The Association of Early Life Factors and Declining Incidence Rates of Dementia in an Elderly Population of African Americans

Hendrie, Hugh C.; Smith-Gamble, Valerie; Lane, Kathleen A.; Purnell, Christianna; Clark, Daniel O.; Gao, Sujuan

doi:10.1093/geronb/gbx143

Cited by 38 publications

(34 citation statements)

References 36 publications

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“…20 Higher levels of education, particularly in childhood, have also been associated with lower rates of dementia in both Western and non-Western nations in some studies. [21][22][23] The second factor that may be related to the decline in dementia incidence is the reduction in cardiovascular risk over the past several decades. Rates of smoking in adults in the United States have declined since the 1960s.…”

Section: Discussionmentioning

confidence: 99%

Incidence of Dementia and Alzheimer Disease Over Time: A Meta‐Analysis

Gao

Burney

Callahan

et al. 2019

J American Geriatrics Society

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BACKGROUND/OBJECTIVES Population‐based incidence estimates of dementia and Alzheimer disease (AD) provide important information for public health policy and resource allocation. We conducted a meta‐analysis of published studies that reported age‐specific incidence rates of dementia and AD to determine whether dementia and AD incidence rates are changing over time. DESIGN PubMed and MEDLINE were searched for publications through June 30, 2017, using key words “dementia”, “Alzheimer”, and “incidence.” Inclusion criteria for the meta‐analysis are: (1) population‐based studies using personal interviews and direct examinations of the study subjects, (2) standardized clinical diagnosis criteria, (3) reporting age‐specific incidence rates, (4) published in English, and (5) sample size of 500 or greater and length of follow‐up of 2 years or greater. Mixed‐effects models were used to determine the association between birth year and incidence rates. MEASUREMENTS Age‐specific dementia/AD incidence rates and their standard errors reported in each study. RESULTS Thirty‐eight articles with 53 cohorts on dementia incidence and 31 articles with 35 cohorts on AD incidence met the inclusion criteria. There were significant associations between later birth years and decreased dementia incidence rates in all three age groups (65‐74, 75‐84, and 85 years and older). There were no significant associations between birth year and AD incident rates in any of the three age groups. In particular, AD incidence rates reported from Western countries stayed steady in all age groups, while studies in non‐Western countries showed significantly increased AD incidence rates for the 65 to 74 years age group (odds ratio = 2.78; P = .04), but a nonsignificant association for the 75 to 84 or 85 years and older groups. CONCLUSION Dementia incidence declined over the past four decades, but AD incidence did not decline. Further research, especially from non‐Western countries, is needed to elucidate the mechanism underlying the trends in dementia and AD incidence over time.

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Section: Discussionmentioning

confidence: 99%

Incidence of Dementia and Alzheimer Disease Over Time: A Meta‐Analysis

Gao

Burney

Callahan

et al. 2019

J American Geriatrics Society

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“…Given that environmental factors likely can explain the variance unaccounted for by genetic risks, involvement of a family’s shared environments (captured by FH + ) needs to be considered carefully as they may interact with APOE4 and other genetic risks. Shared environmental factors, which are seldom reported in association with Aβ, include a family’s socioeconomic status, place of living (e.g., urban versus rural), lifestyle or dietary habits, parents’ educational attainment and intellectual environment, and exposure to pollution [ 42 – 46 ]. Cognitive activity during the early life stage, for example, has been found to be associated with reduced neurodegeneration in AD signature regions in later life [ 47 ].…”

Section: Discussionmentioning

confidence: 99%

Synergistic interaction between APOE and family history of Alzheimer’s disease on cerebral amyloid deposition and glucose metabolism

