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Incidence and relative risk of dementia in an urban elderly population: findings of a prospective field study

  • Horst Bickel (a1) and Brian Cooper (a1)

Synopsis

To ascertain the frequency and distribution of new cases of dementing illness in the elderly population of Mannheim (population 308000), a survey sample of community residents of > 65 years of age was re-examined after an interval of 7–8 years, and a sample of elderly persons in long-stay care after 5–6 years. The estimated annual incidence rate for all forms of dementia, after correction for ageing of the samples, was 15·4 per 1000 persons aged > 65, made up of dementia of Alzheimer type (8·9 per 1000), vascular dementia (4·4 per 1000) and other forms (2·1 per 1000). Apart from the expected association with age > 65 years, the most powerful predictors of onset of a dementing illness were residence in long-stay care and the presence of minor cognitive deficits at the initial examination, each of which was associated with a highly significant increase in risk. In addition, a number of socio-demographic characteristics (marital status, occupational history and quality of present living accommodation) was found to be predictive, though analysis of larger samples or pooled research data would be necessary to establish their importance in this respect. The findings suggest that identification of mild cognitive impairment on screening could prove helpful in assessing risk for dementia from two to three years before the condition becomes clinically apparent.

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Corresponding author

1Address for correspondence: Dr H. Bickel, Zentralinstitut für Seelische Gesundheit, Postfach 122 120, D-6800 Mannheim, Germany.

