Abstract
OBJECTIVES: The goal of this study was to project the future prevalence and incidence of Alzheimer's disease in the United States and the potential impact of interventions to delay disease onset. METHODS: The numbers of individuals in the United States with Alzheimer's disease and the numbers of newly diagnosed cases that can be expected over the next 50 years were estimated from a model that used age-specific incidence rates summarized from several epidemiological studies, US mortality rates, and US Bureau of the Census projections. RESULTS: in 1997, the prevalence of Alzheimer's disease in the United States was 2.32 million (range: 1.09 to 4.58 million); of these individuals, 68% were female. It is projected that the prevalence will nearly quadruple in the next 50 years, by which time approximately 1 in 45 Americans will be afflicted with the disease. Currently, the annual number of new incident cases in 360,000. If interventions could delay onset of the disease by 2 years, after 50 years there would be nearly 2 million fewer cases than projected; if onset could be delayed by 1 year, there would be nearly 800,000 fewer prevalent cases. CONCLUSIONS: As the US population ages, Alzheimer's disease will become an enormous public health problem. interventions that could delay disease onset even modestly would have a major public health impact.
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- Andersen K., Launer L. J., Ott A., Hoes A. W., Breteler M. M., Hofman A. Do nonsteroidal anti-inflammatory drugs decrease the risk for Alzheimer's disease? The Rotterdam Study. Neurology. 1995 Aug;45(8):1441–1445. doi: 10.1212/wnl.45.8.1441. [DOI] [PubMed] [Google Scholar]
- Bachman D. L., Wolf P. A., Linn R. T., Knoefel J. E., Cobb J. L., Belanger A. J., White L. R., D'Agostino R. B. Incidence of dementia and probable Alzheimer's disease in a general population: the Framingham Study. Neurology. 1993 Mar;43(3 Pt 1):515–519. doi: 10.1212/wnl.43.3_part_1.515. [DOI] [PubMed] [Google Scholar]
- Beard C. M., Kokmen E., Offord K. P., Kurland L. T. Lack of association between Alzheimer's disease and education, occupation, marital status, or living arrangement. Neurology. 1992 Nov;42(11):2063–2068. doi: 10.1212/wnl.42.11.2063. [DOI] [PubMed] [Google Scholar]
- Breitner J. C., Gau B. A., Welsh K. A., Plassman B. L., McDonald W. M., Helms M. J., Anthony J. C. Inverse association of anti-inflammatory treatments and Alzheimer's disease: initial results of a co-twin control study. Neurology. 1994 Feb;44(2):227–232. doi: 10.1212/wnl.44.2.227. [DOI] [PubMed] [Google Scholar]
- Breitner J. C., Welsh K. A., Helms M. J., Gaskell P. C., Gau B. A., Roses A. D., Pericak-Vance M. A., Saunders A. M. Delayed onset of Alzheimer's disease with nonsteroidal anti-inflammatory and histamine H2 blocking drugs. Neurobiol Aging. 1995 Jul-Aug;16(4):523–530. doi: 10.1016/0197-4580(95)00049-k. [DOI] [PubMed] [Google Scholar]
- Brenner D. E., Kukull W. A., Stergachis A., van Belle G., Bowen J. D., McCormick W. C., Teri L., Larson E. B. Postmenopausal estrogen replacement therapy and the risk of Alzheimer's disease: a population-based case-control study. Am J Epidemiol. 1994 Aug 1;140(3):262–267. doi: 10.1093/oxfordjournals.aje.a117245. [DOI] [PubMed] [Google Scholar]
