Lifetime risk and projected burden of dementia – Nature.com
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701 AltmetricMetrics detailsUnderstanding the lifetime risk of dementia can inform public health planning and improve patient engagement in prevention. Using data from a community-based, prospective cohort study (n = 15,043; 26.9% Black race, 55.1% women and 30.8% with at least one apolipoprotein E4 (APOE ε4) allele), we estimated the lifetime risk of dementia (from age 55 years to 95 years), with mortality treated as a competing event. We applied lifetime risk estimates to US Census projections to evaluate the annual number of incident dementia cases from 2020 to 2060. The lifetime risk of dementia after age 55 years was 42% (95% confidence interval: 41–43). Rates were substantially higher in women, Black adults and APOE ε4 carriers, with lifetime risks ranging from approximately 45% to 60% in these populations. The number of US adults who will develop dementia each year was projected to increase from approximately 514,000 in 2020 to approximately 1 million in 2060. The relative growth in new dementia cases was especially pronounced for Black adults. These results highlight the urgent need for policies that enhance healthy aging, with a focus on health equity.This is a preview of subscription content, access via your institution
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We are sorry, but there is no personal subscription option available for your country.Buy this articlePrices may be subject to local taxes which are calculated during checkoutARIC data access procedures are in accordance with participant informed consent and NIH data-sharing policy. Anonymized data from the ARIC study are available at the NHLBI Biologic Specimen and Data Repository Information Coordinating Center and can be accessed through the website (https://biolincc.nhlbi.nih.gov/studies/aric/). Requests for access of ARIC data may also be submitted to the ARIC Publications Committee according to established study procedures, which include submission of a completed ARIC Manuscript Proposal Form (available at https://aric.cscc.unc.edu/aric9/publications/policies_forms_and_guidelines) to the ARIC Publications Committee at aricpub@unc.edu. Review and approval of data access requests typically takes approximately 1 month.The analytic code used for analyses in this study is available from the corresponding author upon reasonable request.Caplan, Z. US older population grew from 2010 to 2020 at fastest rate since 1880 to 1890. United States Census Bureau. https://www.census.gov/library/stories/2023/05/2020-census-united-states-older-population-grew.html (2023).Rajan, K. B. et al. Population estimate of people with clinical Alzheimer’s disease and mild cognitive impairment in the United States (2020–2060). Alzheimers Dement. 17, 1966–1975 (2021).Article
PubMed
Google Scholar
Murphy, S., Kochanek, K., Xu, J. & Arias, E. Mortality in the United States, 2020. NCHS Data Brief, No. 427. National Center for Health Statistics. https://www.cdc.gov/nchs/data/databriefs/db427.pdf (2021).Nandi, A. et al. Global and regional projections of the economic burden of Alzheimer’s disease and related dementias from 2019 to 2050: a value of statistical life approach. EClinicalMedicine 51, 101580 (2022).Article
PubMed
PubMed Central
Google Scholar
2023 Alzheimer’s disease facts and figures. Alzheimers Dement. 19, 1598–1695 (2023).Seshadri, S. & Wolf, P. A. Lifetime risk of stroke and dementia: current concepts, and estimates from the Framingham Study. Lancet Neurol. 6, 1106–1114 (2007).Article
PubMed
Google Scholar
