneumonia than the nondemented participants. No other significant differences in causes of death were found. Conclusion: Dementia increased the risk of death. Even in the very early stages of dementia the risk of death was increased.

B-type natriuretic peptide as a predictor of declining cognitive function and dementia—a cohort study of an elderly general population with a 5-year follow-up

Background. Several traditional cardiovascular risk factors assessed in the middle-aged are associated with the risk of dementia, but they are known to lose much of their prognostic value when measured in the elderly. The aim of the study was to compare B-type natriuretic peptide (BNP) with previously known risk markers for dementia in their association with cognitive decline and dementia during a follow-up.Methods. A total of 464 subjects free of dementia aged 75 years or more were examined and followed up for 5 years in a prospective population-based stratified cohort study. The association of clinical variables to base-line Mini Mental State Examination score (MMSE), the decline of MMSE, and onset of dementia during the follow-up were examined.Results. The only variable to significantly associate with the decline of MMSE was BNP (beta 0.140; P = 0.019). A total of 59 new cases of dementia were diagnosed after the follow-up. Significant predictors of the occurrence of dementia over the study period were BNP (adjusted odds ratio (OR) 1.53; 95% confidence interval (CI) 1.09–2.16; P = 0.013), length of education (OR 0.50; 95% CI 0.33–0.77; P = 0.001), and diagnosis of hypertension (OR 0.53; 95% CI 0.27–0.95; P = 0.036). BNP remained as a significant predictor of dementia and the decline of MMSE even after adjustment to the base-line MMSE.Conclusions. BNP is an independent harbinger of the cognitive decline and incidence of new onset of dementia in an elderly general population. This is a ground for testing the impact of antihypertensive treatment in the prevention of cognitive impairment in those with elevated BNP.

Predictors of Cognitive Decline in Older Individuals With Diabetes

OBJECTIVE—The purpose of this study was to determine longitudinal predictors of cognitive decline in older individuals with diabetes who did not have dementia.RESEARCH DESIGN AND METHODS—Cognitive assessments were performed in 205 subjects with diabetes (mean age 75.3 years) and repeated a median 1.6 years later. The sample was drawn from an existing cohort study, and data on diabetes, cardiovascular risk factors, and complications were collected 7.6 ± 1.1 years before and at the time of the initial cognitive assessment. Cognitive status was defined using the Clinical Dementia Rating (CDR) scale, and cognitive decline was defined by change in CDR.RESULTS—The sample included 164 subjects with normal cognition (CDR 0) and 41 with cognitive impairment without dementia (CDR 0.5). At follow-up, 33 (16.1%) had experienced cognitive decline (4 new cases of dementia and 29 cognitive impairment without dementia). Only educational attainment predicted cognitive decline from the data collected 7.6 years before cognitive assessment. Univariate predictors of cognitive decline at the time of the first cognitive assessment included age, education, urinary albumin-to-creatinine ratio (ACR), and treatment with either ACE inhibitors (ACEIs) or angiotensin receptor blockers (ARBs). With multiple logistic regression controlling for age and education, cognitive decline was predicted by natural logarithm ACR (odds ratio 1.37 [95% CI 1.05–1.78], P = 0.021), whereas treatment with either ACEIs or ARBs was protective (0.28 [0.12–0.65], P = 0.003).CONCLUSIONS—In this sample of older patients with diabetes, microalbuminuria was a risk factor for cognitive decline, whereas drugs that inhibit the renin-angiotensin system were protective. These observations require confirmation because of their considerable potential clinical implications.

