- Email: [email protected]
Dynamic processes in life-course: exposure to risk and incidence of dementia—CFAS-II
Tuesday, July 16, 2013: Symposia: S3-01: Life-Course Approach and Temporal Trends in Dementia Incidence
TUESDAY, JULY 16, 2013 SYMPOSIA: S3-01 LIFE-COURSE APPROACH AND TEMPORAL TRENDS IN DEMENTIA INCIDENCE S3-01-01
DYNAMIC PROCESSES IN LIFE-COURSE: EXPOSURE TO RISK AND INCIDENCE OF DEMENTIA—CFAS-II
Fiona Matthews, Cambridge, England, United Kingdom. Contact e-mail: [email protected] Background: Many studies were initiated to explore the occurrence and risk for dementia at the population level during the 1990’s. These studies can be used to provide a contemporary investigation of dementia risk. Methodologies have, however, changed in the intervening 20 years in ways that might affect such investigations. True comparative studies must therefore investigate both risk and outcome with near identical measures. Most current estimates used for policy are based on the estimates from 20 years ago, with limited ability to examine change in population estimates over time. New prevalence studies are needed for policy as well as the investigation of the potential for change in risk across generations. Methods: The Cognitive Function and Ageing Studies (CFAS) are population based studies of dementia prevalence and incidence, linked over time. CFAS I was undertaken in the early 1990s (18,000 people aged 65 and over at baseline), CFAS II completed its baseline study in 2011 (7,500 people). CFAS I had 6 sites, CFAS II repeated the population sampling methodology and approach in three of these sites, also retaining the same diagnostic and risk measurement in these sites. Results: Results will describe the prevalence of dementia in the large contemporaneous older population, and also compare this with that of the previous generation with analysis of the potential impact that life course risk has played in the dementia patterns seen. Conclusions: Studies to investigate changes over time are complex to design and carry out. The desire to improve the measures must be contained so that robust comparisons can be made which can also inform policy. The potential for changes in methodology and other features to impact the estimates must be fully accounted for before any differences can reliably be interpreted as true change in population risk. S3-01-02
IS DEMENTIA INCIDENCE DECLINING? THE SNAC-K STUDY
Laura Fratiglioni, Karolinska Institutet, Stockholm, Sweden. Contact e-mail: [email protected] Background: Recently it has been estimated that one third of all health-related expenses in Europe are caused by brain disorders, of which dementia is one of the most relevant. As dementia is strongly associated with age (70% of all people with dementia are older than 75 years) and the number of elderly people is increasing worldwide, the world will face an epidemic of dementia in the coming decades. Therefore any variation in dementia risk becomes a relevant public health issue. Indeed, since the 1980s risk of major cardiovascular disease has decreased substantially, owing to preventative and therapeutic interventions for major vascular risk factors. Because cardiovascular risk factors are involved in dementia, it is plausible to hypothesize that along with the decline in incidence of cardiovascular disease, risk of dementia may decrease. In this study, we explored this hypothesis by investigating whether prevalence, survival, and incidence of dementia in the Kungsholmen district of central Stockholm have changed in last two decades. Methods: We used clinical data from two cross-sectional surveys of people aged 75 years or over conducted in central Stockholm: the Kungsholmen Project (KP) (1987-1989, n¼1700) and the Swedish National study on Aging and Care in Kungsholmen (SNAC-K) (2001-2004, n¼1575). We inferred incidence of dementia from prevalence and survival meausured in KP and SNAC-K. Results: The age- and sex-standardized prevalence of dementia was 17.5% (12.8% in men; 19.2% in women) in KP and 17.9% (10.8% in men; 20.5% in women) in SNAC-K. The adjusted odds ratio of dementia in SNAC-K vs. KP was 1.17 (95% confidence interval 0.95-1.46). The multi-adjusted hazard ratio of death in SNAC-K vs. KP
P511
was 0.71 (0.57-0.88) in subjects with dementia, 0.68 (0.59-0.79) in those without dementia, and 0.66 (0.59-0.74) in all participants. Conclusions: Prevalence of dementia was stable from the late 1980s to the early 2000s in central Stockholm, Sweden, whereas survival of patients with dementia increased. These results suggest that incidence of dementia may have decreased during this time period. S3-01-03
RISK FACTORS FOR DEMENTIA IN LIFE COURSE APPROACH
M. Maria Glymour, Harvard School of Public Health, Boston, Massachusetts, United States. Contact e-mail: [email protected] Background: Increasing evidence implicates risk factors occurring throughout life - from conception through old age-in the development of both Alzheimer’s disease and vascular dementia. It is important to test competing life course risk factor models, e.g., sensitive period or accumulation of risk models, because they have divergent implications for prevention and treatment of dementia. This talk will contrast alternative life course models for the effects of cognitive stimulation and education on dementia risk. Methods: I summarize three alternative life course etiologic models for dementia: immediate risk, cumulative risk, and sensitive/latency period models. These models are modified from conventional life course frameworks to distinguish between determinants