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Incidence and etiology of dementia in a large elderly Italian population

From the Department of Internal Medicine, Cardioangiology, and Hepatology (Drs. Ravaglia, Forti, Maioli, Martelli, Servadei, and Brunetti), University Hospital S. Orsola-Malpighi, Bologna; Health District of Lugo (Drs. Dalmonte and Bianchin), Local Health Unit Ravenna; and Laboratory of Immunology and Genetics (Dr. Mariani), Codivilla Putti Research Institute, Rizzoli Orthopaedic Institute, Bologna, Italy.

Address correspondence and reprint requests to Prof. Giovanni Ravaglia, Department of Internal Medicine, Cardioangiology, and Hepatology, University Hospital S. Orsola-Malpighi, Via Massarenti, 9-40138 Bologna, Italy; e-mail: ravaglia{at}med.unibo.it

Objective: To estimate age- and sex-specific incidence of dementia, Alzheimer disease (AD), and vascular dementia (VaD) in the Conselice Study of Brain Aging, an Italian prospective population-based study, and to assess whether poor education is a risk factor for dementia.

Methods: In 1999 to 2000, the baseline study identified a dementia-free cohort of 937 subjects aged 65 years and older who were reexamined in 2003 to 2004 using a two-phase procedure.

Results: Information was obtained for 91% of the subjects at risk; 115 incident cases of dementia were identified. Incidence rates per 1,000 person-years were 37.8 (95% CI = 30.0 to 47.7) for dementia, 23.8 (95% CI = 17.3 to 31.7) for AD, and 11.0 (95% CI = 7.2 to 16.9) for VaD. This translates into more than 400,000 new cases of dementia expected per year in Italy. Increasing age was an independent risk factor for both AD and VaD. Poor education was an independent risk factor for AD but not VaD. Sex did not affect dementia risk.

Conclusions: In this Italian population-based cohort, incidence of dementia increased with age, and Alzheimer disease (AD) was the most frequent type of dementia. Poor education was associated with a higher risk of AD. Our incidence rates are higher than previously reported in Italy, and provide new estimates for projection of future burden of disease in Italy.

Supported by grants from the Ministero dell'Università e della Ricerca Scientifica (ex-60% fund) and from Ricerca Corrente, Istituti Ortopedici Rizzoli.

Received September 10, 2004. Accepted in final form January 25, 2005.

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