Epidemiology of Dementia in Canada: Information from the Canadian Study of Health and Aging

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