Incidence of dementia over three decades in the Framingham heart study
Open accessAbstract
BACKGROUND: The prevalence of dementia is expected to soar as the average life expectancy increases, but recent estimates suggest that the age-specific incidence of dementia is declining in high-income countries. Temporal trends are best derived through continuous monitoring of a population over a long period with the use of consistent diagnostic criteria. We describe temporal trends in the incidence of dementia over three decades among participants in the Framingham Heart Study. METHODS: Participants in the Framingham Heart Study have been under surveillance for incident dementia since 1975. In this analysis, which included 5205 persons 60 years of age or older, we used Cox proportional-hazards models adjusted for age and sex to determine the 5-year incidence of dementia during each of four epochs. We also explored the interactions between epoch and age, sex, apolipoprotein E ε4 status, and educational level, and we examined the effects of these interactions, as well as the effects of vascular risk factors and cardiovascular disease, on temporal trends. RESULTS: The 5-year age- and sex-adjusted cumulative hazard rates for dementia were 3.6 per 100 persons during the first epoch (late 1970s and early 1980s), 2.8 per 100 persons during the second epoch (late 1980s and early 1990s), 2.2 per 100 persons during the third epoch (late 1990s and early 2000s), and 2.0 per 100 persons during the fourth epoch (late 2000s and early 2010s). Relative to the incidence during the first epoch, the incidence declined by 22%, 38%, and 44% during the second, third, and fourth epochs, respectively. This risk reduction was observed only among persons who had at least a high school diploma (hazard ratio, 0.77; 95% confidence interval, 0.67 to 0.88). The prevalence of most vascular risk factors (except obesity and diabetes) and the risk of dementia associated with stroke, atrial fibrillation, or heart failure have decreased over time, but none of these trends completely explain the decrease in the incidence of dementia. CONCLUSIONS: Among participants in the Framingham Heart Study, the incidence of dementia has declined over the course of three decades. The factors contributing to this decline have not been completely identified. (Funded by the National Institutes of Health.).
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Higher childhood education levels and lifelong higher educational attainment reduce dementia risk.
“Higher childhood education levels and lifelong higher educational attainment reduce dementia risk.2, 35, 36, 37”
From Dementia prevention, intervention, and care: 2020 report of the Lancet Commission (2020) · cites this paper as [36]
The Results (page not provided) report that dementia incidence declined over three decades among participants with a high school diploma, but not among those without one. The Methods (page not provided) classify education only by high school diploma status; the paper does not examine childhood education or lifelong attainment. The Discussion says rising education levels *might* have contributed to later dementia onset, not that higher attainment itself reduces risk. (LLM, conf=0.86)
Experimental — accuracy not yet measuredThe Lancet Commission on Dementia Prevention, Intervention, and Care suggested that lifestyle modifications may already have an influence on dementia risk decades before the onset of dementia.
“The Lancet Commission on Dementia Prevention, Intervention, and Care suggested that lifestyle modifications may already have an influence on dementia risk decades before the onset of dementia.3-8”
From Awareness of dementia risk reduction among current and future healthcare professionals: A survey study (2021) · cites this paper as [5]
The Discussion says prevention might reduce dementia burden, but it does not attribute a suggestion to the Lancet Commission or establish that lifestyle modifications affect risk decades before onset. It also says the study lacked data to examine diet and physical activity. Searches for the Commission and for lifestyle changes before onset found no passage addressing the attributed claim. (LLM, conf=0.76)
Experimental — accuracy not yet measuredDecades of efforts to reduce stroke and cardiovascular risks and to promote cardiovascular health likely contributed to the declining incidence of dementia.
“Decades of efforts to reduce stroke and cardiovascular risks by the AHA/ASA and other health organizations and, more recently, to promote cardiovascular health are likely to have already contributed to the declining incidence of dementia.172”
From Defining Optimal Brain Health in Adults: A Presidential Advisory From the American Heart Association/American Stroke Association (2017) · cites this paper as [172]
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- Authors
- Satizabal, C. L., Beiser, A. S., Chouraki, V., Chêne, G., Dufouil, C., & Seshadri, S.
- Affiliations
- Boston University (US)
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2016-02-11
- Volume
- 374
- Issue
- 6
- Pages
- 523-532
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- PMC
- PMC4943081
- OpenAlex
- W2265553328
- Cited by
- 1,051
- References
- 37
- Citations by year
- 2026: 49 · 2025: 90 · 2024: 77 · 2023: 78 · 2022: 94 · 2021: 110 · 2020: 109 · 2019: 105 · 2018: 128 · 2017: 125 · 2016: 83 · 2015: 1
- FWCI
- 130.58
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (n01hc25195-41-0-1, HHSN268201500001I, N01-HC 25195)
- National Institute on Aging (P30AG010129, U01AG049505, N01-HC-25195, AG08122, R01AG054076, R01AG049607, AG033193, NS017950, R01AG033040, R01AG033193, R01AG008122)
- National Heart, Lung, and Blood Institute (N01‐HC25195, HHSN268201500001I, AG08122, HHSN268201500001C, N01-HC-025195, NS017950, AG033193)
- National Institute of Neurological Disorders and Stroke (NS017950, N01‐HC‐25195, HHSN268201500001I, R01NS017950)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Menopause: Health Impacts and Treatments
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Cognitive Abilities and Testing
- Keywords
- dementia incidence, temporal trends, age-specific incidence, older adults, APOE ε4, educational attainment, vascular risk factors, stroke, atrial fibrillation, heart failure, cardiovascular disease, dementia risk factors
- MeSH terms
- Aged, Aged, 80 and over, Atrial Fibrillation, Dementia, Educational Status, Female, Heart Failure, Humans, Longitudinal Studies, Male, Massachusetts, Middle Aged, Risk Factors, Dementia, Vascular, Incidence, Proportional Hazards Models, Stroke
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