The number of people with Alzheimer's and dementia - both new cases and total numbers with the disease - continues to rise among the very oldest segments of the population in contradiction of the conventional wisdom, according to research reported today at the Alzheimer's Association 2009 International Conference on Alzheimer's Disease (ICAD 2009) in Vienna.

Previous epidemiological studies have suggested that the number of people with Alzheimer's and dementia begins to level off and perhaps even go down a bit in people age 90 and above, known as the "oldest old." This is the fastest growing segment of the population in western countries.

"The number of people affected by Alzheimer's and dementia is growing at an epidemic pace, and the skyrocketing financial and personal costs will devastate the world's economies and healthcare systems, and far too many families," said William Thies, Ph.D., Chief Medical & Scientific Officer at the Alzheimer's Association. "We must make the fight against Alzheimer's a priority before it's too late."

"However there is hope. There are many drugs in late stage clinical trials for Alzheimer's that show promise to slow or stop the progression of the disease. This, combined with advancements in early detection, has the potential to change the landscape of Alzheimer's in our lifetimes. But we need more funding for research to see these possibilities through to completion," Thies said.

The research reported at ICAD 2009 includes a study of more than 2,100 individuals age 80 years or older in eight municipalities of Varese province, Italy, and a systematic review and collaborative analysis of studies reporting the prevalence of dementia in Europe.

The Monzino 80-plus Study - Dementia Risk Continues to Rise in the "Oldest Old"

Ugo Lucca, head of the Laboratory of Geriatric Neuropsychiatry at the Mario Negri Institute for Pharmacological Research in Milano, Italy, and colleagues conducted a prospective, door-to-door, population-based study of all people age 80 years or older in eight municipalities of Varese province, Italy, roughly 30 kilometers (20 miles) north of Milan (known as the Monzino 80-plus Study). Their goal was to estimate the prevalence (total number with the disease) and incidence (new cases of the disease) of dementia in this population.

The researchers were able to gather information and an initial dementia evaluation for 2,138 individuals. The mean age of the population at that first evaluation was 87.5 years; 74.1% were women. Mean education was 5.1 years, and mean MMSE score was 21.4. After an average follow-up period of three years, of the 1,085 survivors non-demented at baseline, 995 were re-evaluated for dementia.

Prevalence of dementia standardized on the 2008 Italian population was 22.9% and was higher in women (25.8%) than in men (17.1%). Prevalence increased with advancing age: 13.5% at 80-84 years

30.8% at 85-89

39.5% at 90-94

52.8% over 94 The estimated annual incidence of dementia standardized on the 2008 Italian population was 8.6% and was higher in women (9.2%) than in men (7.2%). Incidence also rose with increasing age: 6.0% at 80-84 years

12.4% at 85-89

13.1% at 90-94

20.7% over 94 "Gathering reliable information on such a large number of the 'oldest old' makes this one of the largest studies investigating dementia in this age segment of the population," Lucca said. "This study's results confirm that Alzheimer's and dementia are very common among the oldest people in society. We believe this strengthens the need to shift more of the focus of clinical research to this segment of the elderly population."

According to the researchers, though the rate of women who developed dementia during the follow-up period was higher than in men in this study, no definite conclusion can be drawn about this difference because the number of men in the oldest ages became very small.

Systematic Review of Dementia in Europe - Higher Prevalence in Female "Oldest Old"

The goal of Dr. Emma Reynish, a consultant geriatrician and coordinator of the European Alzheimer's Disease Consortium from the Victoria Hospital, Kirkcaldy, Scotland, UK, and colleagues at the EuroCoDe (European Collaboration on Dementia) project, was to determine the prevalence of dementia in Europe based on up to date research findings and including data from Eastern Europe. They conducted an extensive literature search using Cochrane review methodologies and compiled a database of all European epidemiological studies in the field up to the present date. 194 articles were identified by the review and 26 studies met inclusion criteria to participate with raw data in the collaborative analysis.

According to the researchers, while dementia prevalence rates for all men and for women up to age 85 confirmed previous findings, age-specific prevalence rates were higher than previously documented in the female "oldest old" age groups, rising to over 50% in those over 95 years.

"Our key findings confirmed that age remains as the single most important risk factor for dementia," Reynish said. "Nevertheless, due to the lack of data in the oldest old in previous prevalence studies, the prevalence of dementia of women over the age of 85 had been underreported."

About ICAD 2009

The 2009 Alzheimer's Association International Conference on Alzheimer's Disease (ICAD 2009) brings together more than 3,000 researchers from 70 countries to share groundbreaking research and information on the cause, diagnosis, treatment and prevention of Alzheimer's disease and related disorders. As a part of the Association's research program, ICAD 2009 serves as a catalyst for generating new knowledge about dementia and fostering a vital, collegial research community. ICAD 2009 is being held in Vienna, Austria at Messe Wien Exhibition and Congress Center from July 11.

About the Alzheimer's Association
The Alzheimer's Association is the leading voluntary health organization in Alzheimer care, support and research. Our mission is to eliminate Alzheimer's disease through the advancement of research, to provide and enhance care and support for all affected, and to reduce the risk of dementia through the promotion of brain health. Our vision is a world without Alzheimer's.

