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Incidence and Risk of Dementia: The Rotterdam study
Abstract
To assess age-, sex-, and subtype-specific incidence rates of dementia and to calculate the risk of dementia, the authors performed a large, community-based, prospective cohort study on dementia as part of the Rotterdam Study. Participants were recruited among residents of a suburb of Rotterdam, aged 55 years and older. Baseline examinations took place between 1990 and 1993. The average follow-up was 2.1 years. Screening for dementia followed a three-stage protocol. Medical records of subjects who had died or could not be examined in person were evaluated. Of 7,046 subjects who were nondemented at baseline, 162 developed dementia during 15,135 person-years of follow-up, resulting in an overall incidence rate of 10.7 per 1,000 person-years. From the youngest to the oldest 5-year age category, the incidence rate increased from 0.6 to 97.2 per 1,000 person-years. Only in men did the increase level off after age 85. Overall, the incidence rate per 1,000 person-years was 7.7 for Alzheimer's disease and 1.5 for vascular dementia. Dementia incidence rates and dementia-free Kaplan-Meier survival tables were used to calculate age- and sex-specific cumulative risks of dementia. Although the incidence rates of men and women up to age 85 were similar, the lifetime risk of dementia for 55-year-old women was twice as high as for men (0.33 vs. 0.16), reflecting both the higher life expectancy of women and the higher dementia risk at very old age.
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“Aging is a common risk factor for developing AD and cancer (6,7).”
From Alzheimer's Disease–Associated Amyloid-β Precursor Protein Prevents Aging Stress–Induced Mitophagy and Fumarate Depletion to Improve Antitumor Immunity (2025) · cites this paper as [6]
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“A typical patient aged 65-70 might normally expect a period incidence of dementia of around 10% over the next 15 years,36 so this odds ratio would be consistent with an absolute risk increase of 2% (1% to 3%) over that period, corresponding to a number needed to harm of 50 (33 to 100).”
From Anticholinergic drugs and risk of dementia: case-control study (2018) · cites this paper as [36]
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“The Rotterdam Study was a longitudinal study of the elderly (N57,046) with a design similar to the CHS.(3) Reported incidence of dementia per 1,000 person-years for Table 5.”
BackgroundMethodIs dementia incidence declining?: Trends in dementia incidence since 1990 in the Rotterdam Study
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“The lifetime risk for a 55-year-old man of becoming demented is 16%, and the lifetime risk for a woman of the same age is as high as 33% (Ott et al., 1998).”
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“Ten of 13 studies reporting a single rate for everyone over age 65 found that women had 2‐3 times the AD rate of men (3, 5, 7, 8, 10, 17, 18, 32, 39, 41 ).”
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“For the 563 subjects originating from the Rotterdam Study (Hofman et al., 1991), we added a 3D half-Fourier acquisition single-shot turbo spin echo (HASTE) sequence to the protocol (inversion time 440 ms, repetition time 2800 ms, 128 contiguous sagittal slices of 1.2 mm, matrix 192 Q 256, ®eld of view 256 Q 256).”
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“Other studies, including the Cache County Study (Cache County, Utah) [13] in the United States and European studies such as the PAQUID project [14], the Rotterdam Study [15], the Kungsholmen Study [16], and the Cambridge Project for Later Life [17], report a markedly higher incidence in women than inmen after about ag…”
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“The Rotterdam Study.”