References

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Adelstein, A. M., Downham, D. Y., Stein, Z. & Susser, M. W. (1968). The epidemiology of mental illness in an English city. Inceptions recognized by Salford psychiatric services. Social Psychiatry 3, 4759.
Akesson, H. O. (1969). A population study of senile and arteriosclerotic psychoses. Human Heredity 19, 546566.
Akhtar, A. J. (1972). Refusal to participate in a survey of the elderly. Gerontologia Clinica 14, 205211.
Ames, D., Ashby, D., Mann, A. H. & Graham, N. (1988). Psychiatric illness in elderly residents of Part III homes in one London borough: prognosis and review. Age and Ageing 17, 249256.
Berg, L., Smith, D. S., Morris, J. C., Miller, J. P., Rubin, E. H., Storandt, M. & Coben, L. A. (1990). Mild senile dementia of the Alzheimer type. 3. Longitudinal and cross-sectional assessment. Annals of Neurology 28, 648652.
Bergmann, K., Kay, D. W. K., Foster, E. M., McKechnie, A. A. & Roth, M. (1973). A follow-up study of randomly selected community residents to assess the effects of chronic brain syndrome and cerebrovascular disease. In Proceedings of the Vth World Congress of Psychiatry, Mexico, 1971 (ed. de la Fuente, R. and Weisman, M. N.), pp. 856865. Excerpta Medica: Amsterdam.
Boothby, H., Blizard, R., Livingstone, G. & Mann, A. (1994). The Gospel Oak study. III. The incidence of dementia. Psychological Medicine 24, (in the press).
Cooper, B. (1984). Home and away: the disposition of mentally ill old people in an urban population. Social Psychiatry 19, 187196.
Cooper, B. (1986). Mental illness, disability and social conditions among old people in Mannheim. In Mental Health in the Elderly (ed. Häfner, H., Moschel, G. and Sartorius, N.), pp. 3545. Springer: Berlin.
Cooper, B. (1992). Late-life mental disorders and primary health care. a review of research. In Primary Health Care and Psychiatric Epidemiology (ed. Cooper, B. and Eastwood, R.), pp. 213233. Tavistock/Routledge: London.
Cooper, B. & Bickel, H. (1989). Prävalenz und Inzidenz von Demenzerkrankungen in der Altenbevölkerung. Ergebnisse einer populationsbezogenen Längsschnittstudie in Mannheim. Nervenarzt 60, 472482.
Cooper, B. & Schwarz, R. (1982). Psychiatric case-identification in an elderly urban population. Social Psychiatry 17, 4352.
Cooper, B. & Sosna, U. (1983). Psychische Erkrankung in der Altenbevölkerung. Eine epidemiologische Feldstudie in Mannheim. Nervenarzt 54, 239249.
Copeland, J. R. M., Davidson, I. A., Dewey, M. E., Gilmore, C., Larkin, B. A., McWilliam, C., Saunders, P. A., Scott, A., Sharma, V. & Sullivan, C. (1992). Alzheimer's disease, other dementias, depression and pseudo-dementia: prevalence, incidence and three-year outcome in Liverpool. British Journal of Psychiatry 161, 230239.
Cox, D. R. (1972). Regression models and life tables. Journal of the Royal Statistical Society 34, 187220.
Eaton, W. W., Kramer, M., Anthony, J. C., Dryman, A., Shapiro, S. & Locke, B. Z. (1989). The incidence of specific DIS/DSM-III mental disorders: data from the NIMH Epidemiologic Catchment Area Program. Acta Psychiatrica Scandinavica 79, 163178.
Flicker, C., Ferris, S. H. & Reisberg, B. (1991). Mild cognitive impairment in the elderly: predictors of dementia. Neurology 41, 10061009.
Fratiglioni, L., Grut, M., Forsell, Y., Viitanen, M., Grafstroem, M., Holmen, K., Ericsson, K., Bäckman, L., Ahlbom, A. & Winblad, B. (1991). Prevalence of Alzheimer's disease and other dementias in an elderly urban population: relationship with age, sex, and education. Neurology 41, 18861892.
Fukunishi, I., Hayabara, T. & Hosokawa, K. (1991). Epidemiological surveys of senile dementia in Japan. International Journal of Social Psychiatry 37, 5156.
Goldberg, D. P., Cooper, B., Kedward, H. B., Eastwood, M. R. & Shepherd, M. (1970). A standardized psychiatric interview for use in community surveys. British Journal of Preventive and Social Medicine 24, 1823.
Hagnell, O., Lanke, J., Rorsman, B. & Öjesjö, L. (1981). Does the incidence of age psychosis decrease? A prospective, longitudinal study of a complete population investigated during the 25-year period 1947–1972: the Lundby study. Neuropsychobiology 7, 201211.
Helgason, L. (1977). Psychiatric services and mental illness in Iceland. Acta Psychiatrica Scandinavica 55, Suppl. 268,
Helgason, T. & Magnusson, H. (1989). The first 80 years of life. A psychiatric epidemiological study. Acta Psychiatrica Scandinavica 79, Suppl. 348, 8594.
Hofman, A., Rocca, W. A., Brayne, C., Breteler, M. M., Clarke, M.Cooper, B., Copeland, J. R. M., Dartigues, J. F., da Silva Droux, A., Hagnell, O.Heeren, T. J., Engedal, K., Jonker, C., Lindsay, J.Lobo, A., Mann, A. H., Mölsä, P. K., Morgan, K., O'Connor, D. W.Sulkava, R., Kay, D. W. K. & Amaducci, L. (1991). The prevalence of dementia in Europe: a collaborative study of 1980–1990 findings. International Journal of Epidemiology 20, 736748.
Hughes, C. P., Berg, L., Danziger, W. L., Coben, L. A. & Martin, R. L. (1982). A new clinical scale for the staging of dementia. British Journal of Psychiatry 140, 566572.
Jagger, C., Clarke, M. & Cook, A. J. (1989). Mental and physical health of elderly people: five-year follow-up of a total population. Age and Ageing 18, 7782.