Lee

Byun

et al. 2018

Alz Res Therapy

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BackgroundRecently, the field of gene-gene or gene-environment interaction research appears to have gained growing interest, although it is seldom investigated in Alzheimer’s disease (AD). Hence, the current study aims to investigate interaction effects of the key genetic and environmental risks—the apolipoprotein ε4 allele (APOE4) and family history of late-onset AD (FH)—on AD-related brain changes in cognitively normal (CN) middle-aged and older adults.Methods[11C] Pittsburg compound-B (PiB) positron emission tomography (PET) imaging as well as [18F] fluoro-2-deoxyglucose (FDG) PET that were simultaneously taken with T1-weighted magnetic resonance imaging (MRI) were obtained from 268 CNs from the Korean Brain Aging Study for Early Diagnosis and Prediction of AD (KBASE). Composite standardized uptake value ratios were obtained from PiB-PET and FDG-PET images in the AD signature regions of interests (ROIs) and analyzed. Voxel-wise analyses were also performed to examine detailed regional changes not captured by the ROI analyses.ResultsA significant synergistic interaction effect was found between the APOE4 and FH on amyloid-beta (Aβ) deposition in the AD signature ROIs as well as other regions. Synergistic interaction effects on cerebral glucose metabolism were observed in the regions not captured by the AD signature ROIs, particularly in the medial temporal regions.ConclusionsStrong synergistic effects of APOE4 and FH on Aβ deposition and cerebral glucose metabolism in CN adults indicate possible gene-to-gene or gene-to-environment interactions that are crucial for pathogenesis of AD involving Aβ. Other unspecified risk factors—genes and/or environmental—that are captured by the positive FH status might either coexpress or interact with APOE4 to alter AD-related brain changes in CN. Healthy people with both FH and APOE4 need more attention for AD prevention.Electronic supplementary materialThe online version of this article (10.1186/s13195-018-0411-x) contains supplementary material, which is available to authorized users.

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“…People with more years of formal education are at lower risk for Alzheimer's and other dementias than those with fewer years of formal education. 71,[134][135][136][137][138] Some researchers believe that having more years of education builds "cognitive reserve." Cognitive reserve refers to the brain's ability to make flexible and efficient use of cognitive networks (networks of neuron-to-neuron connections) to enable a person to continue to carry out cognitive tasks despite brain changes 139,140 such as beta-amyloid and tau accumulation.…”

Section: Educationmentioning

confidence: 99%

2020 Alzheimer's disease facts and figures

2020

Alzheimer's & Dementia

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653

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This article describes the public health impact of Alzheimer's disease (AD), including incidence and prevalence, mortality and morbidity, use and costs of care, and the overall impact on caregivers and society. The Special Report discusses the future challenges of meeting care demands for the growing number of people living with Alzheimer's dementia in the United States with a particular emphasis on primary care. By mid‐century, the number of Americans age 65 and older with Alzheimer's dementia may grow to 13.8 million. This represents a steep increase from the estimated 5.8 million Americans age 65 and older who have Alzheimer's dementia today. Official death certificates recorded 122,019 deaths from AD in 2018, the latest year for which data are available, making Alzheimer's the sixth leading cause of death in the United States and the fifth leading cause of death among Americans age 65 and older. Between 2000 and 2018, deaths resulting from stroke, HIV and heart disease decreased, whereas reported deaths from Alzheimer's increased 146.2%. In 2019, more than 16 million family members and other unpaid caregivers provided an estimated 18.6 billion hours of care to people with Alzheimer's or other dementias. This care is valued at nearly $244 billion, but its costs extend to family caregivers’ increased risk for emotional distress and negative mental and physical health outcomes. Average per‐person Medicare payments for services to beneficiaries age 65 and older with AD or other dementias are more than three times as great as payments for beneficiaries without these conditions, and Medicaid payments are more than 23 times as great. Total payments in 2020 for health care, long‐term care and hospice services for people age 65 and older with dementia are estimated to be $305 billion. As the population of Americans living with Alzheimer's dementia increases, the burden of caring for that population also increases. These challenges are exacerbated by a shortage of dementia care specialists, which places an increasing burden on primary care physicians (PCPs) to provide care for people living with dementia. Many PCPs feel underprepared and inadequately trained to handle dementia care responsibilities effectively. This report includes recommendations for maximizing quality care in the face of the shortage of specialists and training challenges in primary care.

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The Association of Early Life Factors and Declining Incidence Rates of Dementia in an Elderly Population of African Americans

Cited by 38 publications

References 36 publications

Incidence of Dementia and Alzheimer Disease Over Time: A Meta‐Analysis

Incidence of Dementia and Alzheimer Disease Over Time: A Meta‐Analysis

Synergistic interaction between APOE and family history of Alzheimer’s disease on cerebral amyloid deposition and glucose metabolism

2020 Alzheimer's disease facts and figures

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