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“26,28 Variables estimated from actigraphy used in this analysis included: (1) total sleep time (TST): h per night spent sleep-”
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The Metabolic Syndrome and Development of Cognitive Impairment Among Older Women
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“T HE LIFETIME RISK OF DEMENtia is 33% for women and 20% for men, and lifetime risks for milder forms of cognitive impairment are even higher.(1) During the next 50 years, the incidence and prevalence of Alzheimer disease (AD) and other forms of dementia are expected to double in people aged 75 to 85 years and to quadr…”
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Schrijvers, E. M. C. (2011) · JAMA · doi:10.1001/jama.2011.381 · Cited by 220
“In addition, the total cohort was continuously monitored for incident dementia through computerized linkage between the study database and digitized medical records from general practitioners and the Regional Institute for Outpatient Mental Health Care.(10) The diagnoses of dementia and AD were made in accordance with…”
MethodInfluentialfor the Osteoporotic Fractures in Men (MrOS) Study Group, Blackwell, T., Yaffe, K., Laffan, A., Ancoli-Israel, S., Redline, S., Ensrud, K. E., Song, Y., & Stone, K. L. (2014) · Sleep · doi:10.5665/sleep.3562 · Cited by 221
Ten-year risk of dementia in subjects with mild cognitive impairment
Visser, P. J., Kester, A. D. M., JOLLES, J., & Verhey, F. R. J. (2006) · Neurology · doi:10.1212/01.wnl.0000238517.59286.c5 · Cited by 217
Sooner or later? Issues in the early diagnosis of dementia in general practice: a qualitative study
Iliffe, S., Manthorpe, J., & Eden, A. (2003) · Family Practice · doi:10.1093/fampra/cmg407 · Cited by 218
Yaffe, K. S., Krueger, K. A., Cummings, S. R., BLACKWELL, T. L., Henderson, V. W., Sarkar, S., Ensrud, K. E., & Grady, D. G. (2005) · American Journal of Psychiatry · doi:10.1176/appi.ajp.162.4.683 · Cited by 212
Body Mass Index, Other Cardiovascular Risk Factors, and Hospitalization for Dementia
Rosengren, A. (2005) · Archives of Internal Medicine · doi:10.1001/archinte.165.3.321 · Cited by 207
BLACKWELL, T. L., Yaffe, K. S., Ancoli‐Israel, S., Redline, S. S., Ensrud, K. E., Stefanick, M. L., Laffan, A. M., Stone, K. L., & for the Osteoporotic Fractures in Men Study Group (2011) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2011.03731.x · Cited by 207
“At least 10% of people aged 65 an older will develop cognitive impairment, with the rate increasing exponentially with advancing age.(1,2) With life expectancies rising, the number of people with cognitive impairment will continue to grow in future years, increasing the importance of identifying factors related to cog…”
BackgroundDietary intake of fish and omega-3 fatty acids in relation to long-term dementia risk
Devore, E. E., Grodstein, F., van Rooij, F. J., Hofman, A., Rosner, B., Stampfer, M. J., Witteman, J. C., & Breteler, M. M. (2009) · The American Journal of Clinical Nutrition · doi:10.3945/ajcn.2008.27037 · Cited by 205
“The diagnosis of dementia was made following a 3-step protocol at baseline and the follow-up examinations (18).”
MethodSelf-citationLehmann, D. J., Cortina-Borja, M., Warden, D. R., Smith, A. D., Sleegers, K., Prince, J. A., van Duijn, C. M., & Kehoe, P. G. (2005) · American Journal of Epidemiology · doi:10.1093/aje/kwi202 · Cited by 199
Characterization of the 3xTg-AD mouse model of Alzheimer's disease: Part 1. Circadian changes
Sterniczuk, R., Dyck, R. H., LaFerla, F. M., & Antle, M. C. (2010) · Brain Research · doi:10.1016/j.brainres.2010.05.013 · Cited by 208
Hippocampal Head Size Associated with Verbal Memory Performance in Nondemented Elderly
Hackert, V., den Heijer, T., Oudkerk, M., Koudstaal, P. J., Albert Hofman, D., & Breteler, M. M. B. (2002) · NeuroImage · doi:10.1006/nimg.2002.1248 · Cited by 199
“Subjects with dementia were excluded based on a stepwise approach as used in the Rotterdam Study (Ott et al., 1998).”
