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Articles
May 2, 2012

Is dementia incidence declining?
Trends in dementia incidence since 1990 in the Rotterdam Study

May 8, 2012 issue
78 (19) 1456-1463

Abstract

Objective:

To investigate whether dementia incidence has changed over the last 2 decades.

Methods:

We compared dementia incidence in 2 independent subcohorts of persons aged 60–90 years from the Rotterdam Study, a population-based cohort study. The first subcohort started in 1990 (n = 5,727), the second in 2000 (n = 1,769). Participants were dementia-free at baseline and followed for at maximum 5 years. We calculated age-adjusted dementia incidence rates for the 2 subcohorts in total, in 10-year age strata, and for men and women separately. We also compared mortality rates, differences in prevalence of vascular risk factors, and medication use. Finally, we compared brain volumes and the extent of cerebral small vessel disease in participants who underwent brain imaging 5 years after the baseline examinations.

Results:

In the 1990 subcohort (25,696 person-years), 286 persons developed dementia, and in the 2000 subcohort (8,384 person-years), 49 persons. Age-adjusted dementia incidence rates were consistently, yet nonsignificantly, lower in the 2000 subcohort in all strata, reaching borderline significance in the overall analysis (incidence rate ratio 0.75, 95% confidence interval [CI] 0.56–1.02). Mortality rates were also lower in the 2000 subcohort (rate ratio 0.63, 95% CI 0.52–0.77). The prevalence of hypertension and obesity significantly increased between 1990 and 2000. This was paralleled by a strong increase in use of antithrombotics and lipid-lowering drugs. Participants in 2005–2006 had larger total brain volumes (p < 0.001) and less cerebral small vessel disease (although nonsignificant in men) than participants in 1995–1996.

Conclusions:

Although the differences in dementia incidence were nonsignificant, our study suggests that dementia incidence has decreased between 1990 and 2005.

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Supplementary Material

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Information & Authors

Information

Published In

Neurology®
Volume 78Number 19May 8, 2012
Pages: 1456-1463
PubMed: 22551732

Publication History

Received: May 11, 2011
Accepted: October 18, 2011
Published online: May 2, 2012
Published in print: May 8, 2012

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Disclosure

Dr. Schrijvers and Dr. Verhaaren report no disclosures. Dr. Koudstaal has received travel and national coordinator fees for the Perform study from Servier and is funded by grants from the Neurovascular Research Fund Rotterdam. Dr. Hofman received LpPLA2 summit travel grants, and is funded by grants from the Netherlands Genomics Initiative for the Rotterdam Study and from the Ministry of Health for the Generation R study. Dr. Ikram received research support from The Netherlands Heart Foundation. Dr. Breteler is funded by the Netherlands Organization for Scientific Research grant 948-00-010 and grant 918-46-615, and received research support from NIH subaward to grant 1 R01 AG 033 193-01, the Dutch Cancer Society, the Netherlands Brain Foundation, and The Netherlands Heart Foundation. Go to Neurology.org for full disclosures.