- Broe G. A., Henderson A. S., Creasey H., McCusker E., Korten A. E., Jorm A. F., Longley W., Anthony J. C. A case-control study of Alzheimer's disease in Australia. Neurology. 1990 Nov;40(11):1698–1707. doi: 10.1212/wnl.40.11.1698. [DOI] [PubMed] [Google Scholar]
- Cobb J. L., Wolf P. A., Au R., White R., D'Agostino R. B. The effect of education on the incidence of dementia and Alzheimer's disease in the Framingham Study. Neurology. 1995 Sep;45(9):1707–1712. doi: 10.1212/wnl.45.9.1707. [DOI] [PubMed] [Google Scholar]
- Copeland J. R., Davidson I. A., Dewey M. E., Gilmore C., Larkin B. A., McWilliam C., Saunders P. A., Scott A., Sharma V., Sullivan C. Alzheimer's disease, other dementias, depression and pseudodementia: prevalence, incidence and three-year outcome in Liverpool. Br J Psychiatry. 1992 Aug;161:230–239. doi: 10.1192/bjp.161.2.230. [DOI] [PubMed] [Google Scholar]
- Corder E. H., Saunders A. M., Strittmatter W. J., Schmechel D. E., Gaskell P. C., Small G. W., Roses A. D., Haines J. L., Pericak-Vance M. A. Gene dose of apolipoprotein E type 4 allele and the risk of Alzheimer's disease in late onset families. Science. 1993 Aug 13;261(5123):921–923. doi: 10.1126/science.8346443. [DOI] [PubMed] [Google Scholar]
- Corrada M., Brookmeyer R., Kawas C. Sources of variability in prevalence rates of Alzheimer's disease. Int J Epidemiol. 1995 Oct;24(5):1000–1005. doi: 10.1093/ije/24.5.1000. [DOI] [PubMed] [Google Scholar]
- Ernst R. L., Hay J. W. The US economic and social costs of Alzheimer's disease revisited. Am J Public Health. 1994 Aug;84(8):1261–1264. doi: 10.2105/ajph.84.8.1261. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Evans D. A. Estimated prevalence of Alzheimer's disease in the United States. Milbank Q. 1990;68(2):267–289. [PubMed] [Google Scholar]
- Evans D. A., Smith L. A., Scherr P. A., Albert M. S., Funkenstein H. H., Hebert L. E. Risk of death from Alzheimer's disease in a community population of older persons. Am J Epidemiol. 1991 Aug 15;134(4):403–412. doi: 10.1093/oxfordjournals.aje.a116102. [DOI] [PubMed] [Google Scholar]
- Fourrier A., Letenneur L., Bégaud B., Dartigues J. F. Nonsteroidal antiinflammatory drug use and cognitive function in the elderly: inconclusive results from a population-based cohort study. J Clin Epidemiol. 1996 Oct;49(10):1201–1201. doi: 10.1016/0895-4356(96)00202-8. [DOI] [PubMed] [Google Scholar]
- Fratiglioni L., Viitanen M., von Strauss E., Tontodonati V., Herlitz A., Winblad B. Very old women at highest risk of dementia and Alzheimer's disease: incidence data from the Kungsholmen Project, Stockholm. Neurology. 1997 Jan;48(1):132–138. doi: 10.1212/wnl.48.1.132. [DOI] [PubMed] [Google Scholar]
- Hebert L. E., Scherr P. A., Beckett L. A., Albert M. S., Pilgrim D. M., Chown M. J., Funkenstein H. H., Evans D. A. Age-specific incidence of Alzheimer's disease in a community population. JAMA. 1995 May 3;273(17):1354–1359. [PubMed] [Google Scholar]
- Henderson V. W., Paganini-Hill A., Emanuel C. K., Dunn M. E., Buckwalter J. G. Estrogen replacement therapy in older women. Comparisons between Alzheimer's disease cases and nondemented control subjects. Arch Neurol. 1994 Sep;51(9):896–900. doi: 10.1001/archneur.1994.00540210068014. [DOI] [PubMed] [Google Scholar]