MethodSelf-citationWorldwide variation in the doubling time of Alzheimer's disease incidence rates
Ziegler‐Graham, K., Brookmeyer, R., Johnson, E. M., & Arrighi, H. M. (2008) · Alzheimer s & Dementia · doi:10.1016/j.jalz.2008.05.2479 · Cited by 195
Cognitive Performance in Hypertensive and Normotensive Older Subjects
Harrington, F., Saxby, B. K., McKeith, I. G., Wesnes, K. A., & Ford, G. A. (2000) · Hypertension · doi:10.1161/01.hyp.36.6.1079 · Cited by 195
Mielke, M. M., Aggarwal, N. T., Vila‐Castelar, C., Agarwal, P., Arenaza‐Urquijo, E. M., Brett, B., Brugulat‐Serrat, A., DuBose, L. E., Eikelboom, W. S., Flatt, J., et al. (2022) · Alzheimer's & Dementia · doi:10.1002/alz.12662 · Cited by 198
Relation between smoking and risk of dementia and Alzheimer disease
Reitz, C., den Heijer, T., van Duijn, C. M., Albert Hofman, D., & Breteler, M. M. B. (2007) · Neurology · doi:10.1212/01.wnl.0000271395.29695.9a · Cited by 200
Self-citationCreutzfeldt-Jakob disease in Germany: a prospective 12-year surveillance
Heinemann, U., Krasnianski, A., Meißner, B., Varges, D., Kallenberg, K., Schulz‐Schaeffer, W., Steinhoff, B. J., Grasbon-Frodl, E. M., Kretzschmar, H. A., & Zerr, I. (2007) · Brain · doi:10.1093/brain/awm063 · Cited by 194
“Incidence and mortality clearly decrease after a peak between 70 and 79 years similar to other studies on sCJD, but in contrast to other neurodegenerative diseases which tend to increase with age (Ott et al., 1998; Ladogana et al., 2005).”
ResultIncidence and Recurrence of Late-Life Depression
Luijendijk, H. J., van den Berg, J. F., Dekker, M. J. H. J., van Tuijl, H. R., Otte, W., Smit, F., Albert Hofman, D., Stricker, B. H. C., & Tiemeier, H. W. (2008) · Archives of General Psychiatry · doi:10.1001/archpsyc.65.12.1394 · Cited by 192
Incidence and subtypes of dementia in three elderly populations of central Spain
Bermejo‐Pareja, F., Benito‐León, J., Vega, S., Medrano, M., & Román, G. C. (2007) · Journal of the Neurological Sciences · doi:10.1016/j.jns.2007.07.021 · Cited by 191
“In the last decade, a limited number of large, population-based, prospective cohort studies on dementia subtypes, providing age- and genderspecific incidence rates of persons 65 years and older, have been published worldwide [2–12].”
BackgroundResultBrain tissue volumes in the general elderly population
Ikram, M. A., Vrooman, H. A., Vernooij, M. W., van der Lijn, F., Albert Hofman, D., van der Lugt, A., Niessen, W. J., & Breteler, M. M. B. (2007) · Neurobiology of Aging · doi:10.1016/j.neurobiolaging.2006.12.012 · Cited by 192
Self-citationRahman, A., Jackson, H. C., Hristov, H., Isaacson, R., Saif, N., Shetty, T., Etingin, O. R., Henchcliffe, C., Brinton, R. D., & Mosconi, L. (2019) · Frontiers in Aging Neuroscience · doi:10.3389/fnagi.2019.00315 · Cited by 204
Arendt, T. (2003) · Progress in Neurobiology · doi:10.1016/j.pneurobio.2003.09.007 · Cited by 189
Metabolic Syndrome and Cognitive Disorders
Yaffe, K. S. (2007) · Alzheimer Disease & Associated Disorders · doi:10.1097/wad.0b013e318065bfd6 · Cited by 186
“Over 33% of women and 20% of men aged 65 and older will develop dementia during their lifetime, and many more will develop a milder form of cognitive impairment.(1) Given the anticipated exponential increase in both the incidence and prevalence of cognitive dementia in the next century, it is critical to identify prev…”
BackgroundTom, S. E., Hubbard, R. A., Crane, P. K., Haneuse, S. J., Bowen, J., McCormick, W. C., McCurry, S., & Larson, E. B. (2015) · American Journal of Public Health · doi:10.2105/ajph.2014.301935 · Cited by 185
Dementia and Alzheimer Disease Incidence Rates Do Not Vary by Sex in Rochester, Minn
Edland, S. D., Rocca, W. A., Petersen, R. C., Cha, R. H., & Kokmen, E. (2002) · Archives of Neurology · doi:10.1001/archneur.59.10.1589 · Cited by 184
“Some investigators have reported higher agespecific incidence rates of AD in women than in men.(6,7) Others have found an increased risk, but only in the oldest ages.”
