Hostname: page-component-cd9895bd7-gxg78 Total loading time: 0 Render date: 2024-12-22T19:20:41.908Z Has data issue: false hasContentIssue false
  • English
  • Français

Incidence of dementia: evidence for an effect modification by gender. The ILSA Study

Published online by Cambridge University Press:  02 August 2013

Marianna Noale ,
Federica Limongi ,
Sabina Zambon ,
Gaetano Crepaldi  and
Stefania Maggi
Marianna Noale*
Affiliation:
CNR –Institute of Neuroscience, Aging Branch, Via Giustiniani 2, 35128 Padova, Italy
Federica Limongi
Affiliation:
CNR –Institute of Neuroscience, Aging Branch, Via Giustiniani 2, 35128 Padova, Italy
Sabina Zambon
Affiliation:
CNR –Institute of Neuroscience, Aging Branch, Via Giustiniani 2, 35128 Padova, Italy Department of Medical and Surgical Sciences, University of Padova, Via Giustiniani, 2, 35128 Padova, Italy
Gaetano Crepaldi
Affiliation:
CNR –Institute of Neuroscience, Aging Branch, Via Giustiniani 2, 35128 Padova, Italy
Stefania Maggi
Affiliation:
CNR –Institute of Neuroscience, Aging Branch, Via Giustiniani 2, 35128 Padova, Italy
*
Correspondence should be addressed to: Marianna Noale, CNR – Institute of Neuroscience, Aging Branch, Via Giustiniani, 2, 35128 Padova, Italy. Phone: +39-049-8218899; Fax +39-049-8211818. Email [email protected].
Get access

Abstract

Background:

Gender differences for incidence of dementia among elderly people have been usually investigated considering gender as a predictor and not as a stratification variable.

Methods:

Analyses were based on data collected by the Italian Longitudinal Study on Aging (ILSA), which enrolled 5,632 participants aged 65–84 years between 1992 and 2000. During a median follow-up of 7.8 years, there were 194 cases of incident dementia in the participants with complete data. Cox proportional hazard models for competing risks, stratified by sex, were defined to determine risk factors in relation to developing dementia.

Results:

The incidence rate of dementia increased from 5.57/1,000 person-years at 65–69 years of age to 30.06/1,000 person-years at 80–84 years. Cox proportional hazard models for competing risks of incidence of dementia and death revealed that, among men, significant risk factors were heart failure, Parkinson's disease, family history of dementia, mild depressive symptomatology and age, while triglycerides were associated with a lower risk of developing dementia. Significant risk factors in women were age, both mild and severe depressive symptomatology, glycemia ≥109 mg/dL, and a BMI < 24.1 kg/m2. Even as little as three years of schooling was found to be a significant protective factor against the incidence of dementia only for women.

Conclusions:

Our results suggest that there is an effect modification by gender in our study population in relation to the association between low education level, lipid profile, BMI, and glycemia and dementia.

