Number Of Dementia Cases Research Articles

Trends in prevalence, mortality, and risk factors of dementia among the oldest-old adults in the United States: the role of the obesity epidemic.

The oldest-old population, those aged ≥ 80years, is the fastest-growing group in the United States (US), grappling with an increasingly heavy burden of dementia. We aimed to dissect the trends in dementia prevalence, mortality, and risk factors, and predict future levels among this demographic. Leveraging data from the Global Burden of Disease Study 2019, we examined the trends in dementia prevalence, mortality, and risk factors (with a particular focus on body mass index, BMI) for US oldest-old adults. Through decomposition analysis, we identified key population-level contributors to these trends. Predictive modeling was employed to estimate future prevalence and mortality levels over the next decade. Between 1990 and 2019, the number of dementia cases and deaths among the oldest-old in the US increased by approximately 1.37 million and 60,000 respectively. The population growth and aging were highlighted as the primary drivers of this increase. High BMI emerged as a growing risk factor. Females showed a disproportionately higher dementia burden, characterized by a unique risk factor profile, including BMI. Predictions for 2030 anticipate nearly 4 million dementia cases and 160,000 related deaths, with a marked increase in prevalence and mortality anticipated among those aged 80-89. The past 30years have witnessed a notable rise in both the prevalence and mortality of dementia among the oldest-old in the US, accompanied by a significant shift in risk factors, with obesity taking a forefront position. Targeted age and sex-specific public health strategies that address obesity control are needed to mitigate the dementia burden effectively.

Dementia and Hip Fractures

» The elderly population is the fastest growing demographic, and the number of dementia cases in the United States is expected to double to 10 million by 2050.» Patients with dementia are at 3× higher risk of hip fractures and have higher morbidity and mortality after hip fractures.» Hip fracture patients with dementia benefit from early analgesia and timely surgical fixation of fracture.» Early and intensive inpatient rehabilitation is associated with improved postoperative outcomes in patients with dementia.» Coordination of care within a “orthogeriatric” team decreases mortality, and fracture liaison services show potential for improving long-term outcomes in hip fracture patients with dementia.

PS-C01-12: EARLY DETECTION OF DEMENTIA USING AI-BASED EYE-TRACKING TECHNOLOGY

Responding to the rapid rise in the number of dementia cases is becoming increasingly urgent. A great deal of evidence indicates that early diagnosis and timely intervention lead to beneficial outcomes. Vascular risk factors such as hypertension can be a potential target for dementia prevention as controlling blood pressure can reduce the risk of developing dementia later in life. A diagnostic method for the easy and accurate detection of mild symptoms of dementia is necessary to provide early intervention. Neuropsychological tests, such as the Mini-Mental State Examination (MMSE), are commonly used as a screening tool to detect cognitive impairment. These traditional neuropsychological tests are valid and reliable; however, they are not sufficiently simple and rapid as routine screening tools. Here, we developed a newly developed eye tracking-based cognitive assessment tool to detect cognitive impairment. The gaze points of the subjects were recorded by the eye-tracking device while a series of short (178 s) task movies are displayed on the monitor, and the cognitive scores are determined from the gaze plots data. Eighty participants, including 27 cognitively healthy controls (HC), 26 patients with mild cognitive impairment (MCI), and 27 patients with dementia, were assessed by both an eye tracking-based and neuropsychological tests. A strong positive correlation was observed between the MMSE and eye tracking-based cognitive scores (r = 0.74, p < 0.00001, Spearman rank test). The eye tracking-based cognitive scores also correlated well with other neuropsychological tests such as FAB and ADAS-cog, and they also demonstrated a good diagnostic performance in detecting MCI. Eye tracking-based cognitive assessment provides a new platform for a quantitative scoring and sensitive detection of cognitive impairment. Furthermore, we developed an easy-to-administer cognitive assessment application for smart devices such as iPad. This will facilitate early intervention, leading to the prevention of dementia. We are currently conducting a medical device clinical trial in Japan and preparing for the global extension of this service.