- Jorm A. F. Cross-national comparisons of the occurrence of Alzheimer's and vascular dementias. Eur Arch Psychiatry Clin Neurosci. 1991;240(4-5):218–222. doi: 10.1007/BF02189530. [DOI] [PubMed] [Google Scholar]
- Jorm A. F., Korten A. E., Henderson A. S. The prevalence of dementia: a quantitative integration of the literature. Acta Psychiatr Scand. 1987 Nov;76(5):465–479. doi: 10.1111/j.1600-0447.1987.tb02906.x. [DOI] [PubMed] [Google Scholar]
- Katzman R. Education and the prevalence of dementia and Alzheimer's disease. Neurology. 1993 Jan;43(1):13–20. doi: 10.1212/wnl.43.1_part_1.13. [DOI] [PubMed] [Google Scholar]
- Kawas C., Resnick S., Morrison A., Brookmeyer R., Corrada M., Zonderman A., Bacal C., Lingle D. D., Metter E. A prospective study of estrogen replacement therapy and the risk of developing Alzheimer's disease: the Baltimore Longitudinal Study of Aging. Neurology. 1997 Jun;48(6):1517–1521. doi: 10.1212/wnl.48.6.1517. [DOI] [PubMed] [Google Scholar]
- Kokmen E., Chandra V., Schoenberg B. S. Trends in incidence of dementing illness in Rochester, Minnesota, in three quinquennial periods, 1960-1974. Neurology. 1988 Jun;38(6):975–980. doi: 10.1212/wnl.38.6.975. [DOI] [PubMed] [Google Scholar]
- Lautenschlager N. T., Cupples L. A., Rao V. S., Auerbach S. A., Becker R., Burke J., Chui H., Duara R., Foley E. J., Glatt S. L. Risk of dementia among relatives of Alzheimer's disease patients in the MIRAGE study: What is in store for the oldest old? Neurology. 1996 Mar;46(3):641–650. doi: 10.1212/wnl.46.3.641. [DOI] [PubMed] [Google Scholar]
- Le Bars P. L., Katz M. M., Berman N., Itil T. M., Freedman A. M., Schatzberg A. F. A placebo-controlled, double-blind, randomized trial of an extract of Ginkgo biloba for dementia. North American EGb Study Group. JAMA. 1997 Oct 22;278(16):1327–1332. doi: 10.1001/jama.278.16.1327. [DOI] [PubMed] [Google Scholar]
- Letenneur L., Commenges D., Dartigues J. F., Barberger-Gateau P. Incidence of dementia and Alzheimer's disease in elderly community residents of south-western France. Int J Epidemiol. 1994 Dec;23(6):1256–1261. doi: 10.1093/ije/23.6.1256. [DOI] [PubMed] [Google Scholar]
- Martin G. M., Kukull W. A. Do cultural differences affect Alzheimer disease? JAMA. 1996 Sep 25;276(12):993–995. [PubMed] [Google Scholar]
- McGeer P. L., Schulzer M., McGeer E. G. Arthritis and anti-inflammatory agents as possible protective factors for Alzheimer's disease: a review of 17 epidemiologic studies. Neurology. 1996 Aug;47(2):425–432. doi: 10.1212/wnl.47.2.425. [DOI] [PubMed] [Google Scholar]
- McKhann G., Drachman D., Folstein M., Katzman R., Price D., Stadlan E. M. 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. 1984 Jul;34(7):939–944. doi: 10.1212/wnl.34.7.939. [DOI] [PubMed] [Google Scholar]
- Nilsson L. V. Incidence of severe dementia in an urban sample followed from 70 to 79 years of age. Acta Psychiatr Scand. 1984 Nov;70(5):478–486. doi: 10.1111/j.1600-0447.1984.tb01237.x. [DOI] [PubMed] [Google Scholar]
- Paganini-Hill A., Henderson V. W. Estrogen deficiency and risk of Alzheimer's disease in women. Am J Epidemiol. 1994 Aug 1;140(3):256–261. doi: 10.1093/oxfordjournals.aje.a117244. [DOI] [PubMed] [Google Scholar]