of cognitive reserve, determinants of onset or progression of neuropathologic disease, and determinants of compensation or resilience. I contrast the implications of these three life course models for prevention and treatment of dementia. These models can be evaluated and distinguished using specific statistical analyses. We use data from the Health and Retirement Study cohort to illustrate the statistical models appropriate for evaluating the alternatives. We integrate results from multiple prior studies to evaluate evidence for the alternative life course models. Results: Evidence supports the hypothesis that cognitive stimulation throughout the life course - for example generated by familial interactions in early childhood, formal educational experiences, occupational demands, and daily leisure time activities in adulthood - influences dementia risk. The evidence is most consistent with a sensitive period in early life shaping cognitive reserve, rather than supporting direct effects on pathologic processes. There is also some evidence supporting influences of cognitive stimulation on compensation, although this is more challenging to establish. Conclusions: Identifying the potential contributions of life course risk factors to Alzheimer’s and vascular dementia can improve opportunities for prevention. However, the complex correlations of risk factors across the life course, combined with the challenges in diagnosing dementia, can result in spurious associations in observational research. Specifically, early life correlates of cognitive reserve appear to be causal risk factors for disease, even though interventions in late life may not have similar benefits as interventions at earlier ages. Future research should explicitly contrast competing life course models for determinants of dementia. S3-01-04
CHANGES IN DEMENTIA RISK FACTORS OVER 40 YEARS: EXPERIENCES FROM FINLAND
Alina Solomon1, Tiia Ngandu2, Tiina Laatikainen2, Hilkka Soininen1, Miia Kivipelto3, 1University of Eastern Finland, Kuopio, Finland; 2 National Institute for Health and Welfare, Helsinki, Finland; 3Karolinska Institutet, Stockholm, Sweden. Contact e-mail: [email protected] Background: Dementia and cardiovascular disease (CVD) prevention have more in common than previously thought. Finland has over 40 years of experience of successful CVD prevention, and has established a countrywide monitoring system for risk factors for chronic diseases. Methods: This presentation will summarize and discuss the trends in dementia risk factors during the past 40 years in Finland, and how the experience from CVD prevention can be used in dementia research. Results: The national population-based FINRISK study has followed the trends in the CVD risk factors every 5 years since 1972. We have seen e.g., drastic declines in cholesterol and blood pressure levels and prevalence of smoking, whereas body mass
TUESDAY, JULY 16, 2013 SYMPOSIA: S3-01 LIFE-COURSE APPROACH AND TEMPORAL TRENDS IN DEMENTIA INCIDENCE S3-01-01
DYNAMIC PROCESSES IN LIFE-COURSE: EXPOSURE TO RISK AND INCIDENCE OF DEMENTIA—CFAS-II
Fiona Matthews, Cambridge, England, United Kingdom. Contact e-mail: [email protected] Background: Many studies were initiated to explore the occurrence and risk for dementia at the population level during the 1990’s. These studies can be used to provide a contemporary investigation of dementia risk. Methodologies have, however, changed in the intervening 20 years in ways that might affect such investigations. True comparative studies must therefore investigate both risk and outcome with near identical measures. Most current estimates used for policy are based on the estimates from 20 years ago, with limited ability to examine change in population estimates over time. New prevalence studies are needed for policy as well as the investigation of the potential for change in risk across generations. Methods: The Cognitive Function and Ageing Studies (CFAS) are population based studies of dementia prevalence and incidence, linked over time. CFAS I was undertaken in the early 1990s (18,000 people aged 65 and over at baseline), CFAS II completed its baseline study in 2011 (7,500 people). CFAS I had 6 sites, CFAS II repeated the population sampling methodology and approach in three of these sites, also retaining the same diagnostic and risk measurement in these sites. Results: Results will describe the prevalence of dementia in the large contemporaneous older population, and also compare this with that of the previous generation with analysis of the potential impact that life course risk has played in the dementia patterns seen. Conclusions: Studies to investigate changes over time are complex to design and carry out. The desire to improve the measures must be contained so that robust comparisons can be made which can also inform policy. The potential for changes in methodology and other features to impact the estimates must be fully accounted for before any differences can reliably be interpreted as true change in population risk. S3-01-02
IS DEMENTIA INCIDENCE DECLINING? THE SNAC-K STUDY
