European studies on the prevalence of dementia in the elderly: Time for a step towards a methodological consensus
The aim of this study was to discuss methodological limitations in studies on the prevalence of dementia across European countries with particular attention to post-EURODEM studies. Methods
Two people independently focused on an iterative literature search for studies published in the years 2000-2012 using the following keywords: dementia', Alzheimer', incidence', prevalence' that were cross-linked with names of European countries. After that, the results obtained were compared and publications in English were included in a subsequent analysis. ResultsWe included 26 studies published in the years 2000-2012. The majority of epidemiological studies come from Spain and Italy. The past decade has not provided prevalence rates from a considerable number of countries. There is also a lack of nationwide surveys on the prevalence of dementia. Predominantly, epidemiological studies on the prevalence of dementia follow a two-stage approach that consists of a screening phase and a subsequent confirmation of dementia. However, several differences, particularly with regard to the neuropsychological instruments used, still exist and contribute to inconsistent prevalence rates. Conclusions
Although the EURODEM study was a milestone in the epidemiology of dementia in Europe and provided several future directions for research, methodological limitations are apparent in a number of European studies on the prevalence of dementia and require particular attention. In particular, a variety of diagnostic instruments requires unification for future studies. On the other hand, given the lack of epidemiological studies from a number of countries and the increasing prevalence of dementia, the need for population-based surveys should be emphasized. Copyright (c) 2013 John Wiley & Sons, Ltd.
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ABSTRACT: Developed countries are experiencing an unprecedented increase in life expectancy that is accompanied by a tremendous rise in the number of people with dementia. The purpose of this paper is to report on the study design and methodology of an Italian population-based study on brain aging and dementia in the elderly. This multi-domain study is structured in two phases. Our goal is to gather sufficient data to estimate the prevalence (phase I: cross-sectional study), the incidence and the progression of dementia and its subtypes as well as cognitive impairment (phase II: follow-up study) and to identify socio-demographic, clinical, and lifestyle factors associated with dementia and the quality of brain aging in people aged 70--74 years, a crucial point between late adulthood and old age.
We chose to contact all 1773 people born between 1935--39 residing in Abbiategrasso, Milan, Italy. Those who agreed to participate in the "Invece.Ab" study were enrolled in a cross-sectional assessment and will be contacted two and four years after the initial data collection to participate in the longitudinal survey. Both the cross-sectional and longitudinal assessments include a medical evaluation, a neuropsychological test battery, several anthropometric measurements, a social and lifestyle interview, blood analyses, and the storage of a blood sample for the evaluation of putative biological markers.
Now at the end of the recruitment phase, the evaluable population has amounted to 1644 people. Among these, 1321 (80.35%) of the participants have completed phase I. This high return rate was likely due to the style of recruitment and personalization of the contacts.Trial registration: ClinicalTrials.gov: NCT01345110.
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ABSTRACT: The number of elderly in the world is increasing rapidly, especially in China. The prevalence of dementia among elderly was investigated in a community of Sheshan town, located in the Southwest suburb of Shanghai, China. Face-to-face interviews were conducted to collect relevant information with prepared questionnaires. The Chinese version of the Mini-Mental Status Examination was used to screen subjects with cognitive impairment (CI). Physical examinations and neuropsychological assessments were carried out. Dementia and its major subtypes, Alzheimer's disease (AD) and vascular dementia (VaD), were diagnosed by senior neurologists according to relevant diagnostic criteria. In addition, magnetic resonance imaging and EEG (with P300) were performed for a number of cases with AD or VaD. There were 1,472 participants (666 males and 806 females) aged 60 years and over in the study. A total of 167 subjects with CI were screened. Among them, dementia was recognized in 79 cases with a prevalence of 5.37% (95% confidence intervals: 4.22%-6.52%). The diagnosis of AD was made for 53 cases (16 males and 37 females) with a prevalence of 3.60% (95% confidence intervals: 2.65%-4.55%), and VaD for 21 cases (5 males and 16 females) with a prevalence of 1.43% (95% confidence intervals: 0.82%-2.03%); while the ratio of AD to VaD was 2.52. The prevalence rates of dementia among elderly from our study are higher than that previously reported from China, but in line with that reported from most world regions. A nationwide survey and surveillance system on the prevalence of dementia is recommended.
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