Incidence of Dementia and Associated Factors in the EPIC-Spain Dementia Cohort

Article type: Research Article

Authors: Andreu-Reinón, María Encarnación^{a; b} | Huerta, José María^{b; c; d; *} | Gavrila, Diana^{b; d} | Amiano, Pilar^{d; e; f} | Mar, Javier^{f; g; h; i} | Tainta, Mikel^{j; k} | Ardanaz, Eva^{d; l} | Larumbe, Rosa^{l; m; n} | Navarro, Carmen^{b; o} | Colorado-Yohar, Sandra M.^{b; c; d; p} | Navarro-Mateu, Fernando^{b; d; q} | Chirlaque, María Dolores^{b; c; d; o}

Affiliations: [a] Section of Neurology, Department of Internal Medicine, Rafael Méndez Hospital, Murcia Health Service, Lorca, Murcia, Spain | [b] Murcia Biomedical Research Institute (IMIB-Arrixaca), Murcia, Spain | [c] Department of Epidemiology, Murcia Regional Health Council, Murcia, Spain | [d] CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain | [e] Public Health Division of Gipuzkoa, Basque Government, Donostia-San Sebastián, Spain | [f] Biodonostia Health Research Institute, San Sebastián, Spain | [g] Clinical Management Unit, OSI Alto Deba, Arrasate-Mondragón, Spain | [h] AP-OSIs Gipuzkoa Research Unit, OSI Alto Deba, Arrasate-Mondragón, Spain | [i] Health Services Research Network on Chronic Patients (REDISSEC), Bilbao, Spain | [j] CITA Alzheimer Foundation, Donostia-San Sebastián, Spain | [k] Neurology Service, OSI Goierri-Alto Urola, Zumárraga, Spain | [l] Public Health Institute of Navarra, IdiSNA, Pamplona, Spain | [m] Neuroepigenetics Laboratory, Navarrabiomed, Public University of Navarre (UPNA), Pamplona, Spain | [n] Department of Neurology, Complejo Hospitalario de Navarra, Pamplona, Spain | [o] Department of Health and Social Sciences, University of Murcia, Murcia, Spain | [p] Research Group on Demography and Health, National Faculty of Public Health, University of Antioquia, Medellín, Colombia | [q] Unidad de Docencia, Investigación y Formación en Salud Mental (UDIF-SM). Servicio Murciano de Salud, Murcia, Spain

Correspondence: [*] Correspondence to: José María Huerta, PhD, Murcia Regional Health Council, Department of Epidemiology, Ronda de Levante, 11, 30008, Murcia, Spain. Tel.: +34 968 365710; Fax: +34 968 366656; E-mail: [email protected].

Abstract: Background:Dementia has become a public health priority as the number of cases continues to grow worldwide. Objective:To assess dementia incidence and determinants in the EPIC-Spain Dementia Cohort. Methods:25,015 participants (57% women) were recruited from three Spanish regions between 1992-1996 and followed-up for over 20 years. Incident cases were ascertained through individual revision of medical records of potential cases. Crude and age-adjusted incidence rates (IR) of dementia and sub-types (Alzheimer’s disease (AD), and non-AD) were calculated by sex. Neelson-Aalen cumulative incidence estimates at 10, 15, and 20 years were obtained for each sex and age group. Multivariate Royston-Parmar models were used to assess independent determinants. Results:Global IR were higher in women for dementia and AD, and similar by sex for non-AD. IR ranged from 0.09 cases of dementia (95% confidence interval: 0.06–0.13) and 0.05 (0.03–0.09) of AD per 1000 person-years (py) in participants below 60 years, to 23.2 (15.9–33.8) cases of dementia and 14.6 (9.1–33.5) of AD (per 1000 py) in those ≥85 years. Adjusted IR were consistently higher in women than men for overall dementia and AD. Up to 12.5% of women and 9.1% of men 60–65 years-old developed dementia within 20 years. Low education, diabetes, and hyperlipidemia were the main independent predictors of dementia risk, whereas alcohol showed an inverse association. Conclusion:Dementia incidence increased with age and was higher among women, but showed no geographical pattern. Dementia risk was higher among subjects with lower education, not drinking alcohol, and presenting cardiovascular risk factors.

Keywords: Alzheimer’s disease, cohort study, dementia, EPIC-Spain, epidemiology, incidence, risk factors

DOI: 10.3233/JAD-200774

Journal: Journal of Alzheimer's Disease, vol. 78, no. 2, pp. 543-555, 2020