Population attributable fractions for risk factors and disability burden of dementia in Jiangxi Province, China: a cross-sectional study

BackgroundIn view of the fact that there is no effective treatment for dementia, the number of years that dementia patients have to live with dementia will gradually increase for the rest of their lives, and the disability loss caused by dementia will increase. It is urgent to study the influence of risk factors on dementia by making use of the potential of prevention. The purpose of this study is to quantify the burden of dementia disability attributable to risk factors by assessing the population attributable fractions (PAFs) in Jiangxi Province, which is one of the regions of moderate aging process of China.MethodsThe prevalence data of nine risk factors were obtained through the Sixth National Health Service Survey in 2018, which covered 2713 older people. Levin’s formula was used to calculate the PAF for each risk factor for dementia. We adjusted the PAF for communality between risk factors, and used these values to calculate overall weighted PAFs and the years lived with disability (YLDs), which were attributable to nine risk factors.ResultsThe number of dementia cases and their proportions that can theoretically be prevented by nine identified risk factors were 111636 (99595-120877) and 66.8% (59.6-72.3), respectively. The total YLDs of dementia were estimated to be 61136 (46463-78369) (males: 36434 [24100-49330], females: 23956 [14716-34589]). Physical inactivity (11639 [8845-14920]), low social contact (9324 [7086-11952]), and hearing loss (5668 [4307-7265] were the top three contributors to dementia.ConclusionsThe moderate aging areas represented by Jiangxi Province have great potential in the prevention of dementia. Targeted interventions and management of risk factors can effectively reduce the disability burden of dementia.

Diagnosing Alzheimer's dementia - a playground for academics or a sensible clinical measure?

The number of dementia cases continues to increase with Alzheimer's disease as the leading cause. The diagnostic workup of Alzheimer's dementia is complex, and its clinical relevance debatable considering the current lack of disease-modifying treatments. From this perspective, a stepwise diagnostic approach is recommended. Whenever Alzheimer's dementia is suspected, a patient' history a physical and psychiatric examination, neuropsychological tests, routine blood tests and standard cerebral imaging should be conducted. This allows in many cases a diagnosis to be given. In cases remaining unclear, modern biomarker tests are proving increasingly useful. Knowledge of the diagnosis is pivotal for the patients to assess the prognosis, to enable them to make plans for their future and to get access to available treatment. The approval of aducanumab in the USA and other promising monoclonal antibodies currently in phase 3-trials as well as the development of blood biomarkers give us hope for the future.

A self-management mobile application system for patients with mild cognitive impairment and mild dementia

The projected increase in the number of dementia cases has prompted the development of an automated solution to assist patients with self-management in everyday life. This paper proposes a new mobile application (app) called DDoMate to help users with Mild Cognitive (MC) impairment or mild dementia, and their caregivers, organise tasks to improve the patient's quality of life. DDoMate has been developed using the latest in research design for medical mobile apps for elderly people to ensure a carefree experience without hassle. DDoMate offers easy to navigate interfaces with large fonts and a dynamic environment that enables users to record their own voices for reminders to manage tasks. DDoMate is implemented in the Android environment and is accessible through the Google App Store. Data within the proposed app is anonymous and can be further analysed using machine learning to improve the self-management characteristics of mild dementia patients.

Association of coffee, green tea, and caffeine with the risk of dementia in older Japanese people.

Coffee, green tea, and caffeine are potential preventive factors for dementia, but the underlying evidence is insufficient. This study aimed to examine associations between the consumption of coffee, green tea, and caffeine and dementia risk in middle-aged and older people. This was a cohort study with an 8.0-year follow-up. Participants were community-dwelling individuals (n=13,757) aged 40-74 years. A self-administered questionnaire survey was conducted in 2011-2013. Predictors were the consumption of coffee/green tea, from which caffeine consumption was estimated. The outcome was incident dementia obtained from the long-term care insurance database. Covariates were demographic factors, body mass index, physical activity, energy, smoking, drinking, and disease history. Adjusted hazard ratios (HRs) were calculated using Cox proportional hazards models. HRs were also calculated using a Cox model with delayed entry. The number of dementia cases during the study period was 309. Participants with higher coffee consumption had lower HRs (adjusted p for trend=0.0014), with the fifth quintile (≥326 ml/day) having a significantly lower HR (0.49, 95% confidence interval [CI]: 0.30-0.79) than the first quintile (<26 ml/day, reference). Similarly, participants with higher caffeine consumption had a significantly lower HR (adjusted p for trend=0.0004) than the reference. The Cox model with delayed entry yielded similar results. These associations were significant in men, but not in women. Moreover, participants who consumed 2-2.9cups/day and ≥3cups/day of coffee had lower HRs (0.69, 95% CI: 0.48-0.98 and 0.53, 95% CI: 0.31-0.89, respectively) than those who consumed 0cup/day. The association between green tea consumption and reduced dementia risk was significant (adjusted p for trend=0.0146) only in the 60-69 years age subgroup. High levels of coffee and caffeine consumption were significantly associated with a reduced dementia risk in a dose-dependent manner, especially in men. Moreover, coffee consumption of ≥3cups/day was associated with a 50% reduction in dementia risk.