BackgroundEffect of smoking on global cognitive function in nondemented elderly
Ott, A., Andersen, K., Dewey, M. E., Letenneur, L., Brayne, C., Copeland, J. R. M., Dartigues, J. F., Kragh-Sørensen, P., Lobo, A., Martínez‐Lage, J. M., et al. (2004) · Neurology · doi:10.1212/01.wnl.0000115110.35610.80 · Cited by 183
Self-citationHenderson, V. W. (2013) · The Journal of Steroid Biochemistry and Molecular Biology · doi:10.1016/j.jsbmb.2013.05.010 · Cited by 185
“It is controversial, however, whether women face greater risk for Alzheimer’s disease than men [62, 63].”
BackgroundBrookmeyer, R., & Abdalla, N. (2018) · Alzheimer's & Dementia · doi:10.1016/j.jalz.2018.03.005 · Cited by 176
“A study from the population-based Mayo Clinic Study of Aging reported that the hazard ratio of death for persons with amnestic MCI before the onset of dementia relative to cognitively normal persons was 1.65 [17].”
MethodResultInfluentialDementia literacy: Recognition and beliefs on dementia of the Australian public
Low, L., & Anstey, K. J. (2008) · Alzheimer s & Dementia · doi:10.1016/j.jalz.2008.03.011 · Cited by 171
The incidence of dementia in Canada
The Canadian Study of Health and Aging Working Group (2000) · Neurology · doi:10.1212/wnl.55.1.66 · Cited by 205
γ-secretases: from cell biology to therapeutic strategies
Bergmans, B. A., & Strooper, B. D. (2010) · The Lancet Neurology · doi:10.1016/s1474-4422(09)70332-1 · Cited by 179
Mutter, J., Curth, A., Naumann, J., Deth, R. C., & Walach, H. (2010) · Journal of Alzheimer s Disease · doi:10.3233/jad-2010-100705 · Cited by 168
Is Age-related Maculopathy Associated with Alzheimer's Disease?: The Rotterdam Study
Klaver, C. C. W., Ott, A., Hofman, A., Assink, J. J. M., Breteler, M. M. B., & de Jong, P. T. V. M. (1999) · American Journal of Epidemiology · doi:10.1093/oxfordjournals.aje.a010105 · Cited by 162
Self-citationReproductive Period and Risk of Dementia in Postmenopausal Women
Geerlings, M. I. (2001) · JAMA · doi:10.1001/jama.285.11.1475 · Cited by 162
Vernooij, M. W., van der Lugt, A., Ikram, M. A., Wielopolski, P. A., Vrooman, H. A., Hofman, A., Krestin, G. P., & Breteler, M. M. (2008) · Journal of Cerebral Blood Flow & Metabolism · doi:10.1038/sj.jcbfm.9600526 · Cited by 156
“This study is embedded within the Rotterdam Study, a large population-based cohort study in the Netherlands that started in 1990 (Ott et al, 1998), and is aimed at investigating determinants of various chronic diseases among elderly participants.”