Keywords

dementiarisk factorseffect modificationcohort studysex
Type
Research Article
Information
International Psychogeriatrics , Volume 25 , Issue 11 , November 2013 , pp. 1867 - 1876
Copyright
Copyright © International Psychogeriatric Association 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Psychiatric Association (1987). Diagnostic and Statistical Manual of Mental Disorders, 3rd edn, revised, DSM-III-R. Washington DC: American Psychiatric Association.Google Scholar
Atti, A. R.et al. (2008). Late-life body mass index and dementia incidence: nine-year follow-up data from the Kungsholmen Project. Journal of the American Geriatrics Society, 56, 111–116.CrossRefGoogle ScholarPubMed
Azad, N. A., Al Bugami, M. and Loy-English, I. (2007). Gender differences in dementia risk factors. Gender Medicine, 4, 120–129.CrossRefGoogle ScholarPubMed
Barnes, D. E. and Yaffe, K. (2011). The projected effect of risk factor reduction on Alzheimer's disease prevalence. Lancet Neurology, 10, 819–828.CrossRefGoogle ScholarPubMed
Barrett-Connor, E. and Ferrara, A. (1998). Isolated postchallenge hyperglycemia and the risk of fatal cardiovascular disease in older women and men. Diabetes Care, 21, 1236–1239.CrossRefGoogle ScholarPubMed
Berger, K.et al. (2000). Prognosis with Parkinson's disease in Europe: a collaborative study of population-based cohorts. Neurologic Diseases in the Elderly Research Group. Neurology, 54(suppl 5), S24–S27.Google ScholarPubMed
Brink, T. L.et al. (1982). Screening tests for geriatric depression. Clinical Gerontologist, 1, 37–43.CrossRefGoogle Scholar
Chen, J. H., Lin, K. P. and Chen, Y. C. (2009). Risk factors for dementia. Journal of the Formosan Medical Association, 108, 754–764.CrossRefGoogle ScholarPubMed
Di Carlo, A.et al. (2002), Incidence of dementia, Alzheimer's disease and vascular dementia in Italy. The ILSA Study. Journal of the American Geriatrics Society, 50, 41–48.CrossRefGoogle ScholarPubMed
Elbaz, A.et al. (2003). Survival study of Parkinson disease in Olmsted County, Minnesota. Archives of Neurology, 60, 91–96.CrossRefGoogle ScholarPubMed
Fabbris, L. (1997). Statistica multivariata Analisi esplorativa dei dati. Milano: McGraw-Hill Libri Italia.Google Scholar
Ferri, C. P.et al. (2005). Global prevalence of dementia: a Delphi consensus study. Lancet, 366, 2112–2117.CrossRefGoogle ScholarPubMed
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). “Mini-Mental State”: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198.CrossRefGoogle ScholarPubMed
Gatz, M.et al. (2003). Sex differences in genetic risk for dementia. Behavior Genetics, 33, 95–105.CrossRefGoogle ScholarPubMed
Genazzani, A. R.et al. (2007). Estrogen, cognition and female ageing. Human Reproduction Update, 13, 175–187.CrossRefGoogle ScholarPubMed
Gustafson, D.et al. (2003). An 18-year follow-up of overweight and risk of Alzheimer disease. Archives of Internal Medicine, 163, 1524–1528.CrossRefGoogle ScholarPubMed
Harvey, J., Solovyova, N. and Irving, A. (2006). Leptin and its role in hippocampal synaptic plasticity. Progress in Lipid Research, 45, 369–378.CrossRefGoogle ScholarPubMed
Hosmer, D. W. and Lemeshow, S. (1999). Applied Survival Analysis. Regression Modelling of Time to Event Data. New York: John Wiley & Sons Inc.Google Scholar
Jankowiak, J. (2004). Patient page. Too much sugar may cause “brain decay”. Neurology, 63: E9–10. Original report in Neurology, 63, 658–663.CrossRefGoogle ScholarPubMed
Letenneur, L.et al. (2000). Education and the risk for Alzheimer's disease: sex makes a difference. EURODEM Pooled analyses. American Journal of Epidemiology, 151, 1064–1071.CrossRefGoogle ScholarPubMed
Louis, E. D.et al. (1997). Mortality from Parkinson disease. Archives of Neurology, 54, 260–264.CrossRefGoogle ScholarPubMed
Lunn, M. and McNeil, D. (1995). Applying Cox regression to competing risks. Biometrics, 51, 524–532.CrossRefGoogle ScholarPubMed
Maggi, S.et al. (1994). The Italian Longitudinal Study on Aging (ILSA): design and methods. Aging (Milano), 6, 464–473.Google ScholarPubMed
Marzari, C.et al. (2005). Depressive symptoms and development of coronary heart disease events: the Italian longitudinal study on aging. The Journals of Gerontology Series A, Biological Sciences Medical Sciences, 60, 85–92.CrossRefGoogle ScholarPubMed
McKhann, G.et al. (1984) Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's disease. Neurology, 34, 939–944.CrossRefGoogle ScholarPubMed
Mielke, M. M.et al. (2005). High total cholesterol levels in late life associated with a reduced risk of dementia. Neurology, 64, 1689–1695.CrossRefGoogle ScholarPubMed
Mortel, K. F.et al. (1995). Education and occupation as risk factors for dementias of the Alzheimer and ischemic vascular types. Dementia, 6, 55–62.Google ScholarPubMed
Nilsson, G.et al. (2009). Ten-year survival in 75-year-old men and women: predictive ability of total cholesterol, HDL-C, and LDL-C. Current Gerontology and Geriatrics Research, 158425.CrossRefGoogle Scholar
Nourhashemi, F.et al. (2003). Body mass index and incidence of dementia: the PAQUID study. Neurology, 60, 117–119.CrossRefGoogle ScholarPubMed
Ownby, R. L.et al. (2006). Depression and risk for Alzheimer disease: systematic review, meta analysis and metaregression analysis. Archives of General Psychiatry, 63, 530–538.CrossRefGoogle ScholarPubMed
Pfeffer, R. I.et al. (1982). Measurement of functional activities in older adults in the community. Journal of Gerontology, 37, 323–329.CrossRefGoogle ScholarPubMed
Philbin, E. F.et al. (1999). Clinical outcomes in heart failure: report from a community hospital-based registry. The American Journal of Medicine, 107, 549–555.CrossRefGoogle ScholarPubMed
Plassman, B. L.et al. (2010). Systematic review: factors associated with risk for and possible prevention of cognitive decline in later life. Annals of Internal Medicine, 153, 182–193.CrossRefGoogle ScholarPubMed
Rosano, C. and Newman, A. B. (2006) Cardiovascular disease and risk of Alzheimer's diseases. Neurological Research, 28, 612–620.CrossRefGoogle Scholar
Roth, M.et al. (1986). CAMDEX: a standardised instrument for the diagnosis of mental disorder in the elderly with special reference to the early detection of dementia. British Journal of Psychiatry, 149, 698–709.CrossRefGoogle Scholar
Ruitenberg, A.et al. (2001) Incidence of dementia: does gender make a difference? Neurobiology of Aging, 22, 575–580.CrossRefGoogle Scholar
The Italian Longitudinal Study on Aging Working Group (1997). Prevalence of chronic diseases in older Italians: comparing self-reported and clinical diagnoses. International Journal of Epidemiology, 26, 995–1002.CrossRefGoogle Scholar
Whitson, H. E.et al. (2010). Chronic medical conditions and the sex-based disparity in disability: the cardiovascular health study. The Journals of Gerontology Series A, Biological Sciences Medical Sciences, 65, 1325–1331.CrossRefGoogle ScholarPubMed
World Health Organization (1992). International Statistical Classification of Diseases and Related Health Problems, 10th edn, revised. ICD-10. Geneva: World Health Organization.Google Scholar
Yamamoto, H. and Kato, Y. (1993). Relationship between plasma insulin-like growth factor I (IGF-I) levels and body mass index (BMI) in adults. Endocrine Journal, 40, 41–45.CrossRefGoogle ScholarPubMed
Zambon, S.et al. (2009). Metabolic syndrome and all-cause and cardiovascular mortality in an Italian elderly population: the Progetto Veneto Anziani (Pro.V.A.) Study. Diabetes Care, 32, 153–159.CrossRefGoogle Scholar