Model-Based Projection of Dementia Prevalence in China and Worldwide: 2020-2050.

Current and future incidence and prevalence estimates of dementia are essential for public health planning. The objective was to establish prediction model of incidence and estimate the prevalence of dementia in the Chinese and worldwide population from 2020 to 2050. A model-based method was used to project the dementia prevalence from 2020 to 2050 in China, which required incidence, the mortality rate for individual without dementia, and the relative risk of death. Furthermore, we detected the impact of intervention on the prevalence projection for dementia using a simulation method. We applied the same method to other projections worldwide. In 2020, the model predicted 16.25 million (95%confidence interval 11.55-21.18) persons with dementia in China. By 2050, this number would increase by approximately three-fold to 48.98 million (38.02-61.73). Through data simulation, if the incidence of dementia decreased by 10%every 10 years from 2020 after intervention and prevention, the number of dementia cases by 2050 was reduced by 11.96 million. This would reduce the economic burden by US $639.04 billion. In addition, using this model, dementia cases grew relatively slowly over the next few decades in the United States of America, the United Kingdom, and Japan, with percentage changes of 100.88%, 65.93%, and 16.20%, respectively. The number of people with dementia in China is large and will continue to increase rapidly. Effective interventions could reduce the number of patients drastically. Therefore, prevention and control strategies must be formulated urgently to reduce the occurrence of dementia.

Hearing Impairment and Cognition in an Aging World.

With the increasing number of older adults around the world, the overall number of dementia cases is expected to rise dramatically in the next 40years. In 2020, nearly 6 million individuals in the USA were living with Alzheimer's disease, the most common type of dementia, with anticipated growth to nearly 14 million by year 2050. This increasing prevalence, coupled with high societal burden, makes prevention and intervention of dementia a medical and public health priority. As clinicians and researchers, we will continue to see more individuals with hearing loss with other comorbidities including dementia. Epidemiologic evidence suggests an association between hearing loss and increased risk of dementia, presenting opportunity for targeted intervention for hearing loss to play a fundamental role in dementia prevention. In this discussion, we summarize current research on the association between hearing loss and dementia and review potential casual mechanisms behind the association (e.g., sensory-deprivation hypothesis, information-degradation hypothesis, common cause). We emphasize key areas of research which might best inform our investigation of this potential casual association. These selected research priorities include examination of the causal mechanism, measurement of co-existing hearing loss and cognitive impairment, and potential of aural rehabilitation. Addressing these research gaps and how results are then translated for clinical use is paramount for dementia prevention and overall health of older adults.

The development of a microsimulation model to predict the future burden of dementia and effects of public health interventions

AbstractBackgroundMicrosimulation models can synthesise complex information, evaluate uncertainties, estimate long‐term and population wide effects of (hypothetical) interventions, and take time trends in risk factors into account. No microsimulation models have been developed so far that include all stages from cognitively healthy to severe dementia and evaluate risk factor changes and the effects of (hypothetical) interventions. We developed a microsimulation model that predicts how dementia incidence and mortality will develop over the coming decades in The Netherlands, taking into account different risk factor scenarios and interventions.MethodBased on the well‐known Microsimulation Screening Analysis (MISCAN) model from cancer research, a dementia microsimulation model was developed. It synthesises dementia incidence data and survival probabilities from the large population‐based Rotterdam Study cohort (Ikram et al., 2017) with dementia severity stage duration estimates from the literature (Vermunt et al., 2019). The model simulates the life histories of a large number of individuals, each of whom can develop mild cognitive impairment (MCI) which can then progress to mild dementia and moderate/severe dementia and finally death. Based on these life histories, the number of dementia cases, dementia deaths, (quality adjusted) life years of both patients and caregivers, and costs can be evaluated by age and gender. Finally, the model can estimate the effect of different interventions on the life histories and subsequently the outcome measures.ResultWe were able to develop the MISCAN‐Dementia model, as depicted in Figure 1. MISCAN‐Dementia consists of three modules: a demography module, a natural history module, and a screening module. Given this structure, the model can be used to evaluate long‐term benefits and harms of important interventions at different disease stages: 1) changes in risk factors (i.e. onset of cognitive decline); 2) earlier detection and treatment by population screening (i.e. early, pre‐dementia stage); and 3) care and cure (i.e. dementia stage).ConclusionThe dementia microsimulation model developed in this study predicts how the burden of dementia will develop over the coming decades, including incidence, mortality, quality of life, and costs. In addition, modelling the effect of interventions on a population level will provide essential information for researchers and policy makers.