BackgroundMethodInfluentialSelf-citationBrain tissue volumes in relation to cognitive function and risk of dementia
Ikram, M. A., Vrooman, H. A., Vernooij, M. W., den Heijer, T., Albert Hofman, D., Niessen, W. J., van der Lugt, A., Koudstaal, P. J., & Breteler, M. M. B. (2008) · Neurobiology of Aging · doi:10.1016/j.neurobiolaging.2008.04.008 · Cited by 156
Self-citationBLACKWELL, T. L., Yaffe, K. S., Laffan, A. M., Redline, S. S., Ancoli‐Israel, S., Ensrud, K. E., Song, Y., Stone, K. L., & the Osteoporotic Fractures in Men Study Group (2015) · Journal of the American Geriatrics Society · doi:10.1111/jgs.13321 · Cited by 153
“At least 10% of people aged 65 and older will develop cognitive impairment, with the rate rising exponentially with advancing age.(3,4) With the rate of cognitive impairment increasing(5) and the high prevalence of SDB in elderly adults, it is important to determine prospective associations between SDB and cognitive d…”
BackgroundPrevalence of dementia according to DSM–III–R and ICD–10
Riedel-Heller, S. G., Busse, A., Aurich, C., Matschinger, H., & Angermeyer, M. C. (2001) · The British Journal of Psychiatry · doi:10.1192/bjp.179.3.250 · Cited by 149
Ziere, G. J., Dieleman, J. P., van der Cammen, T. J. M., Albert Hofman, D., Pols, H. A. P., & Stricker, B. H. C. (2008) · Journal of Clinical Psychopharmacology · doi:10.1097/jcp.0b013e31817e0ecb · Cited by 147
“elsewhere.(33) Lower-limb disability was assessed by using a modified version of the Stanford Health Assessment Questionnaire(34) and by calculating the mean score of answers to questions about rising, walking, bending, and getting in and out of a car.”
MethodMethusaleh's Zoo: How Nature provides us with Clues for Extending Human Health Span
Austad, S. N. (2009) · Journal of Comparative Pathology · doi:10.1016/j.jcpa.2009.10.024 · Cited by 143
“If as many as 50% of people age 85 years or older suffer from disabling dementia (Ott et al., 1998), what benefit could be gleaned from further extending life if we did not simultaneously delay dementia?”
Metadata
- Authors
- Ott, A., Breteler, M. M. B., Harskamp, F. V., Stijnen, T., & Hofman, A.
- Affiliations
- Erasmus MC (NL)
- Corresponding author
- Ott, A.
- Venue
- American Journal of Epidemiology
- Publisher
- Oxford University Press (OUP)
- Published
- 1998-03-15
- Volume
- 147
- Issue
- 6
- Pages
- 574-580
- ISSN
- 0002-9262 (ISSN-L)
- 1476-6256
- OpenAlex
- W2039379003
- Cited by
- 455
- References
- 16
- Citations by year
- 2026: 6 · 2025: 10 · 2024: 4 · 2023: 9 · 2022: 16 · 2021: 9 · 2020: 36 · 2019: 9 · 2018: 16 · 2017: 11 · 2016: 10 · 2015: 14 · 2014: 10 · 2013: 16 · 2012: 18
- FWCI
- 15.00
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Epidemiology (publishedVersion)
- PubMed (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion)
- Funders
- Nederlandse Organisatie voor Wetenschappelijk Onderzoek
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Alzheimer's disease research and treatments
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Menopause: Health Impacts and Treatments
- Keywords
- dementia incidence, dementia risk, Alzheimer's disease, vascular dementia, age-specific incidence, sex differences, lifetime risk, older adults, Rotterdam Study
- MeSH terms
- Aged, Aged, 80 and over, Dementia, Female, Humans, Male, Middle Aged, Netherlands, Prospective Studies, Risk, Incidence, Age Distribution, Sex Distribution
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