Jorm, A. F., van Duijn, C. M., Chandra, V., Fratiglioni, L., Graves, A. B., Heyman, A., Kokmen, E., Kondo, K., Mortimer, J. A., Rocca, W. A., Shalat, S. L., Soinenen, H. & Hofman, A. (1991). Psychiatric history and related exposures as risk factors for Alzheimer's disease: a collaborative re-analysis of case-control studies. International Journal of Epidemiology 20, Suppl. 2, 4347.
Kastrup, M. (1987). Elderly first admissions to psychiatric institutions: findings of a nationwide Danish cohort. International Journal of Geriatric Psychiatry 2, 169175.
Katzman, R., Aronson, M., Fuld, P., Kawas, C., Brown, T., Morgenstern, H., Frishman, W., Gidez, L., Eder, H. & Ooi, W. L. (1989). Development of dementing illnesses in an 80-year-old volunteer cohort. Annals of Neurology 25, 317324.
Kleining, G. & Moore, H. (1968). Soziale Selbsteinstufung: ein Instrument zur Messung sozialer Schichten. Kölner Zeitschrift für Soziologie und Sozialpsychologie 20, 502552.
Kokmen, E., Chandra, V. & Schoenberg, B. S. (1988). Trends in incidence of dementing illness in Rochester, Minnesota, in three quinquennial periods, 1960–1974. Neurology 38, 975980.
Lammi, U.-K., Kivelä, S. L., Nissinen, A., Punsar, S., Puska, S. & Karvonen, M. (1989). Mental disability among elderly men in Finland: prevalence, predictors and correlates. Acta Psychiatrica Scandinavica 80, 459468.
Larsson, T., Sjögren, T. & Jacobson, G. (1963). Senile dementia: a clinical, socio-medical and genetic study. Acta Psychiatrica Scandinavica 39, Suppl. 167, 1259.
Last, J. M. (ed.) (1983). A Dictionary of Epidemiology. Oxford University Press: New York.
Launer, L. J. (1992). Overview of incidence studies of dementia conducted in Europe. Neuroepidemiology 11, Suppl. 1, 213.
Li, G., Shen, Y. C., Chen, C. H., Zhau, Y. W., Li, S. R., & Lu, M. (1991). A three-year follow-up study of age-related dementia in an urban area of Beijing. Acta Psychiatrica Scandinavica 83, 99104.
Magnusson, H. (1989). Mental health of octogenarians in Iceland. An epidemiological study. Acta Psychiatrica Scandinavica 79, Suppl. 349.
Milne, J. S., Maule, M. M. & Williamson, J. (1971). Method of sampling in a study of older people with a comparison of respondents and non-respondents. British Journal of Preventive and Social Medicine, 25, 3741.
Mölsä, P. K., Marttila, R. J. & Rinne, U. K. (1982). Epidemiology of dementia in a Finnish population. Acta Neurologica Scandinavica 65, 541552.
Morgan, K., Lilley, J., Arie, T., Byrne, J., Jones, R. & Waite, J. (1992). Incidence of dementia: preliminary findings from the Nottingham longitudinal study of activity and ageing. Neuroepidemiology 11, Suppl. 1, 8083.
Mortimer, J. A. (1988). Do psychosocial risk factors contribute to Alzheimer's disease? In Etiology of Dementia of Alzheimer's Type (ed. Henderson, A. S. and Henderson, J. H.), pp. 3952. Wiley: Chichester.
Nielsen, J. A., Biörn-Henriksen, T. & Bork, B. R. (1981). Incidence and disease expectancy for senile and arteriosclerotic dementia in a geographically delimited Danish rural population. In Epidemiology and Prevention of Mental Illness in Old Age (ed. Magnussen, G., Nielsen, J. and Buch, J.), pp. 5254. Nordisk Samråd för Ældreaktivitet: Hellerup, Denmark.
Nilsson, L. V. (1984). Incidence of severe dementia in an urban sample followed from 70 to 79 years of age. Acta Psychiatrica Scandinavica 70, 478486.
Roth, M., Huppert, F. A., Tym, E. & Mountjoy, C. Q. (1988). CAMDEX: The Cambridge Examination for Mental Disorders of the Elderly. Cambridge University Press: Cambridge, U.K.
Schoenberg, B. S., Kokmen, E. & Okazaki, H. (1987). Alzheimer's disease and other dementing illnesses in a defined United States population: incidence rates and clinical features. Annals of Neurology 22, 724729.
Sluss, T. K., Gruenberg, E. M. & Kramer, M. (1981). The use of longitudinal studies in the investigation of risk factors for senile dementia – Alzheimer type. In The Epidemiology of Dementia (ed. Mortimer, J. A. and Schuman, L. M.), pp. 132154. Oxford University Press: London.
van Dijk, P. T. M., Dippel, D. W. J. & Habbema, J. D. F. (1991). Survival of patients with dementia. Journal of the American Geriatrics Society 39, 603610.
van Duijn, C. M., Clayton, D., Chandra, V., Fratiglioni, L., Graves, A. B., Heyman, A., Jorm, A. F., Kokmen, K., Kondo, K., Mortimer, J. A., Rocca, W. A., Shalat, S. L., Soininen, H. & Hofman, A. (1991). Familial aggregation of Alzheimer's disease and related disorders: a collaborative re-analysis of case-control studies. International Journal of Epidemiology 20, Suppl. 2, 1320.
Weissman, M. M., Myers, J. K., Tischler, G. L., Holzer, C. E., Leaf, P. J., Orvaschel, H. & Brody, J. A. (1985). Psychiatric disorders (DSM-III) and cognitive impairment among the elderly in a US urban community. Acta Psychiatrica Scandinavica 71, 366379.
Welsh, K. A., Butters, N., Hughes, J. P., Mohs, R. C. & Heyman, A. (1992). Detection and staging of dementia in Alzheimer's disease. Use of the neuropsychological measures developed for the Consortium to Establish a Registry for Alzheimer's Disease. Archives of Neurology 49, 448452.
World Health Organization (1978). Mental Disorders: Glossary and Guide to their Classification in Accordance with the 9th Revision of the International Classification of Diseases. WHO: Geneva.

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