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From the Department of Neurology (Dr. Seshadri), University of Massachusetts Medical Center, Worcester, MA; the Department of Neurology(Drs. Wolf, Au, and White, Ms. McNulty), the Section of Preventive Medicine and Epidemiology (Dr. Wolf), Boston University School of Medicine; Department of Epidemiology and Biostatistics (Dr. Beiser), Boston University School of Public Health; the Environmental Hazards Center and Psychology Department (Dr. White), Boston VA Medical Center, Boston, MA; and the Department of Mathematics (Dr. D'Agostino), Boston University, Boston, MA.
From the Framingham Heart Study of the National Heart, Lung, and Blood Institute. Supported by NIH/NHLBI Contract N01-HC-38038 and by grant 5-RO1-AG08122-08 from the National Institute on Aging.
Address correspondence and reprint requests to Dr. Philip A. Wolf, Department of Neurology, Boston University School of Medicine, 715 Albany Street, B-608, Boston, MA 02118.
We estimated the remaining lifetime risks of developing Alzheimer's disease (AD) and dementia from all causes, based on data from longitudinal population studies. The risk of developing AD during one's lifetime depends on both disease incidence and life expectancy. Conventional estimates of cumulative incidence overestimate the risk when there is a substantial probability of mortality due to competing causes. A total of 2,611 cognitively intact subjects (1,061 men, 1,550 women; mean age, 66± 7 years) were prospectively evaluated for the development of AD or other dementia. A modified survival analysis was used to estimate both cumulative incidence and the sex-specific remaining lifetime risk estimates for quinquennial age groups above age 65 years. Over a 20-year follow-up period, 198 subjects developed dementia (120 with AD). The remaining lifetime risk of AD or other dementia depended on sex, being higher in women, but varied little with age between 65 and 80 years. In a 65-year-old man, the remaining lifetime risk of AD was 6.3% (95% CI, 3.9 to 8.7) and the remaining lifetime risk of developing any dementing illness was 10.9% (95% CI, 8.0 to 13.8); corresponding risks for a 65-year-old woman were 12% (95% CI, 9.2 to 14.8) and 19% (95% CI, 17.2 to 22.5). The cumulative incidence between age 65 and 100 years was much higher: for AD, 25.5% in men and 28.1% in women; for dementia, 32.8% in men and 45% in women. The actual remaining lifetime risk of AD or dementia varies with age, sex, and life expectancy and is lower than the hypothetical risk estimated by a cumulative incidence in the same population.
Received May 15, 1996. Accepted in final form June 26, 1997.
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