Martin, S. S. et al. 2024 heart disease and stroke statistics: a report of US and global data from the American Heart Association. Circulation 149, e347–e913 (2024).Article
PubMed
Google Scholar
Chêne, G. et al. Gender and incidence of dementia in the Framingham Heart Study from mid-adult life. Alzheimers Dement. 11, 310–320 (2015).Article
PubMed
Google Scholar
Beiser, A., Au, R., McNulty, K., White, R. & D’agostino, R. Lifetime risk of dementia and Alzheimer’s disease: the impact of mortality on risk estimates in the Framingham Study. Neurology 49, 1498–1504 (1997).Article
PubMed
Google Scholar
Licher, S. et al. Lifetime risk of common neurological diseases in the elderly population. J. Neurol. Neurosurg. Psychiatry 90, 148–156 (2019).Article
PubMed
Google Scholar
Chatfield, M. D., Brayne, C. E. & Matthews, F. E. A systematic literature review of attrition between waves in longitudinal studies in the elderly shows a consistent pattern of dropout between differing studies. J. Clin. Epidemiol. 58, 13–19 (2005).Article
PubMed
Google Scholar
Livingston, G. et al. Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. Lancet 396, 413–446 (2020).Article
PubMed
PubMed Central
Google Scholar
Ngandu, T. et al. A 2 year multidomain intervention of diet, exercise, cognitive training, and vascular risk monitoring versus control to prevent cognitive decline in at-risk elderly people (FINGER): a randomised controlled trial. Lancet 385, 2255–2263 (2015).Article
PubMed
Google Scholar
van Charante, E. P. M. et al. Effectiveness of a 6-year multidomain vascular care intervention to prevent dementia (preDIVA): a cluster-randomised controlled trial. Lancet 388, 797–805 (2016).Article
Google Scholar
Lin, F. R. et al. Hearing intervention versus health education control to reduce cognitive decline in older adults with hearing loss in the USA (ACHIEVE): a multicentre, randomised controlled trial. Lancet 402, 786–797 (2023).Article
PubMed
PubMed Central
Google Scholar
Coley, N., Giulioli, C., Aisen, P. S., Vellas, B. & Andrieu, S. Randomised controlled trials for the prevention of cognitive decline or dementia: a systematic review. Ageing Res. Rev. 82, 101777 (2022).Article
PubMed
Google Scholar
Williamson, J. D. et al. Effect of intensive vs standard blood pressure control on probable dementia: a randomized clinical trial. JAMA 321, 553–561 (2019).Article
PubMed
PubMed Central
Google Scholar
Lloyd-Jones, D. M. et al. Status of cardiovascular health in US adults and children using the American Heart Association’s new ‘Life’s Essential 8’ metrics: prevalence estimates from the National Health and Nutrition Examination Survey (NHANES), 2013 through 2018. Circulation 146, 822–835 (2022).Article
CAS
PubMed
Google Scholar
Reed, N. S. et al. Prevalence of hearing loss and hearing aid use among US Medicare beneficiaries aged 71 years and older. JAMA Netw. Open 6, e2326320 (2023).Article
PubMed
PubMed Central
Google Scholar
Qian, J. et al. APOE-related risk of mild cognitive impairment and dementia for prevention trials: an analysis of four cohorts. PLoS Med. 14, e1002254 (2017).Article
PubMed
PubMed Central
Google Scholar
Yamazaki, Y., Zhao, N., Caulfield, T. R., Liu, C.-C. & Bu, G. Apolipoprotein E and Alzheimer disease: pathobiology and targeting strategies. Nat. Rev. Neurol. 15, 501–518 (2019).Article
CAS
PubMed
PubMed Central
Google Scholar
Fortea, J. et al. APOE4 homozygozity represents a distinct genetic form of Alzheimer’s disease. Nat. Med. 30, 1284–1291 (2024).Matthews, K. A. et al. Racial and ethnic estimates of Alzheimer’s disease and related dementias in the United States (2015–2060) in adults aged ≥65 years. Alzheimers Dement. 15, 17–24 (2019).Article