Dementia and physical activity

Already today, the increase in life expectancy and the accelerated increase in longevity—the number of centenarians will triple from the year 2000 to 2050 [15]—confronts us with questions which are not easily answered. But what we can realize from social and economic development is that we will be forced not only to cure diseases but much more to prevent them. This particularly applies to those diseases which coincide with the aging development as Alzheimer’s disease and other forms of dementia. There is not only need of reliable and valid dementia diagnosis [8] and of effective medication but there is also an urgent need to discover and implement effective physical activity interventions. With the worldwide demographic trend of population aging, Alzheimer’s disease and other forms of dementia will become an increasingly major public health problem among the elderly. The term “dementia” describes a syndrome associated with a range of diseases which are characterized by the progressive impairment of brain functions, including language, memory, perception, personality, and cognitive skills. These diseases lead to a decline in the ability to perform everyday activities. These declines in mental function may manifest themselves through different symptoms at various times. Alzheimer’s disease is themost common form of dementia, estimated to be responsible for 70% of dementia cases. It is followed by vascular dementia as probably the next common type. Depression affects up to 40% of patients with dementia, usually when dementia is mild or moderate, andmay cause vegetative symptoms, e.g., withdrawal, anorexia, weight loss, or insomnia (cf. [12]). Wimo et al. [18] estimated the worldwide occurrence of dementia in 2000 and during the period 1950–2050. The calculations were based on worldwide demographics of the elderly and age-specific prevalence and incidence values of dementia, estimated from a meta-analysis. The worldwide number of persons with dementia in 2000 was estimated at about 25 million persons. Almost half of the demented persons (46%) lived in Asia, 30% in Europe, 12% in North America, 7% in Latin America, and 5% in Africa. About 6.1% of the population of 65 years of age and older suffered from dementia (about 0.5% of the worldwide population) and 59% were female. Incidence rates were recently calculated from United Nations estimations and projections from prevalence, remission, and mortality data by Ferri et al. [4]. Though evidence from well-planned representative epidemiological surveys is scarce in many regions, they found that 24–30 million people have dementia today, with four to six million new cases of dementia every year (one new case every 7 s). The number of people affected will double every 20 years to 81–100 million by 2040. Most people with dementia live in developing countries—60% in 2001 and rising to 71% by 2040. Rates of increase are not uniform; numbers in developed countries are forecasted to increase by 100% between 2001 and 2040 and by more than 300% in India, China, and their south Asian and western Pacific neighbors. These detailed estimates seem to constitute the best currently available basis for policymaking, planning, and allocation of health and welfare resources. We must conclude that dementia is one of the most common causes of institutionalization, morbidity, and mortality among the elderly and we have to face the obvious consequences. Eur Rev Aging Phys Act (2008) 5:1–3 DOI 10.1007/s11556-008-0033-6

Enhanced risk for Alzheimer disease in persons with type 2 diabetes and APOE epsilon4: the Cardiovascular Health Study Cognition Study.

Diabetes and the apolipoprotein E epsilon4 allele (APOE epsilon4) increase the risk for Alzheimer disease (AD). We hypothesize that APOE epsilon4 may modify the risk for AD in individuals with diabetes. To examine the joint effect of type 2 diabetes and APOE epsilon4 on the risk of AD, AD with vascular dementia (mixed AD), and vascular dementia without AD. The Cardiovascular Health Study (CHS) Cognition Study (1992-2000) is a prospective study designed to identify all existing and new cases of dementia among study participants. Diagnoses were made according to international criteria for dementia and subtypes. There were 2547 dementia-free participants in the CHS Cognition Study cohort with complete information on APOE epsilon4 and type 2 diabetes status; among these, 411 new cases of dementia developed. Risk of dementia was estimated with a Cox proportional hazard model adjusted for age and other demographic and cardiovascular risk factors. Compared with those who had neither type 2 diabetes nor APOE epsilon4, those with both factors had a significantly higher risk of AD (hazard ratio, 4.58; 95% confidence interval, 2.18-9.65) and mixed AD (hazard ratio, 3.89; 95% confidence interval, 1.46-10.40). These data suggest that having both diabetes and APOE epsilon4 increases the risk of dementia, especially for AD and mixed AD.

Homocysteine, B vitamins, and the incidence of dementia and cognitive impairment: results from the Sacramento Area Latino Study on Aging

Background:High concentrations of homocysteine have been linked to a greater risk of Alzheimer disease, dementia, and cognitive decline.Objective:We evaluated the association between homocysteine and 4.5-y combined incidences of dementia and cognitive impairment without dementia (CIND) in a cohort of 1779 Mexican Americans aged 60–101 y.Design:Homocysteine, red blood cell (RBC) folate, and plasma vitamin B-12 were measured at baseline. New cases of dementia or CIND were ascertained by neuropsychological and clinical examinations and expert adjudication. We used proportional hazards models to estimate the risk of homocysteine-associated dementia or CIND and the influence of RBC folate and plasma vitamin B-12 on that association.Results:High homocysteine concentrations were associated with a greater risk of dementia or CIND: hazard ratio (HR): 2.39; 95% CI: 1.11, 5.16. Plasma vitamin B-12 modified the association between homocysteine and the outcome. The rates of dementia or CIND associated with homocysteine for those in the lowest and highest tertiles of vitamin B-12, respectively, were significantly higher (HR: 1.61, P= 0.04) and lower (HR: 0.94, P= 0.015) than the risk for those in the middle tertile.Conclusions:Homocysteine is an independent risk factor for both dementia and CIND. Higher plasma vitamin B-12 may reduce the risk of homocysteine-associated dementia or CIND.