Laura Fratiglioni, Karolinska Institutet, Stockholm, Sweden. Contact e-mail: [email protected] Background: Recently it has been estimated that one third of all health-related expenses in Europe are caused by brain disorders, of which dementia is one of the most relevant. As dementia is strongly associated with age (70% of all people with dementia are older than 75 years) and the number of elderly people is increasing worldwide, the world will face an epidemic of dementia in the coming decades. Therefore any variation in dementia risk becomes a relevant public health issue. Indeed, since the 1980s risk of major cardiovascular disease has decreased substantially, owing to preventative and therapeutic interventions for major vascular risk factors. Because cardiovascular risk factors are involved in dementia, it is plausible to hypothesize that along with the decline in incidence of cardiovascular disease, risk of dementia may decrease. In this study, we explored this hypothesis by investigating whether prevalence, survival, and incidence of dementia in the Kungsholmen district of central Stockholm have changed in last two decades. Methods: We used clinical data from two cross-sectional surveys of people aged 75 years or over conducted in central Stockholm: the Kungsholmen Project (KP) (1987-1989, n¼1700) and the Swedish National study on Aging and Care in Kungsholmen (SNAC-K) (2001-2004, n¼1575). We inferred incidence of dementia from prevalence and survival meausured in KP and SNAC-K. Results: The age- and sex-standardized prevalence of dementia was 17.5% (12.8% in men; 19.2% in women) in KP and 17.9% (10.8% in men; 20.5% in women) in SNAC-K. The adjusted odds ratio of dementia in SNAC-K vs. KP was 1.17 (95% confidence interval 0.95-1.46). The multi-adjusted hazard ratio of death in SNAC-K vs. KP
P511
was 0.71 (0.57-0.88) in subjects with dementia, 0.68 (0.59-0.79) in those without dementia, and 0.66 (0.59-0.74) in all participants. Conclusions: Prevalence of dementia was stable from the late 1980s to the early 2000s in central Stockholm, Sweden, whereas survival of patients with dementia increased. These results suggest that incidence of dementia may have decreased during this time period. S3-01-03
RISK FACTORS FOR DEMENTIA IN LIFE COURSE APPROACH
M. Maria Glymour, Harvard School of Public Health, Boston, Massachusetts, United States. Contact e-mail: [email protected] Background: Increasing evidence implicates risk factors occurring throughout life - from conception through old age-in the development of both Alzheimer’s disease and vascular dementia. It is important to test competing life course risk factor models, e.g., sensitive period or accumulation of risk models, because they have divergent implications for prevention and treatment of dementia. This talk will contrast alternative life course models for the effects of cognitive stimulation and education on dementia risk. Methods: I summarize three alternative life course etiologic models for dementia: immediate risk, cumulative risk, and sensitive/latency period models. These models are modified from conventional life course frameworks to distinguish between determinants of cognitive reserve, determinants of onset or progression of neuropathologic disease, and determinants of compensation or resilience. I contrast the implications of these three life course models for prevention and treatment of dementia. These models can be evaluated and distinguished using specific statistical analyses. We use data from the Health and Retirement Study cohort to illustrate the statistical models appropriate for evaluating the alternatives. We integrate results from multiple prior studies to evaluate evidence for the alternative life course models. Results: Evidence supports the hypothesis that cognitive stimulation throughout the life course - for example generated by familial interactions in early childhood, formal educational experiences, occupational demands, and daily leisure time activities in adulthood - influences dementia risk. The evidence is most consistent with a sensitive period in early life shaping cognitive reserve, rather than supporting direct effects on pathologic processes. There is also some evidence supporting influences of cognitive stimulation on compensation, although this is more challenging to establish. Conclusions: Identifying the potential contributions of life course risk factors to Alzheimer’s and vascular dementia can improve opportunities for prevention. However, the complex correlations of risk factors across the life course, combined with the challenges in diagnosing dementia, can result in spurious associations in observational research. Specifically, early life correlates of cognitive reserve appear to be causal risk factors for disease, even though interventions in late life may not have similar benefits as interventions at earlier ages. Future research should explicitly contrast competing life course models for determinants of dementia. S3-01-04
CHANGES IN DEMENTIA RISK FACTORS OVER 40 YEARS: EXPERIENCES FROM FINLAND
Alina Solomon1, Tiia Ngandu2, Tiina Laatikainen2, Hilkka Soininen1, Miia Kivipelto3, 1University of Eastern Finland, Kuopio, Finland; 2 National Institute for Health and Welfare, Helsinki, Finland; 3Karolinska Institutet, Stockholm, Sweden. Contact e-mail: [email protected] Background: Dementia and cardiovascular disease (CVD) prevention have more in common than previously thought. Finland has over 40 years of experience of successful CVD prevention, and has established a countrywide monitoring system for risk factors for chronic diseases. Methods: This presentation will summarize and discuss the trends in dementia risk factors during the past 40 years in Finland, and how the experience from CVD prevention can be used in dementia research. Results: The national population-based FINRISK study has followed the trends in the CVD risk factors every 5 years since 1972. We have seen e.g., drastic declines in cholesterol and blood pressure levels and prevalence of smoking, whereas body mass