PubMed
Google Scholar
Weuve, J. et al. Cognitive aging in black and white Americans: cognition, cognitive decline, and incidence of Alzheimer disease dementia. Epidemiology 29, 151 (2018).Article
PubMed
PubMed Central
Google Scholar
Ferretti, M. T. et al. Sex differences in Alzheimer disease—the gateway to precision medicine. Nat. Rev. Neurol. 14, 457–469 (2018).Article
PubMed
Google Scholar
Ott, A., Breteler, M. M., Harskamp, F. V., Stijnen, T. & Hofman, A. Incidence and risk of dementia: the Rotterdam Study. Am. J. Epidemiol. 147, 574–580 (1998).Article
CAS
PubMed
Google Scholar
Feigin, V. L. et al. Burden of neurological disorders across the US from 1990–2017: a global burden of disease study. JAMA Neurol. 78, 165–176 (2021).Article
PubMed
Google Scholar
Vespa, J., Armstrong, D. M. & Medina, L. Demographic Turning Points for the United States: Population Projections for 2020 to 2060 (U.S. Department of Commerce, Economics and Statistics Administration, U.S. Census Bureau, 2018).Wilkinson, T. et al. Identifying dementia cases with routinely collected health data: a systematic review. Alzheimers Dement. 14, 1038–1051 (2018).Article
PubMed
Google Scholar
Lin, P. J. et al. Dementia diagnosis disparities by race and ethnicity: health services research: cost of care and implications for intervention. Alzheimers Dement. 16, e043183 (2020).Article
Google Scholar
Office of the Assistant Secretary for Planning and Evaluation. US Department of Health and Human Services. National Plan to Address Alzheimer’s Disease. https://aspe.hhs.gov/collaborations-committees-advisory-groups/napa/napa-documents/napa-national-plan (2023).Wright, J. D. et al. The ARIC (Atherosclerosis Risk in Communities) Study: JACC Focus Seminar 3/8. J. Am. Coll. Cardiol. 77, 2939–2959 (2021).Article
PubMed
PubMed Central
Google Scholar
Knopman, D. S. et al. Mild cognitive impairment and dementia prevalence: the atherosclerosis risk in communities neurocognitive study. Alzheimers Dement. (Amst.) 2, 1–11 (2016).Article
PubMed
Google Scholar
Knopman, D. S. et al. Patterns of cognitive domain abnormalities enhance discrimination of dementia risk prediction: the ARIC study. Alzheimers Dement. 20, 4559–4571 (2024).Schneider, A. L. et al. Normative data for 8 neuropsychological tests in older blacks and whites from the Atherosclerosis Risk in Communities (ARIC) study. Alzheimer Dis. Assoc. Disord. 29, 32–44 (2015).Article
CAS
PubMed
PubMed Central
Google Scholar
Morris, J. C. The Clinical Dementia Rating (CDR): current version and scoring rules. Neurology 43, 2412–2414 (1993).Folstein, M. F., Folstein, S. E. & McHugh, P. R. ‘Mini-mental state’: a practical method for grading the cognitive state of patients for the clinician. J. Psychiatr. Res. 12, 189–198 (1975).Article
CAS
PubMed
Google Scholar
Pfeffer, R. I., Kurosaki, T. T., Harrah, C. Jr, Chance, J. M. & Filos, S. Measurement of functional activities in older adults in the community. J. Gerontol. 37, 323–329 (1982).Article
CAS
PubMed
Google Scholar
Blessed, G., Tomlinson, B. E. & Roth, M. The association between quantitative measures of dementia and of senile change in the cerebral grey matter of elderly subjects. Br. J. Psychiatry 114, 797–811 (1968).Article
CAS
PubMed
Google Scholar
McKhann, G. M. et al. The diagnosis of dementia due to Alzheimer’s disease: recommendations from the National Institute on Aging–Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer’s disease. Alzheimers Dement. 7, 263–269 (2011).Article
PubMed
Google Scholar
Brandt, J., Spencer, M. & Folstein, M. The telephone interview for cognitive status. Neuropsychiatry Neuropsychol. Behav. Neurol. 1, 111–117 (1988).