Is Dementia Becoming a Global Health Concern?

Dementia, a collective term used to characterize a group of conditions such as memory loss and the deterioration of problem-solving abilities, is caused by the impairment of brain functions, and is becoming increasingly prevalent around the world. The World Health Alzheimer’s Report estimates that the number of dementia cases “will increase with an ageing population and will reach 66 million by the year 2030 and 115 million by 2050” (Wortmann, 2012). Currently, there are 35.6 million people that have dementia, and it is stressful for both the individual affected and those who care for them. It also has an enormous economic and psychological impact on these people, and in many countries, there are not sufficient efforts taken to spread awareness about dementia (WHO). Dementia has devastating consequences and is becoming a serious challenge and threat to global health.

Finding critical features for predicting quality of life in tablet-based serious games for dementia

While the number of dementia cases is steadily increasing, as of today no medication has been developed to cure its underlying causes. Instead, the focus in treatment has shifted to improve quality of life (QoL) for people with dementia (PwD). To this end, some non-pharmacological treatments such as exercising, socializing, and playing games have received increasing attention. PflegeTab is a tablet-based application developed for this purpose. It includes a number of services such as cognitive training games, everyday activity training games, emotional applications, and a biographical picture album. In the present paper, we explore the possibility of QoL prediction for PwD using data collected while nursing home residents played games in PflegeTab ($$N = 81$$). Using features generated from the data and applying linear discriminant analysis for classification, our approach obtained an average accuracy of 74.80% on predicting QoL ratings when measured by Monte Carlo cross-validation. Furthermore, this paper investigates which features were dominant for the classification (prominent features were e.g. time needed for task completion) and briefly discusses how the results might be utilized for managing general QoL of PwD.

An integrated, collaborative healthcare model for the early diagnosis and management of dementia: Preliminary audit results from the first transdisciplinary service integrating family medicine and geriatric psychiatry services to the heart of patients\u2019 homes

BackgroundThe number of dementia cases is expected to rise exponentially over the years in many parts of the world. Collaborative healthcare partnerships are envisaged as a solution to this problem. Primary care physicians form the vanguard of early detection of dementia and influence clinical care that these patients receive. However, evidence suggests that they will benefit from closer support from specialist services in dementia care. An interdisciplinary, collaborative memory clinic was established in 2012 as a collaborative effort between a large family medicine based service and a specialist geriatric psychiatry service in Singapore. It is the first service in the world that integrates a family medicine based service with geriatric psychiatry expertise in conjunction with community-based partnerships in an effort to provide holistic, integrated care right into the heart of patients’ homes as well as training in dementia care for family medicine physicians. We describe our model of care and the preliminary findings of our audit on the results of this new model of care.MethodsThis was a retrospective audit done on the electronic medical records of all patients seen at the Memory Clinic in Choa Chu Kang Polyclinic from August 2013 to March 2016. The information collected included gender, referral source, patient trajectories, presence of behavioural and psychological symptoms of dementia and percentage of caregivers found to be in need of support. A detailed outline of the service workflow and processes were described.ResultsA majority (93.5%) of the patients had their memory problems managed at the memory clinic without escalation to other specialist services. 22.7% of patients presented with behavioural and psychological symptoms of dementia. When initially assessed, a majority (82.2%) of patients’ caregivers were found to be in need of support with 99.5% of such caregivers’ needs addressed with memory clinic services.ConclusionOur model of care has the potential to shape future dementia care in Singapore and other countries with a similar healthcare setting. Redesigning and evolving healthcare services to promote close collaboration between primary care practitioners and specialist services for dementia care can facilitate seamless delivery of care for the benefit of patients.

