epidemiology of dementia in canada: information from the canadian study of health and aging
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Epidemiology of Dementia in Canada:
Information from the Canadian Study of
Health and Aging
Prevalence of DementiaCanada 1991-92
0
50
100
150
200
250
300
350
400
65-74 75-84 85 +
Women
Men
Total
Rate per 1,000
Source: Can Med Assoc J 1994;150:899-913
Prevalence of Cognitive Disorderby severity and gender, ages 65+
Cognitively Cog. Dementia normal Impaired Mild Mod. Severe
Male % 72.6 21.3 2.1 2.6 1.4
Female % 77.1 13.5 2.4 3.6 3.5
M + F % 75.2 16.8 2.3 3.1 2.6
Source: Lancet 1997;349:1793
Prevalence of Cognitive Disorderby severity and age
Cognitively Impaired Dementia normal Mild Mod. Severe
65-74 % 86.6 11.0 1.0 0.9 0.5
75-84 % 64.7 24.0 3.4 4.6 3.2
85+ % 35.0 30.3 7.2 12.9 14.6
Estimated Numbers of Canadians, 65+, with Dementia, 1991
010,00020,00030,00040,00050,00060,00070,00080,00090,000
100,000
Community Institution
Male
Female
Source: Can Med Assoc J 1994;150:899-913
Projected Prevalence of Dementia (x 1,000)Canada, 1991 - 2031
0
100
200
300
400
500
600
700
800
1991 2001 2011 2021 2031
All Dementias
AD
Vascularx 2
x 3
Age-Specific Incidence of Dementia in Canada, per thousand (whole population)
0
10
20
30
40
50
60
70
80
65-69 70-74 75-79 80-84 85+
WomenMen
Source: Neurology 2000; 55: 66-73
Annual Numbers of New Cases of DementiaCanada, 1991
19,770
25,840
14,540
65 - 74
85+
75 - 84
All Ages: 60,150
Source: Neurology 2000; 55: 66-73
Probability of Becoming DementedCanada, 1991
0
10
20
30
40
50
60
65 70 75 80 85 90 95
Women
Men
Undemented at age
% probability
Annual Incidence of Dementia in selected studies, by age,
per thousand (whole population)
0
20
40
60
80
100
120
65-69 70-74 75-79 80-84 85+ 90+
CSHA
Rochester
Turku
Bordeaux
FramighamNew York
Mannheim
Rotterdam
Kungsholmen
Age-Specific Incidence of Alzheimer’s Disease, per thousand
0
10
20
30
40
50
60
70
80
90
65-69 70-74 75-79 80-84 85-89 90+
CSHA
E. Boston
Bordeaux
Baltimore
Lund
Framingham
Rotterdam
Age-Specific Incidence of Alzheimer’s Disease, per thousand
0
10
20
30
40
50
60
70
65-69 70-74 75-79 80-84 85-89 90+
Canada
CSHA Incidence of Alzheimer’s Disease, per thousand (log scale)
0.1
1
10
100
65-69 70-74 75-79 80-84 85-89 90+
Expectation of Life With and Without Dementia: Canadian Women
0
5
10
15
20
25
65 70 75 80 85 90 95
Age
Years
undemented
demented
Expectation of Life With and Without Dementia: Canadian Men
0
5
10
15
20
25
65 70 75 80 85 90 95
Age
Years
undemented
demented
Age-adjusted Mortality Ratios Mortality Ratio
Residence Cognitive status Women Men
Community Normal 1 1 Impaired 2.17 1.95Demented 2.67 2.84
Institution Normal 3.06 2.11Impaired 3.52 3.09Demented 6.03 5.02
(reference group)
Source: Can. J. Public Health 1997;88:303
Progression of Dementia:Survival by Age Category
00.10.20.30.40.50.60.70.80.9
1
0 1 2 3 4 5 6
64-74 yrs
75-84 yrs
85+ yrs
years of survival
Net Annual Costs of Dementia, 1991cost per No. of Annual net
Source patient, $ patients cost x 1,000$
Community 10,100 123,900 1,250,900 - paid services 4,970 123,900 615,200 - unpaid services 5,130 123,900 635,700Institutions 19,100 114,000 2,177,500Drugs 240 252,600 60,600Hospital 0 252,600 0Diagnosis 250 54,100 13,500People < 65 yrs 28,100 389,200Total 3,901,500
Source: CanMedAssocJ 1994;151:1457-64
Dementia and Functional AbilityCommunity Institutions
Normal Demented Normal Demented % % % %
Good function 65.8 6.6 7.1 0.0
Mild disability 20.2 14.8 10.8 0.3
Moderate 12.1 30.8 39.5 2.5
Severe 1.3 21.2 27.3 12.3
Total disability 0.6 26.5 15.3 84.9
Risk Factors for AD(CSHA-1 Case-Control Study)
• One or more relatives with AD: One or more relatives with AD: O.R. O.R. 2.62.6
• 0-6 yrs education: 0-6 yrs education: O.R. O.R. 4.04.0
• Occupational exposure to glues: Occupational exposure to glues: O.RO.R. 2.2. 2.2
• Head injury:Head injury: O.R. O.R. 1.71.7
• Arthritis: Arthritis: O.R. O.R. 0.50.5
• Use of NSAID drugs: Use of NSAID drugs: O.R. O.R. 0.50.5
• Age of onset for smokers 80 yrs; nonsmokers 84 Age of onset for smokers 80 yrs; nonsmokers 84 yrs.yrs.
Source: Neurology 1994;44:2073-80
Risk Factors for Alzheimer’s Disease (Cohort Study)
OR OR 95% CI95% CI
• Any Apolipoprotein E4Any Apolipoprotein E4 3.33.3 2.0 – 5.4 2.0 – 5.4
• 0-8 yrs. education0-8 yrs. education 1.91.9 1.3 - 2.9 1.3 - 2.9
• Head injury Head injury 0.60.6 0.3 - 1.2 0.3 - 1.2
• Family history of dementiaFamily history of dementia 1.1.00 0.6 – 1.8 0.6 – 1.8
• DepressionDepression 2.82.8 1.3 - 6.1 1.3 - 6.1
• SmokingSmoking 1.041.04 0.6 - 1.8 0.6 - 1.8
Risk Factors for Alzheimer’s Disease (continued)
OR OR 95% CI 95% CI
• Vigorous exercise x3 / wk Vigorous exercise x3 / wk 0.70.7 0.5 - 1.0 0.5 - 1.0
• Use of NSAID drugsUse of NSAID drugs 0.70.7 0.4 – 1.0 0.4 – 1.0
• UlcerUlcer 1.81.8 0.9 - 3.3 0.9 - 3.3
• History of hypertensionHistory of hypertension 0.80.8 0.5 - 0.5 - 1.31.3