Google Scholar
Callahan, C. M., Unverzagt, F. W., Hui, S. L., Perkins, A. J. & Hendrie, H. C. Six-item screener to identify cognitive impairment among potential subjects for clinical research. Med. Care 40, 771–781 (2002).Article
PubMed
Google Scholar
Lin, D. Non‐parametric inference for cumulative incidence functions in competing risks studies. Stat. Med. 16, 901–910 (1997).Article
CAS
PubMed
Google Scholar
Stata 18 documentation. https://www.stata-press.com/manuals/documentation-set/Download referencesThis study was supported by National Institutes of Health (NIH)/National Heart, Lung, and Blood Institute (NHLBI) grant K24 HL152440 (to E.S.); NIH/National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) grant K01 DK138273 (to M.F.); NIH/National Institute on Aging (NIA) grant R01AG054787 (to B.G.W.); the National Institute of Neurological Disorders and Stroke (NINDS) Intramural Research Program (to R.F.G.); and the NIA Intramural Research Program (to K.A.W.). The ARIC study is carried out as a collaborative study supported by NHLBI contracts 75N92022D00001, 75N92022D00002, 75N92022D00003, 75N92022D00004 and 75N92022D00005. The ARIC Neurocognitive Study is supported by U01HL096812, U01HL096814, U01HL096899, U01HL096902 and U01HL096917 from the NIH. The funders had no role in the design and conduct of the study; in collection, management, analysis and interpretation of the data; in preparation, review or approval of the manuscript; and in the decision to submit the manuscript for publication. We thank the staff and participants of the ARIC study for their important contributions. We also thank K. Da Silva and J. Pike for their valuable suggestions and help during revisions.Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USAMichael Fang, Jiaqi Hu, A. Richey Sharrett & Elizabeth SelvinInstitute for Hospital Management, Tsinghua University, Beijing, ChinaJiaqi HuOptimal Aging Institute and Department of Medicine, New York University Grossman School of Medicine, New York, NY, USAJordan Weiss & Josef CoreshDepartment of Neurology, Mayo Clinic, Rochester, MN, USADavid S. KnopmanDepartment of Neurology, Johns Hopkins Medicine, Baltimore, MD, USAMarilyn AlbertDepartment of Medicine, University of Mississippi Medical Center, Jackson, MS, USAB. Gwen Windham & Thomas MosleyIntramural Research Program, National Institute on Aging, Bethesda, MD, USAKeenan A. WalkerIntramural Research Program, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USARebecca F. GottesmanDivision of Epidemiology & Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USAPamela L. LutseyDivision of Epidemiology, Department of Population Health, New York University Grossman School of Medicine, New York, NY, USAJosef CoreshYou can also search for this author in
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PubMed Google ScholarM.F. had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Concept and design: M.F. and J.C. Acquisition, analysis or interpretation of data: M.F., J.C., E.S. and J.H. Drafting of the manuscript: M.F. Critical revision of the manuscript for important intellectual content: all authors. Statistical analysis: J.H. and J.W. Administrative, technical or material support: J.C. and E.S. Supervision: J.C.Correspondence to
Josef Coresh.D.S.K. has no disclosures relevant to the current work. D.S.K. serves on a Data Safety Monitoring Board for the Dominantly Inherited Alzheimer Network Treatment Unit study. He was an investigator in Alzheimer clinical trials sponsored by Biogen, Eli Lilly Pharmaceuticals and the University of Southern California and is currently an investigator in a trial in frontotemporal degeneration with Alector. He has served as a consultant for Roche, AriBio, Linus Health, Biovie and Alzeca Biosciences but receives no personal compensation. He receives funding from the NIH. The other authors declare no competing interests.Nature Medicine thanks Robert Clarke, Bryan James and the other, anonymous, reviewer(s) for their contribution to the peer review of this work. Primary handling editor: Jerome Staal, in collaboration with the Nature Medicine team.Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.Reprints and permissionsFang, M., Hu, J., Weiss, J. et al. Lifetime risk and projected burden of dementia.
Nat Med (2025). https://doi.org/10.1038/s41591-024-03340-9Download citationReceived: 15 May 2024Accepted: 03 October 2024Published: 13 January 2025DOI: https://doi.org/10.1038/s41591-024-03340-9Anyone you share the following link with will be able to read this content:Sorry, a shareable link is not currently available for this article.
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