Primary Prevention of Dementia: An Epidemiological Point of View.

From an epidemiological perspective, in order to increase the level of evidence, it is necessary to refer to data from longitudinal studies to validate the temporal relationship between exposure (e.g. the behavior or modifying factor) and the disease. Findings from such studies are useful for defining risk factors and laying the groundwork for proposing interventions for prevention. This step is crucial in order to define the periods (life-course approach) and groups at risk, which will then become the targets of interventions designed to modify behaviors or lifestyle. Specifying the underlying mechanisms of these risk factors is one of the objectives of etiological epidemiology which focuses on the origin of diseases but is not essential for a more pragmatic interventional approach. These questions are essential for dementia prevention and are discussed in this paper. Furthermore, timing interventions is a major problem even if we identify primary prevention pathways in dementia. Another important concern for epidemiologists is the need to make projections to estimate the number of dementia cases in the next decades considering different intervention scenarios. These models require adequate descriptive indicators of dementia, demography and mortality and precise estimations of the impact of potential interventions in terms of delaying disease onset for instance.

Dementia friendly, dementia capable, and dementia positive: concepts to prepare for the future.

With an aging global population, the number of dementia cases is growing exponentially. To address the upcoming dementia crisis, the World Health Organization and Alzheimer's Disease International (2012) collaborated on an extensive report, Dementia: A Public Health Priority. In the United Kingdom, Prime Minster David Cameron initiated a national challenge on dementia, forming 3 dementia challenge champion groups aimed at improving health and care, creating dementia-friendly communities, and promoting dementia research. In the U.S., President Obama signed the National Alzheimer's Project Act, which led to the formation of the Advisory Council on Alzheimer's Research, Care, and Services and the launch of the first National Plan to Address Alzheimer's Disease. The term "dementia capable" was introduced in the 2012 Recommendations of the Public Members of the Advisory Council and has since been adopted in both the recommendations and annual updates of the national plan. This paper will first compare and contrast government usage of the concepts dementia friendly and dementia capable, along with another valuable concept, dementia positive, that was added after reviewing the literature. Finally, a new vision statement for the U.S.' national plan will be proposed and recommendations incorporating these 3 concepts in policy, research, and practice will be made.

Is Hypertension Associated With an Accelerated Aging of the Brain?

One of the first studies to examine the question of a potential negative impact of hypertension on the brain was published in 1971 in Science .1 Subsequently, many studies have been published, mainly on the relationship of blood pressure (BP) with cognitive performance, cognitive decline, and dementia.2 Their results were sometimes contradictory, some studies even suggesting that high BP could protect against the risk of dementia. This apparent contradiction created some confusion and a sense that this issue should not deserve much attention. The accumulation of data from high-quality population-based studies has helped us to decipher this riddle. Indeed, they have shown that the impact of hypertension on the brain strongly depends on when BP is measured in life. High BP in middle age is a risk factor for dementia, but not when measured at an old age. This age-dependent effect of exposure and the fact that, to fully evaluate its impact, hypertension should be assessed several decades before the onset of dementia have made it remarkably more complex to study the role of hypertension on the brain. Because of global aging, the number of dementia cases is skyrocketing around the world. The last World Health Organization report estimates that in 2010, 7.7 million persons have developed dementia, 1 new case every 4 seconds.3 The total number of people with dementia worldwide was estimated at 35.6 million in 2010 and is projected to reach 115.4 million in 2050. This ongoing epidemic of dementia and the absence of any preventive or curative treatment revived interest in studying modifiable risk factors of dementia, even if this relationship is complex as for hypertension. Indeed, simulation studies have shown that delaying by just a few months the entry into the clinical phase of the disease could enable, at the population level, …

Global epidemiology of dementia: Alzheimer's and vascular types.