Authors

Affiliations & Disclosures

E.M.C. Schrijvers, MD, PhD
From the Departments of Epidemiology (E.M.C.S., B.F.J.V., A.H., M.A.I., M.M.B.B.), Neurology (E.M.C.S., P.J.K., M.A.I.), and Radiology (B.F.J.V., M.A.I.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; and German Center for Neurodegenerative Diseases (DZNE) (M.M.B.B.), Bonn, Germany.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers’ Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
B.F.J. Verhaaren, MD
From the Departments of Epidemiology (E.M.C.S., B.F.J.V., A.H., M.A.I., M.M.B.B.), Neurology (E.M.C.S., P.J.K., M.A.I.), and Radiology (B.F.J.V., M.A.I.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; and German Center for Neurodegenerative Diseases (DZNE) (M.M.B.B.), Bonn, Germany.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers’ Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
Netherlands Heart Foundation (Nederlandse Hartstichting), grant number 2009B102.
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
P.J. Koudstaal, MD, PhD
From the Departments of Epidemiology (E.M.C.S., B.F.J.V., A.H., M.A.I., M.M.B.B.), Neurology (E.M.C.S., P.J.K., M.A.I.), and Radiology (B.F.J.V., M.A.I.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; and German Center for Neurodegenerative Diseases (DZNE) (M.M.B.B.), Bonn, Germany.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
Neurologie. Reed Elsevier. 2006
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers’ Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
A. Hofman, MD, PhD
From the Departments of Epidemiology (E.M.C.S., B.F.J.V., A.H., M.A.I., M.M.B.B.), Neurology (E.M.C.S., P.J.K., M.A.I.), and Radiology (B.F.J.V., M.A.I.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; and German Center for Neurodegenerative Diseases (DZNE) (M.M.B.B.), Bonn, Germany.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
Travel to LpPLA2 meeting, GSK 2007
Editorial Boards:
1.
Editor Eur J Epidemiol form 2000 onwards
Patents:
1.
NONE
Publishing Royalties:
1.
Royalties two Dutch books on epidemiology: Grondslagen der Epidemiologie, Elsevier 2008 Klinische Epidemiologie Elsevier 2000 Investigating neurological disease, Cambridge University press 1996
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers’ Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
Grant Netherlands Genomics Initiative for Rotterdam Study Grant Ministry of health for Generation R study
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
M.A. Ikram, MD, PhD
From the Departments of Epidemiology (E.M.C.S., B.F.J.V., A.H., M.A.I., M.M.B.B.), Neurology (E.M.C.S., P.J.K., M.A.I.), and Radiology (B.F.J.V., M.A.I.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; and German Center for Neurodegenerative Diseases (DZNE) (M.M.B.B.), Bonn, Germany.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
Neuroepidemiology, Editorial board member, 2011
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers’ Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
Internationaal Parkinson Fonds; Netherlands Heart Foundation - 2009B102
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
M.M.B. Breteler, MD, PhD
From the Departments of Epidemiology (E.M.C.S., B.F.J.V., A.H., M.A.I., M.M.B.B.), Neurology (E.M.C.S., P.J.K., M.A.I.), and Radiology (B.F.J.V., M.A.I.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; and German Center for Neurodegenerative Diseases (DZNE) (M.M.B.B.), Bonn, Germany.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
Neuroepidemiology, editorial advisory board member; Alzheimer’s & Dementie, editorial advisory board member 3. Stroke, editorial advisory board member
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers’ Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
Netherlands Organisation for Scientific Research (NWO), grant numbers 948-00-010 and 918-46-615
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
Dutch Cancer Society; NIH, subaward to grant 1 R01 AG 033 193-01; Netherlands Brain Foundation; Netherlands Heart Foundation
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE

Notes

Study funding: The Rotterdam Study and the Rotterdam Scan Study are supported by the Erasmus Medical Center and Erasmus University Rotterdam, the Netherlands Organization for Scientific Research (NWO), the Netherlands Organization for Health Research and Development (ZonMw), The Research Institute for Diseases in the Elderly (RIDE), the Ministry of Education, Culture and Science, the Ministry of Health, Welfare and Sports, the European Commission (DG XII), and the Municipality of Rotterdam. This study also was supported by the Netherlands Heart Foundation (de Nederlandse Hartstichting), grant 2009B102.
Correspondence & reprint requests to Dr. Breteler: [email protected]

Author Contributions

E.M.C.S. contributed to data collection, performed the data analysis, and drafted the manuscript. B.F.J.V. contributed to the data analysis and drafting of the manuscript. P.J.K. contributed to data collection and interpretation of the data. A.H. contributed to the design of the study and interpretation of the data. M.A.I. contributed to data collection and interpretation of the data. M.M.B.B. contributed to the design of the study, data collection, data analysis and drafting of the manuscript. All authors reviewed, edited, and approved the final version of the manuscript.

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