Increasing incidence of dementia in the oldest old: evidence and implications
ABSTRACT The oldest old are the fastest growing segment of the US population but accurate estimates of the incidence of dementia in this age group have been elusive. Corrada and colleagues present data on the 5-year age-specific rates of dementia incidence in persons 90 years and older from The 90+ Study. Their findings show a continued exponential increase in dementia incidence after age 90 that mirrors the increase observed in persons aged 65 to 90, with a doubling every 5.5 years. This contrasts with previous smaller studies reporting a slowing of the increase in incidence after age 90. If confirmed, the continued increase, rather than a plateau, in the incidence of dementia in the oldest old has implications for proper healthcare planning. Strategies for prevention and treatment will require more information regarding risk factors and the etiopathogenesis of dementia in the oldest old.
Full-textDOI: · Available from: Julie A Schneider, Aug 20, 2015
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- "The prevalence studies must be interpreted cautiously due to referral biases, confounding effect of their comparison by the lack of common diagnostic criteria for VaD, small numbers of very old individuals in most studies (Xuereb et al., 2000; Polvikoski et al., 2001; Kawas and Corrada, 2006; Zaccai et al., 2006), and the fact that aged subjects with and without dementia show a high frequency of mixed pathologies and comorbidities (Jellinger, 2007a,b; Schneider et al., 2007a,b; James and Schneider, 2010). "
ABSTRACT: Vascular cognitive impairment describes a continuum of cognitive diorders ranging from mild cognitive impairment to dementia, in which vascular brain injury involving regions important for memory, cognition and behaviour plays an important role. Classification, prevalence, and pathophysiology are a matter of current research. Clinical diagnostic criteria show moderate sensitivity (ca 50%) and variable specificity (range 64-98%). In Western clinical series, VaD is suggested in 8-10% of cognitively impaired elderly subjects. Its prevalence in autopsy series varies from 0.03 to 58%. In contrast to Alzheimer disease (AD) and mixed dementia showing significant age-related increase, the prevalence of VaD significantly decreases after age 80 years. Cognitive decline is commonly associated with widespread small ischemic vascular lesions involving subcortical brain areas. The lesions affect neuronal networks involved in cognition, memory, and behavior. Cerebrovascular lesions (CVLs) often coexist wth Alzheimer-type lesions and other pathologies. The lesion pattern of "pure" VaD differs from that in mixed dementia (AD + CVLs), which suggests different pathogenesis of both phenotypes. Minor CVLs appear not essential for cognitive impairment in full-blown AD, while both mild AD-type pathology and small vessel disease may interact synergistically in promoting and progressing dementia. However, both AD-related and vascular brain pathologies have been reported. Despite recent suggestions for staging and grading CVLs in specific brain areas, no validated neuropathological criteria are currently available for VaD and mixed dementia. Further clinico-pathological studies and harmonization of neuropathological procedures are needed to validate the diagostic criteria for VaD and mixed dementia in order to clarify the impact of CVLs and other coexistent pathologies on cognitive impairment as a basis for further successful therapeutic options.Frontiers in Aging Neuroscience 04/2013; 5:17. DOI:10.3389/fnagi.2013.00017 · 2.84 Impact Factor
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- "Applications to monitor the health status of older adults have been an increasing area of work (Helal et al., 2005; Chan et al., 2008; Cook and Schmitter-Edgecombe, 2009; Sagahyroon et al., 2009). The quickest growing demographic group in the USA is that of older adults greater than 85 years of age (Campion, 1994; James and Schneider, 2010). This presents opportunities to apply informatics tools that can help support optimal functionality and overall health for older adults. "
ABSTRACT: Informatics tools can help support the health and independence of older adults. In this paper, we present an approach towards integrating health-monitoring data and describe several techniques for the assessment and visualisation of integrated health and well-being of older adults. We present three different visualisation techniques to provide distinct alternatives towards display of the same information, focusing on reducing the cognitive load of data interpretation. We demonstrate the feasibility of integrating health-monitoring information into a comprehensive measure of wellness, while also highlighting the challenges of designing visual displays targeted at multiple user groups. These visual displays of wellness can be incorporated into personal health records and can be an effective support for informed decision-making.International Journal of Electronic Healthcare 01/2012; 7(2):89-104. DOI:10.1504/IJEH.2012.049872
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- "Less emphasis has been placed on the oldest old, namely adults 85 years of age or older. This group is the fastest growing segment of the US population   . Thus far, the oldest old have not been thought of as potential IT users. "
ABSTRACT: There is a recognized need to develop information technology for the delivery of care services to older adults. However, little attention has been paid to the design of information technology for the oldest old demographic. We made novel use of data from observations, focus groups and cluster analysis of oldest old participant characteristics from a pilot study in a community setting to iteratively construct personas for the design of information technology for the oldest old. The resulting two personas, "Hazel" and "Rose", capture different abilities of members of the oldest old demographic group. In addition, we provide a list of eleven design recommendations to guide the design of technology that supports the abilities of people like Hazel and Rose. The resulting personas, design recommendations and persona construction method can be useful tools for informaticians and designers of new systems for the oldest old.AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium 01/2011; 2011:1166-75.