Incidence and Prevalence of Dementia in the Cardiovascular Health Study

Authors

  • Annette L. Fitzpatrick PhD,

    1. From the Departments of *EpidemiologyBiostatistics, University of Washington, Seattle, WashingtonDepartment of Epidemiology, Graduate School of Public Health, and §Departments of Neurology and Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PennsylvaniaDepartment of Neurology, University of California at Davis, Davis CaliforniaVA Puget Sound Health Care System, Seattle, Washington#Division of Geriatric Psychiatry, Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington**Department of Psychiatry, School of Medicine, Wake-Forest University, Winston-Salem, North Carolina††Division of Geriatric Psychiatry and Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, School of Medicine, and ‡‡Department of Mental Hygiene, School of Public Health, The Johns Hopkins University, Baltimore, Maryland.
    Search for more papers by this author
  • Lewis H. Kuller MD, DrPH,

    1. From the Departments of *EpidemiologyBiostatistics, University of Washington, Seattle, WashingtonDepartment of Epidemiology, Graduate School of Public Health, and §Departments of Neurology and Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PennsylvaniaDepartment of Neurology, University of California at Davis, Davis CaliforniaVA Puget Sound Health Care System, Seattle, Washington#Division of Geriatric Psychiatry, Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington**Department of Psychiatry, School of Medicine, Wake-Forest University, Winston-Salem, North Carolina††Division of Geriatric Psychiatry and Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, School of Medicine, and ‡‡Department of Mental Hygiene, School of Public Health, The Johns Hopkins University, Baltimore, Maryland.
    Search for more papers by this author
  • Diane G. Ives MPH,

    1. From the Departments of *EpidemiologyBiostatistics, University of Washington, Seattle, WashingtonDepartment of Epidemiology, Graduate School of Public Health, and §Departments of Neurology and Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PennsylvaniaDepartment of Neurology, University of California at Davis, Davis CaliforniaVA Puget Sound Health Care System, Seattle, Washington#Division of Geriatric Psychiatry, Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington**Department of Psychiatry, School of Medicine, Wake-Forest University, Winston-Salem, North Carolina††Division of Geriatric Psychiatry and Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, School of Medicine, and ‡‡Department of Mental Hygiene, School of Public Health, The Johns Hopkins University, Baltimore, Maryland.
    Search for more papers by this author
  • Oscar L. Lopez MD,

    1. From the Departments of *EpidemiologyBiostatistics, University of Washington, Seattle, WashingtonDepartment of Epidemiology, Graduate School of Public Health, and §Departments of Neurology and Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PennsylvaniaDepartment of Neurology, University of California at Davis, Davis CaliforniaVA Puget Sound Health Care System, Seattle, Washington#Division of Geriatric Psychiatry, Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington**Department of Psychiatry, School of Medicine, Wake-Forest University, Winston-Salem, North Carolina††Division of Geriatric Psychiatry and Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, School of Medicine, and ‡‡Department of Mental Hygiene, School of Public Health, The Johns Hopkins University, Baltimore, Maryland.
    Search for more papers by this author
  • William Jagust MD,

    1. From the Departments of *EpidemiologyBiostatistics, University of Washington, Seattle, WashingtonDepartment of Epidemiology, Graduate School of Public Health, and §Departments of Neurology and Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PennsylvaniaDepartment of Neurology, University of California at Davis, Davis CaliforniaVA Puget Sound Health Care System, Seattle, Washington#Division of Geriatric Psychiatry, Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington**Department of Psychiatry, School of Medicine, Wake-Forest University, Winston-Salem, North Carolina††Division of Geriatric Psychiatry and Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, School of Medicine, and ‡‡Department of Mental Hygiene, School of Public Health, The Johns Hopkins University, Baltimore, Maryland.
    Search for more papers by this author
  • John C. S. Breitner MD, MPH,

    1. From the Departments of *EpidemiologyBiostatistics, University of Washington, Seattle, WashingtonDepartment of Epidemiology, Graduate School of Public Health, and §Departments of Neurology and Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PennsylvaniaDepartment of Neurology, University of California at Davis, Davis CaliforniaVA Puget Sound Health Care System, Seattle, Washington#Division of Geriatric Psychiatry, Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington**Department of Psychiatry, School of Medicine, Wake-Forest University, Winston-Salem, North Carolina††Division of Geriatric Psychiatry and Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, School of Medicine, and ‡‡Department of Mental Hygiene, School of Public Health, The Johns Hopkins University, Baltimore, Maryland.
    Search for more papers by this author
  • Beverly Jones MD,

