Incidence of Dementia and Alzheimer Disease Over Time: A Meta‐Analysis
Open accessAbstract
BACKGROUND/OBJECTIVES: Population‐based incidence estimates of dementia and Alzheimer disease (AD) provide important information for public health policy and resource allocation. We conducted a meta‐analysis of published studies that reported age‐specific incidence rates of dementia and AD to determine whether dementia and AD incidence rates are changing over time. DESIGN: PubMed and MEDLINE were searched for publications through June 30, 2017, using key words “dementia”, “Alzheimer”, and “incidence.” Inclusion criteria for the meta‐analysis are: (1) population‐based studies using personal interviews and direct examinations of the study subjects, (2) standardized clinical diagnosis criteria, (3) reporting age‐specific incidence rates, (4) published in English, and (5) sample size of 500 or greater and length of follow‐up of 2 years or greater. Mixed‐effects models were used to determine the association between birth year and incidence rates. MEASUREMENTS: Age‐specific dementia/AD incidence rates and their standard errors reported in each study. RESULTS: Thirty‐eight articles with 53 cohorts on dementia incidence and 31 articles with 35 cohorts on AD incidence met the inclusion criteria. There were significant associations between later birth years and decreased dementia incidence rates in all three age groups (65‐74, 75‐84, and 85 years and older). There were no significant associations between birth year and AD incident rates in any of the three age groups. In particular, AD incidence rates reported from Western countries stayed steady in all age groups, while studies in non‐Western countries showed significantly increased AD incidence rates for the 65 to 74 years age group (odds ratio = 2.78; P = .04), but a nonsignificant association for the 75 to 84 or 85 years and older groups. CONCLUSION: Dementia incidence declined over the past four decades, but AD incidence did not decline. Further research, especially from non‐Western countries, is needed to elucidate the mechanism underlying the trends in dementia and AD incidence over time.
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Age-specific dementia prevalence in Japan, South Korea, Hong Kong, and Taiwan appears to be increasing, as does Alzheimer's disease in low-income and middle-income countries, although diagnostic methods might not always be comparable.
“In contrast, age-specific dementia prevalence in Japan, South Korea, Hong Kong, and Taiwan looks as if it is increasing, as is Alzheimer's in LMIC, although whether diagnostic methods are always the same in comparison studies is unclear.5, 6, 7”
From Dementia prevention, intervention, and care: 2020 report of the Lancet Commission (2020) · cites this paper as [7]
The Results (Incidence of AD; page unavailable) report increasing Alzheimer’s disease incidence in non-Western cohorts aged 65–74, but not a significant increase in older groups. The paper analyzes incidence, not age-specific dementia prevalence in Japan, South Korea, Hong Kong, and Taiwan, and it does not equate its non-Western cohorts with low- and middle-income countries. The Discussion (page unavailable) acknowledges possible changes in AD identification but suggests that shifting diagnosis is unlikely to explain the increase. (LLM, conf=0.86)
Experimental — accuracy not yet measuredAge-specific dementia incidence has declined in many countries, probably owing to better education, nutrition, health care, and lifestyle.
“However, the age-specific incidence of dementia has fallen in many countries, probably because of improvements in education, nutrition, health care, and lifestyle changes.”
From Dementia prevention, intervention, and care: 2020 report of the Lancet Commission (2020) · cites this paper as [7]
The Discussion (page not provided) reports declining dementia incidence in both Western and non-Western populations and discusses education, nutrition, medicine, smoking, and cardiovascular care as possible contributors. It calls these explanations postulated or possible, however, and says the mechanisms need further research; “probably because” expresses more causal confidence than the paper does. (LLM, conf=0.84)
Experimental — accuracy not yet measuredOne recent systematic review found that incidence of dementia has decreased over the last four decades while incidence of Alzheimer's dementia specifically has held steady.
“One recent systematic review found that incidence of dementia has decreased over the last four decades while incidence of Alzheimer's dementia, specifically, has held steady”
From 2023 Alzheimer's disease facts and figures (2023) · cites this paper as [351]
The Discussion reports that dementia incidence declined over four decades. The Results describe steady Alzheimer’s disease incidence in Western cohorts, but a significant increase among ages 65–74 in non-Western cohorts; saying it held steady without that qualification overstates the finding. Page numbers are not supplied in our copy. (LLM, conf=0.90)
Experimental — accuracy not yet measuredOne recent systematic review found that incidence of dementia has decreased worldwide over the last four decades while incidence of Alzheimer's dementia, specifically, has held steady.
“One recent systematic review found that incidence of dementia has decreased worldwide over the last four decades while incidence of Alzheimer's dementia, specifically, has held steady, but more research on this distinction is needed, especially in low‐income and middle‐income countries.”
From 2024 Alzheimer's disease facts and figures (2024) · cites this paper as [382]
The Discussion reports declining dementia incidence over four decades in both Western and non-Western populations. It says Alzheimer’s disease incidence stayed steady in Western countries but increased among younger age groups in non-Western countries, so the claim that it held steady worldwide overgeneralizes the finding. (LLM, conf=0.90)
Experimental — accuracy not yet measuredAll-cause dementia incidence is lower in people born more recently, probably because of educational, socio-economic, health-care, and lifestyle changes.
“All-cause dementia incidence is lower in people born more recently,7 probably due to educational, socio-economic, health care, and lifestyle changes.2, 5”
From Dementia prevention, intervention, and care: 2020 report of the Lancet Commission (2020) · cites this paper as [7]
The incidence of dementia is showing a decline in several studies from high-income countries, and one from Nigeria, especially in the last three decades.
“The incidence of dementia is showing a different trend, with several studies from high‐income countries, and one from Nigeria, showing a decline, especially in the last three decades98, 99.”
From Mental health care for older adults: recent advances and new directions in clinical practice and research (2022) · cites this paper as [99]
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- Authors
- Gao, S., Burney, H. N., Callahan, C. M., Purnell, C. E., & Hendrie, H. C.
- Affiliations
- Indiana University Indianapolis (US)
- Regenstrief Institute (US)
- Corresponding author
- Gao, Sujuan
- Venue
- Journal of the American Geriatrics Society
- Publisher
- Wiley
- Published
- 2019-06-20
- Volume
- 67
- Issue
- 7
- Pages
- 1361-1369
- ISSN
- 0002-8614 (ISSN-L)
- 1532-5415
- PMC
- PMC6612587
- OpenAlex
- W2952223503
- Cited by
- 104
- References
- 34
- Citations by year
- 2026: 15 · 2025: 11 · 2024: 15 · 2023: 19 · 2022: 17 · 2021: 18 · 2020: 8 · 2019: 1
- FWCI
- 1.86
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of the American Geriatrics Society (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- IUScholarWorks (Indiana University) (submittedVersion)
- Purdue University Indianapolis (Indiana University) (submittedVersion)
- PMC
- Funders
- National Institutes of Health (P30 AG010133, RO1 AG045350)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Medicine › Physiology › Alzheimer's disease research and treatments
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Menopause: Health Impacts and Treatments
- Keywords
- dementia incidence, Alzheimer's disease, temporal trends, birth year, age-specific incidence, population-based cohort, older adults
- MeSH terms
- Age Factors, Aged, Aged, 80 and over, Alzheimer Disease, Dementia, Humans
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