Improving the quality of care for mild to moderate dementia: an evaluation of the Croydon Memory Service Model

The large majority of people with dementia receive nothing in the way of specialist assessment and care at any stage of their illness. There is a particular lack of services focussed on early identification and intervention in dementia where there is the possibility of long-term harm reduction for people with dementia and their family carers. We have developed a model of care that is complementary to local systems of health and social care (The Croydon Memory Service Model [CMSM]). This is a low-cost, high-throughput, generic service to enable early identification and intervention in dementia. It is a multi-agency approach with joint ownership by health services, social services and the voluntary sector with embedded specifically-tailored approaches to primary care and minority ethnic communities. We completed a service evaluation of the introduction of the CMSM in a single borough in South London. Six predefined service goals were set: high acceptability; high appropriate referral rate; successful engagement with people from minority ethnic groups; successful engagement with people with young onset dementia; focus on engagement with mild cases to enable early intervention; and an increase in the overall number of new cases of dementia seen. Mixed qualitative and quantitative methodologies were used including a description and 6-month follow-up of a cohort of 290 consecutive referrals. All key predefined service goals were met: 95% acceptability; 94% appropriate referrals; successful engagement with minority ethnic groups (two-fold greater number compared with that expected from general population demographic data); 17% of referrals under 65 years of age; 68% referrals with mild or minimal dementia severity; and an estimated 63% increase in the number of new cases of dementia seen in Croydon. At 6-month follow up, those referred to the service had decreased behavioural disturbance and increased quality of life compared with baseline. Specific services for early dementia, which deliver diagnosis and care, can be established. These services can increase the numbers of people with early dementia identified and provided with care. Those receiving such services appear to improve in terms of quality of life and behavioural and psychological symptoms of dementia. Next steps should include the establishment of such services in other representative areas and evaluation of their effectiveness in comparison with other models of care.

Viabilidad de un registro de demencias: características clínicas y cobertura diagnóstica

Classic epidemiological studies do not allow to know the dementia patterns of derivation and diagnosis in a defined territory. This information is fundamental for the planning and distribution of the sanitary and social resources to a medium-to-long term. The results of a pilot-registry program for dementia cases based on the population surveillance principles is presented. Consecutive and standardized registry of the incident dementia diagnoses of a memory unit during biennium 2004-2005. 670 new cases of dementia, of which 74% corresponded to Alzheimer's disease, were registered. The presenile dementias were 10.3% of the cases. The mean time between the beginning of the symptoms and the clinical diagnosis was of 2.4 years and the severity of the dementia was mild in 60.0%. 90.1% of the cases lived in their homes or in a relative's home. The hypertension, the diabetes mellitus and the antecedents of depressive disease were the more frequent pathological antecedents (> 20%). The diagnostic coverage based on the estimated dementia cases was 75% for the memory unit's reference territorial area. The diagnostic coverage for the health region of Girona was 38%. The registered data show the viability and validity of the proposed registry program for dementia cases. Nowadays the registry program is able to extend the diagnostic coverage all over the health region of Girona.

Plasma Phosphatidylcholine Docosahexaenoic Acid Content and Risk of Dementia and Alzheimer Disease