    1. From the Departments of *EpidemiologyBiostatistics, University of Washington, Seattle, WashingtonDepartment of Epidemiology, Graduate School of Public Health, and §Departments of Neurology and Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PennsylvaniaDepartment of Neurology, University of California at Davis, Davis CaliforniaVA Puget Sound Health Care System, Seattle, Washington#Division of Geriatric Psychiatry, Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington**Department of Psychiatry, School of Medicine, Wake-Forest University, Winston-Salem, North Carolina††Division of Geriatric Psychiatry and Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, School of Medicine, and ‡‡Department of Mental Hygiene, School of Public Health, The Johns Hopkins University, Baltimore, Maryland.
    Search for more papers by this author
  • Constantine Lyketsos MD, MHS,

    1. From the Departments of *EpidemiologyBiostatistics, University of Washington, Seattle, WashingtonDepartment of Epidemiology, Graduate School of Public Health, and §Departments of Neurology and Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PennsylvaniaDepartment of Neurology, University of California at Davis, Davis CaliforniaVA Puget Sound Health Care System, Seattle, Washington#Division of Geriatric Psychiatry, Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington**Department of Psychiatry, School of Medicine, Wake-Forest University, Winston-Salem, North Carolina††Division of Geriatric Psychiatry and Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, School of Medicine, and ‡‡Department of Mental Hygiene, School of Public Health, The Johns Hopkins University, Baltimore, Maryland.
    Search for more papers by this author
  • Corinne Dulberg PhD

    1. From the Departments of *EpidemiologyBiostatistics, University of Washington, Seattle, WashingtonDepartment of Epidemiology, Graduate School of Public Health, and §Departments of Neurology and Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PennsylvaniaDepartment of Neurology, University of California at Davis, Davis CaliforniaVA Puget Sound Health Care System, Seattle, Washington#Division of Geriatric Psychiatry, Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington**Department of Psychiatry, School of Medicine, Wake-Forest University, Winston-Salem, North Carolina††Division of Geriatric Psychiatry and Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, School of Medicine, and ‡‡Department of Mental Hygiene, School of Public Health, The Johns Hopkins University, Baltimore, Maryland.
    Search for more papers by this author

  • The research reported in this article was supported by Grant 5 R01 AG15928-02 from the National Institute on Aging and Contracts N01-HC-85079 and N01-HC-85086 from the National Heart, Lung, and Blood Institute.

Address correspondence to Annette L. Fitzpatrick, PhD, Department of Epidemiology, University of Washington, Building 29, Suite 310, 6200 NE 74th Street, Seattle, WA 98115. E-mail: fitzpal@u.washington.edu

Abstract

Objectives: To estimate the incidence and prevalence of dementia, Alzheimer's disease (AD), and vascular dementia (VaD) in the Cardiovascular Health Study (CHS) cohort.

Design: Longitudinal cohort study using prospectively and retrospectively collected data to evaluate dementia.

Setting: Four U.S. communities.

Participants: There were 3,602 CHS participants, including 2,865 white and 492 African-American participants free of dementia, who completed a cranial magnetic resonance image between 1992 and 1994 and were followed for an average of 5.4 years.

Measurements: Dementia was classified by neurologist/psychiatrist committee review using neuropsychological tests, neurological examinations, medical records, physician questionnaires, and proxy/informant interviews. Demographics and apolipoprotein E (APOE) genotype were collected at baseline. Incidence by type of dementia was determined using National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association criteria for AD and Alzheimer's Disease Diagnostic and Treatment Center's State of California criteria for VaD.

Results: Classification resulted in 227 persons with prevalent dementia at entry into the study and 480 incident cases during follow-up. Incidence rates of dementia scaled to age 80 were 34.7 per 1,000 person-years for white women, 35.3 for white men, 58.8 for African-American women, and 53.0 for African-American men. Sex differences were not significant within race. Adjusted for age and education, racial differences were only of borderline significance and may have been influenced by ascertainment methodology. Rates differed substantially by educational attainment but were only significant for whites. Those with the APOE ɛ4 allele had an incidence rate at age 80 of 56.4, compared with 29.6 for those without this allele (P<.001). In whites, type-specific incidence at age 80 was 19.2 for AD versus 14.6 for VaD. These rates were 34.7 and 27.2 for African Americans. At termination of observation, women had only a slightly higher prevalence of dementia (16.0%) than men (14.7%).

Conclusion: Sex and racial differences were not found, and VaD was higher than reported in other studies. These data provide new estimates of dementia incidence in a community sample for projection of future burden.

Ancillary