The prevalence of dementia varies substantially worldwide. This is partially attributed to the lack of methodological uniformity among studies, including diagnostic criteria and different mean population ages. However, even after considering these potential sources of bias, differences in age-adjusted dementia prevalence still exist among regions of the world. In Latin America, the prevalence of dementia is higher than expected for its level of population aging. This phenomenon occurs due to the combination of low average educational attainment and high vascular risk profile. Among developed countries, Japan seems to have the lowest prevalence of dementia. Studies that evaluated the immigration effect of the Japanese and blacks to USA evidenced that acculturation increases the relative proportion of AD cases compared to VaD. In the Middle East and Africa, the number of dementia cases will be expressive by 2040. In general, low educational background and other socioeconomic factors have been associated with high risk of obesity, sedentarism, diabetes, hypertension, dyslipidemia, and metabolic syndrome, all of which also raise the risk of VaD and AD. Regulating these factors is critical to generate the commitment to make dementia a public health priority.

Young-Onset Dementia

We think of dementia as an illness of the old. Regan described the senility of her father, King Lear, as “the infirmity of his age.”1However, dementia can affect younger ormiddleaged adults. Approximately 200000Americans younger than 65 years have dementia.2 Young-onset dementia (YOD) represents 4% to 10%of all dementia cases.2 By convention, YOD is defined as dementia occurring before age 65 years, although this age criterion is a sociological construct. Thediagnosis of YOD is challenging. Young-onset dementia constitutes a heterogeneous groupof disorders. The broad differential diagnosis includes metabolic, genetic, neurodegenerative, infectious, cerebrovascular, autoimmune, and inflammatorydisorders.AdultswithYODcommonlyundergoextensive testing.However,nocause is identified in roughly20% to40%of cases.3,4 Thesediagnostic challenges aremajor concerns for patients with YOD and their families.4 Because of remarkable scientific advances,wenowknow more about the basis of YOD. The identification of several genetic mutations has improved our understanding of the neurobiologic featuresandpathogenesisofYODand late-onsetdementia. We can now apply information from genetics, functionalbrain imaging, and neuropathology to the bedside and correlate these data with the neurologic signs, systemic manifestations, cognitive impairments, and behavioral abnormalities of patients with YOD. Still, there is much about YOD that we do not know. Despite these advances, we cannotpredictwhowill developYODformany individuals and families. ThearticlebyNordstromandcolleagues5providesnew insights about potential risk factors for YOD. The investigators determinedwhether risk factors in lateadolescence (meanage, 18 years) were associated with incident YOD among 488 000 men conscripted for mandatory military service from 1969 through 1979 in Sweden, a countrywithuniversal health care. Information fromstandardized cognitive andphysical examinations performed at the time of conscription was linked to longitudinal administrative data on hospital discharges, demographics,parentalhistoryofdementia,medicationuse, and deaths. The investigators validated the diagnosis of dementia in approximately 95% of cases in a subsample. In thatpopulation,487menwerediagnosedashavingYOD at a median age of 54 years. Median follow-up was 37 years. Three risk factors in late adolescence predicted incident YOD: low level of cognitive function, low height, and high systolic blood pressure. Six additional predictors included paternal dementia, and the occurrence of alcohol or other drug intoxication, stroke,useofantipsychotics, anddepressionduring follow-up. These 9 risk factors explained 68% of the populationattributable risk of YOD. Premorbid cognition and other risk factorsoperated independently to increase theriskofYOD.Men whohadthecombinationof lowbaselinecognitivefunctionand at least 2 risk factors were atmarkedly increased risk of developing YOD (hazard ratio, 20.37). The study has a novel finding. Independent of stroke, higher systolic blood pressure in late adolescence increased theriskof incidentYOD.Althoughstudieshaveestablishedthat highbloodpressure inmidlife is associatedwith late-onsetdementia, studies have not found consistently that high blood pressure in childhood or young adulthood is associated with cognitiveperformanceordementia inmidlife.The finding that high systolic blood pressure in late adolescence is associated with an increased risk of YOD, if confirmed, provides a potential target for intervention studies to prevent YOD and possibly late-onset dementia. Somepreviousdata are confirmedby this study. Lowcognitive performance is associated with late-onset dementia in older adults. Stroke, alcohol or other drug intoxication, and familyhistory of dementia predict YOD.Adolescentswith low heightmayhaveagreater riskofYODbecause their brainsmay be less developed.6 The study also generates somenewquestions.Dodepressionandantipsychoticuserepresent risk factors forYOD,symptoms of YOD, or primary psychiatric disease (and a misdiagnosis ofYOD)?What fetal or early childhoodexposuresmodify the risk of having low cognitive function in late adolescence? Is high blood pressure a modifiable risk factor for YOD? Nordstrom and colleagues5 challenge us to consider the noninherited factors, such as high blood pressure, that may exacerbate genetic, neurodegenerative, or metabolic processes that cause incident YOD. Do some adults who develop YOD have an unidentified vulnerability to dementia because of factors related to genetics, neurobiologic characteristics, or early life development? Do these at-risk adults develop dementia after acquiring a second“hit” or insult that injures vulnerable brain structures or cognitive pathways?What are the pathogenic mechanisms that converge to cause YOD? The study has several strengths. This longitudinal study has information on risk factors from the physical examination, cognitiveperformance, family andmedical histories, and medicationprescriptions because it combinesunique sources of national data. Few population-based studies of YOD have been performed. The study by Nordstrom et al5 appears representative of the larger population of Swedish men because it captures data on nearly all men eligible for military service andmost episodes of inpatient care. The diagnosis of dementia had high sensitivity in a medical record review of a subsample, although diagnostic criteria are not given. The number of dementia cases was large. Related article page 1612 Risk Factors for Young-Onset Dementia in Men Original Investigation