Docosahexaenoic acid (DHA) is an abundant fatty acid in the brain. In the diet, DHA is found mostly in fatty fish. The content of DHA has been shown to be decreased in the brain and plasma of patients with dementia. To determine whether plasma phosphatidylcholine (PC) DHA content is associated with the risk of developing dementia. A prospective follow-up study in 899 men and women who were free of dementia at baseline, had a median age of 76.0 years, and were followed up for a mean of 9.1 years for the development of all-cause dementia and Alzheimer disease. Plasma PC fatty acid levels were measured at baseline. Cox proportional regression analysis was used to assess relative risks of all-cause dementia and Alzheimer disease according to baseline plasma levels. Ninety-nine new cases of dementia (including 71 of Alzheimer disease) occurred during the follow-up. After adjustment for age, sex, apolipoprotein E epsilon4 allele, plasma homocysteine concentration, and education level, subjects in the upper quartile of baseline plasma PC DHA levels, compared with subjects in the lower 3 quartiles, had a relative risk of 0.53 of developing all-cause dementia (95% confidence interval, 0.29-0.97; P=.04) and 0.61 of developing Alzheimer disease (95% confidence interval, 0.31-1.18; P=.14). Subjects in the upper quartile of plasma PC DHA levels had a mean DHA intake of 0.18 g/d and a mean fish intake of 3.0 servings per week (P<.001) in a subset of 488 participants. We found no other significant associations. The top quartile of plasma PC DHA level was associated with a significant 47% reduction in the risk of developing all-cause dementia in the Framingham Heart Study.

Präsenile Demenzen in Gedächtnisambulanzen — Konsultationsinzidenz und Krankheitscharakteristika

This study describes the clinical features of presenile dementia diagnosed in memory clinics. It further gives an estimate of the declared incidence for the German city of Munich and surrounding counties. Twelve memory clinics in Switzerland and Germany were considered, among them all of the four in Munich. A total of 267 patients with onset of illness under the age of 65 were included. Only 16 patients (6%) were younger than 50. Men and women were affected about equally often. The most common cause of dementia was Alzheimer's disease (67%), followed by frontotemporal degeneration (13.5%) and vascular (5.6%) dementia. The declared incidence was estimated at 8.3 new cases of dementia per year among 100,000 persons in the 50-64 age range, with an incidence rate of Alzheimer's disease at 6.3/100,000. It can be concluded that memory clinics fulfill an important function in the care of patients with presenile dementia, since they are highly utilized by younger patients in early stages of the illness.

Dementia in primary care: the first survey of Irish general practitioners

To investigate General Practitioners' (GPs) attitudes and practices in relation to screening, diagnosing, and disclosing a dementia diagnosis to patients. National postal survey. A random sample of 600 GPs from a national database of 2,400. Of the 600 GPs surveyed, 60% returned questionnaires of which 50% (300) were useable. GPs reported diagnosing on average four new cases of dementia annually. A multivariate analysis revealed that females diagnosed significantly fewer cases annually (t=5.532, df=289, p<0.001). A large majority of GPs reported performing thyroid function tests (77%), B(12) (75%) and Folic acid tests (75%) to out rule reversible causes of cognitive impairment. The most reliable signs and symptoms of dementia identified were memory problems (58%). Main barriers to diagnosis were difficulty differentiating normal ageing from symptoms of dementia (31%), lack of confidence (30%) and the impact of the diagnosis on the patient (28%). GPs' age (chi(2)=14.592, df=3, p<0.005) and gender (chi(2)=11.436, df=3, p<0.01) were significantly associated with barriers to diagnosis. Only 19% claimed they often or always disclosed a diagnosis to a patient. Over one-third of GPs (38%) reported that the key factor influencing their disclosure patterns was their perceptions of the patient's level of comprehension. Most GPs (90%) had never undergone any dementia specific training and most (83%) expressed a desire for this. GPs experience difficulty diagnosing and disclosing a diagnosis of dementia to patients. To improve dementia care in Ireland, there is an urgent need to develop an active and more systematic approach to GP training in dementia care.

Global prevalence of dementia: a Delphi consensus study.

100 years after the first description, Alzheimer's disease is one of the most disabling and burdensome health conditions worldwide. We used the Delphi consensus method to determine dementia prevalence for each world region. 12 international experts were provided with a systematic review of published studies on dementia and were asked to provide prevalence estimates for every WHO world region, for men and women combined, in 5-year age bands from 60 to 84 years, and for those aged 85 years and older. UN population estimates and projections were used to estimate numbers of people with dementia in 2001, 2020, and 2040. We estimated incidence rates from prevalence, remission, and mortality. Evidence from well-planned, representative epidemiological surveys is scarce in many regions. We estimate that 24.3 million people have dementia today, with 4.6 million new cases of dementia every year (one new case every 7 seconds). The number of people affected will double every 20 years to 81.1 million by 2040. Most people with dementia live in developing countries (60% in 2001, rising to 71% by 2040). Rates of increase are not uniform; numbers in developed countries are forecast to increase by 100% between 2001 and 2040, but by more than 300% in India, China, and their south Asian and western Pacific neighbours. We believe that the detailed estimates in this paper constitute the best currently available basis for policymaking, planning, and allocation of health and welfare resources.