Ugo Lucca, et al - Risk of dementia continues to rise in the oldest old: The Monzino 80-plus Study (Funder: Fondazione Italo Monzino (Milano, Italy))

Emma Reynish, et al - Systematic Review and Collaborative Analysis of the Prevalence of Dementia in Europe (Funder: European Commission, coordinated by Alzheimer Europe)

Control #: 09-A-1144-ALZ P3 - Tuesday Posters - Presentation #P3-168; Speaking Time: 7/14/2009, 12:30 - 3:00 PM

Risk of dementia continues to rise in the oldest old: The Monzino 80-plus Study

Ugo Lucca, Mariateresa Garrì, Alessandro Nobili, Luca Pasina, Francesca Gandini, Emma Riva, Mauro Tettamanti Istituto di Ricerche Farmacologiche Mario Negri, Milano, Italy.

Disclosure Block: U. Lucca, None; M. Garrì, None; A. Nobili, None; L. Pasina, None; F. Gandini, None; E. Riva, None; M. Tettamanti, None.

Background: Most dementia sufferers are eighty years or older, the fastest growing segment of the elderly population in western countries. Because of the small number of persons in this age class usually included in population-based studies, prevalence and incidence estimates fluctuate widely in the oldest old, making it hard to establish whether the risk of dementia (and Alzheimer's disease) continues to rise also at very high ages.

Objective: To estimate the prevalence and incidence of dementia (mild+) in a prospective, door-to-door population-based study of all eighty years or older residents in eight municipalities of Varese province, Italy (the Monzino 80-plus Study).

Methods: Among the 2,436 eligible residents, information could be gathered for 2,138 individuals (response rate: 87.8%). Of the 1,085 survivors non-demented at baseline, 995 (91.7%) were re-evaluated after an average follow-up period of 3 years. Diagnosis of dementia was based on DSM-IV criteria.

Results: Mean age of the population at baseline evaluation was 87.5 (SD: 4.8) years and 74.1% were women. Some 32% lived alone and 11.5% in an institution. In the whole population, mean education was 5.1 (2.5) years, mean MMSE score 21.4 (7.6), and mean percentage of dependence on IADL 48.5% (36.9%). Prevalence of dementia standardized on the 2008 Italian population was 22.9% (95% CI: 21.1-24.7) and was higher in women 25.8% (95% CI: 23.7-28.1) than in men 17.1% (95% CI: 14.0-20.5). Prevalence increased with advancing age: 13.5% at 80-84 years, 30.8% at 85-89, 39.5% at 90-94, and 52.8% over 94. The number of person-years of observation was 3,110. The estimated annual incidence of dementia standardized on the 2008 Italian population was 8.6% (95%CI: 7.6-9.7) and was higher in women 9.2% (95% CI: 8.0-10.6) than in men 7.2% (95% CI: 5.5-9.2). Incidence as well rose with increasing age: 6.0% at 80-84 years, 12.4% at 85-89, 13.1% at 90-94, and 20.7% over 94.

Conclusions: Although not exponentially, the overall prevalence and incidence rates of dementia continue to rise also in very old age.

Control #: 09-A-1781-ALZ P3 - Tuesday Posters - Presentation #P3-168, Speaking Time: 7/14/2009, 12:30 - 3:00 PM

Systematic Review and Collaborative Analysis of the Prevalence of Dementia in Europe

Emma Reynish1,2, Horst Bickel3, Laura Fratiglioni4, Andrzej Kiejna5, Martin Prince6, Jean Georges7, EUROCODE Prevalence Group

1Victoria Hospital, Kirkcaldy, United Kingdom; 2Toulouse University Hospital, Toulouse, France; 32 Klinik und Poliklinik für Psychiatrie und Psychotherapie der Technischen, Munich, Germany; 4Karolinska Institute, Stockholm, Sweden; 5Department of Psychiatry, Wroclaw, Poland; 6Institute of psychiatry, London, United Kingdom; 7Alzheimer Europe, Luxembourg, Luxembourg.

Disclosure Block: E. Reynish, None; H. Bickel, None; L. Fratiglioni, None; A. Kiejna, None; M. Prince, None; J. Georges, None.

Background: An accurate estimate of the numbers of individuals affected with dementia is essential. Previous collaborative work from Europe is based on studies performed 20 years ago. This current project aims to determine the prevalence of dementia in Europe based on up to date research findings and includes data from Eastern Europe.

Methods: A systematic review followed by collaborative analysis of studies reporting the prevalence of dementia in Europe. Medline and Embase searches were performed using the search terms "Dementia / Prevalence / Incidence / Epidemiology" and/or "Alzheimer's Disease / Vascular dementia, Lewy-body disease / Fronto-temporal dementia / Incidence / Prevalence / Epidemiology. A database of studies was compiled and those fulfilling predetermined quality criteria were invited to submit data for collaborative analysis. Age and sex specific prevalence's were calculated using the total number of prevalence cases from all studies as the numerator and total population examined as the denominator.

Results: A total of 194 articles were identified by the review and 26 studies met inclusion criteria to participate with raw data in the collaborative analysis. Calculated age specific prevalence rates for men confirmed previous findings with rates rising from 1.8% in the 65-69 years age range up to 30% in the over 90 years age group. For women confirmation of previous findings was also true for the 65 to 85 years age ranges with 5 year age specific rates rising from 1.5% to 30% respectively. Age specific prevalence rates were however higher than previously documented in the female oldest old age groups rising to over 50% in those over 95 years.

Conclusions: Epidemiological studies of dementia prevalence in Europe continue to show constant rates in all age ranges with the female oldest old being the exception. Here estimates show a higher than previously reported prevalence in females.

Source:
Niles Frantz
Alzheimer's Association

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