- Paganini-Hill A., Henderson V. W. Estrogen replacement therapy and risk of Alzheimer disease. Arch Intern Med. 1996 Oct 28;156(19):2213–2217. [PubMed] [Google Scholar]
- Rice D. P., Fox P. J., Max W., Webber P. A., Lindeman D. A., Hauck W. W., Segura E. The economic burden of Alzheimer's disease care. Health Aff (Millwood) 1993 Summer;12(2):164–176. doi: 10.1377/hlthaff.12.2.164. [DOI] [PubMed] [Google Scholar]
- Rorsman B., Hagnell O., Lanke J. Prevalence and incidence of senile and multi-infarct dementia in the Lundby Study: a comparison between the time periods 1947-1957 and 1957-1972. Neuropsychobiology. 1986;15(3-4):122–129. doi: 10.1159/000118254. [DOI] [PubMed] [Google Scholar]
- Small G. W., Rabins P. V., Barry P. P., Buckholtz N. S., DeKosky S. T., Ferris S. H., Finkel S. I., Gwyther L. P., Khachaturian Z. S., Lebowitz B. D. Diagnosis and treatment of Alzheimer disease and related disorders. Consensus statement of the American Association for Geriatric Psychiatry, the Alzheimer's Association, and the American Geriatrics Society. JAMA. 1997 Oct 22;278(16):1363–1371. [PubMed] [Google Scholar]
- Stern Y., Tang M. X., Albert M. S., Brandt J., Jacobs D. M., Bell K., Marder K., Sano M., Devanand D., Albert S. M. Predicting time to nursing home care and death in individuals with Alzheimer disease. JAMA. 1997 Mar 12;277(10):806–812. [PubMed] [Google Scholar]
- Stewart W. F., Kawas C., Corrada M., Metter E. J. Risk of Alzheimer's disease and duration of NSAID use. Neurology. 1997 Mar;48(3):626–632. doi: 10.1212/wnl.48.3.626. [DOI] [PubMed] [Google Scholar]
- Tang M. X., Jacobs D., Stern Y., Marder K., Schofield P., Gurland B., Andrews H., Mayeux R. Effect of oestrogen during menopause on risk and age at onset of Alzheimer's disease. Lancet. 1996 Aug 17;348(9025):429–432. doi: 10.1016/S0140-6736(96)03356-9. [DOI] [PubMed] [Google Scholar]
- Thal L. J. Potential prevention strategies for Alzheimer disease. Alzheimer Dis Assoc Disord. 1996 Fall;10 (Suppl 1):6–8. [PubMed] [Google Scholar]
- White L., Petrovitch H., Ross G. W., Masaki K. H., Abbott R. D., Teng E. L., Rodriguez B. L., Blanchette P. L., Havlik R. J., Wergowske G. Prevalence of dementia in older Japanese-American men in Hawaii: The Honolulu-Asia Aging Study. JAMA. 1996 Sep 25;276(12):955–960. [PubMed] [Google Scholar]
- Yoshitake T., Kiyohara Y., Kato I., Ohmura T., Iwamoto H., Nakayama K., Ohmori S., Nomiyama K., Kawano H., Ueda K. Incidence and risk factors of vascular dementia and Alzheimer's disease in a defined elderly Japanese population: the Hisayama Study. Neurology. 1995 Jun;45(6):1161–1168. doi: 10.1212/wnl.45.6.1161. [DOI] [PubMed] [Google Scholar]
- Zaman Z., Roche S., Fielden P., Frost P. G., Niriella D. C., Cayley A. C. Plasma concentrations of vitamins A and E and carotenoids in Alzheimer's disease. Age Ageing. 1992 Mar;21(2):91–94. doi: 10.1093/ageing/21.2.91. [DOI] [PubMed] [Google Scholar]
- van Duijn C. M. Epidemiology of the dementias: recent developments and new approaches. J Neurol Neurosurg Psychiatry. 1996 May;60(5):478–488. doi: 10.1136/jnnp.60.5.478. [DOI] [PMC free article] [PubMed] [Google Scholar]