20-Year prevalence projections for dementia and impact of preventive policy about risk factors

Incidence of dementia increases sharply with age and, because of the increase in life expectancy, the number of dementia cases is expected to rise dramatically over time. Some studies suggest that controlling some modifiable risk factors for dementia like diabetes or hypertension could lower its incidence. However, as treating these vascular factors would also reduce mortality risk, the actual impact of such public-health intervention on dementia prevalence is not known. Accounting for the impact of dementia and risk factors on mortality, the aim of this work was (1) to compute projections of age- and-sex specific prevalence of dementia in France from 2010 to 2030, (2) to evaluate how public-health interventions targeting risk factors for dementia could change these projections. Age-and-sex specific incidence of dementia and mortality of demented subjects were estimated from the Paquid population-based cohort using a semi-parametric illness-death model. Future global mortality rates and population sizes were obtained from national demographic projections. Under the assumption that life expectancy will increase by 3.5 years for men and 2.8 years for women by 2030, the number of subjects with dementia was estimated to increase by about 75% from 2010 to 2030 with a 200% increase after 90 years of age. Therapeutic intervention on the whole population reducing high blood pressure prevalence would lead to a decrease in both dementia incidence rates and mortality and would have a modest impact on the number of dementia cases. On the other hand, a preventive dementia treatment targeting ApoE4 carriers would probably not improve survival and hence would decrease dementia prevalence by 15-25%.

IL-6–174 G/C and ApoE Gene Polymorphisms in Alzheimer’s and Vascular Dementia Patients Attending the Cognitive Disorder Clinic of the All India Institute of Medical Sciences, New Delhi

Background: Remarkable improvement in the life expectancy of the Indian population is expected to commensurate with the increase in number of dementia cases. Among various types of dementia, Alzheimer’s disease (AD) and vascular dementia (VaD) are common and widely studied. We evaluated the role of apolipoprotein E (ApoE) and interleukin-6 (IL-6)–174 G/C gene polymorphism along with serum IL-6 levels in AD and VaD patients. Methods: The polymorphisms in ApoE and IL-6–174 G/C genes were assessed using RFLP. Serum IL-6 level was measured by ELISA. Results: The allele Ε4 of the ApoE gene was found to be associated with AD and VaD patients (p < 0.05). No association of IL-6–174 G/C polymorphism was observed in AD patients, while the IL-6–174 C allele increased the odds of having VaD twofold. Regression analysis to assess possible interaction between ApoE and the IL-6–174 G/C genes revealed that presence of both the Ε4 and C alleles increased the odds of having AD 13.75-fold and VaD 14.7-fold. Serum IL-6 levels did not correlate with either presence or severity of disease among AD or VaD patients. Conclusion: The ApoE Ε4 allele is an important genetic marker for AD and VaD. Presence of both ApoE Ε4 and IL-6 C genes increases the OR of having AD and VaD markedly.