The influence of cerebrovascular risk factors on incident dementia in patients with Parkinson's disease

To examine if risk factors for cerebrovascular disease would increase the risk for dementia in patients with Parkinson's disease (PD). Non-demented patients were recruited from an epidemiological study of PD in the county of Rogaland, Norway. PD and dementia were diagnosed according to strict diagnostic criteria. Established cerebrovascular risk factors were recorded at baseline, and their influence on incident dementia was assessed 4 years later using logistic regression analysis. A total of 171 non-demented PD patients constituted the at-risk population. Seventy-two (55%) had at least one cerebrovascular risk factor. A total of 130 subjects (96% of survivors) completed the follow-up examination. Forty-three (33%) new cases of dementia were found. Twenty-five of the 72 (35%) patients with and 18 of the 58 (31%) subjects without any risk factor developed dementia (ns). A significant association with dementia was found for a diagnosis of heart failure in the univariate analyses. However, in the logistic regression analysis none of the cerebrovascular risk factors were significantly associated with incident dementia. In this large and representative cohort of patients with PD cerebrovascular risk factors were not associated with incident dementia, indicating that the disease-related degenerative brain changes are the main causes of dementia in PD.

Correction: A Breakthrough in R&amp;D for Neglected Diseases: New Ways to Get the Drugs We Need

The third sentence of the Methods and Findings section in the Abstract should read as follows: “Incidence rates rise with age, particularly above the age of 75 y, from 6.7 (95% confi dence interval, 3.8–12.4) per 1,000 person years at age 65–69 y to 68.5 (95% confi dence interval, 52.5–88.1) per 1,000 person years at age 85 y and above.” The fi fth sentence should read as follows: “Hence, it is estimated that approximately 163,000 new cases of dementia occur in England and Wales each year.”

Cognitive Predictors of Dementia in Parkinson’s Disease: A Community-Based, 4-Year Longitudinal Study

Although mild cognitive impairment and dementia are common and have important clinical consequences for patients with Parkinson's disease (PD) and their caregivers, it is still unclear whether cognitive symptoms may predict the development of dementia in PD patients. The objective of this study was to determine whether cognitive deficits in nondemented PD patients predicted the development of dementia 4 years later. A total of 76 nondemented PD patients from an epidemiological study of PD in the county of Rogaland, Norway, were assessed at baseline and 4 years later with neurological, psychiatric, and neuropsychological evaluations. Twenty-five (42%) new cases of dementia were diagnosed after 4 years. Time to complete the third card of the Stroop test was the only variable that was independently associated with dementia. The authors concluded that poor performance on a test sensitive to executive dysfunction predicted later development of dementia in PD patients. This finding may have important clinical implications as a marker of subsequent development of dementia.

The Incidence of Dementia in England and Wales: Findings from the Five Identical Sites of the MRC CFA Study

BackgroundAlthough incidence of dementia is known to vary between nations, variation within country has not been explored because most incidence studies are single site or have insufficient numbers to compare sites. Few countries have conducted multisite incidence studies in order to facilitate national comparisons. This study aims to provide robust measures of the variation of the incidence of dementia across sites within England and Wales and produce overall estimates by age and sex.Methods and FindingsThe Medical Research Council Cognitive Function and Ageing Study used identical methodology in five diverse sites across the United Kingdom, each with different risk patterns and mortality rates. Incidence has been estimated using likelihood-based methods between the first two waves of interviews. Incidence rates rise with age, particularly above the age of 75 y, from 7.4 (95% confidence interval, 3.6–16.1) per 1,000 person years at age 65–69 y to 84.9 (95% confidence interval, 63.0–107.8) per 1,000 person years at age 85 y and above. The rate of increase for both sexes is marked, and continues into the oldest age groups. Hence, it is estimated that approximately 180,000 new cases of dementia occur in England and Wales each year. There is no convincing evidence of variation across sites, and incidence rates do not reflect the variations in the prevalence of possible risk factors in these sites.ConclusionThere is no evidence, within England and Wales, of variation in dementia incidence across sites. Dementia incidence rates do not tail off at the oldest ages.