Systematic review of dementia prevalence - 1994 to 2000

Lopes, Marcos Antonio; Hototian, Sérgio Ricardo; Reis, Geraldo C.; Elkis, Hélio; Bottino, Cassio Machado de Campos

doi:10.1590/S1980-57642008DN10300003

Abstract

Ageing has occurred in all regions of the world, with impact on neuropsychiatric disorders, particularly dementia. However, previous meta-analysis and reviews have shown high variability in world dementia prevalence rates. Objective: The aim of this study was to perform a wide-ranging review of the dementia prevalence studies published in recent years. Methods: The search was made on Medline, Lilacs and Embase databases for research conducted between 1994 and 2000. The main inclusion criteria were: use of standard diagnostic criteria and investigation of community samples. Results: The final selection included 42 papers, from all continents. The mean prevalence rate of dementia in subjects aged 65 years and older, for continents, ranged from 2.2% in Africa to 8.9% in Europe, and among countries, from 1.3% in India to 14.9% in Spain. However, there was a trend of clustering of the world prevalence rates with the majority of studies reporting rates between 4.2% and 7.2% (³65 years). Age directly influenced the rates, with a mean prevalence rate of 1.2% (95% CI: 0.8-1.5) for the 65-69 years group and 39.9% (95% CI: 34.4-45.3) for the 90-94 year group, but showing less pronounced influence in the very elderly age group. The urban samples had higher rates, where no significant gender difference was evidenced. Conclusion: The age influence over dementia rates apparently leveled off in the very elderly group while a trend toward similar dementia prevalence rates around the world was probably influenced by greater homogeneity in diagnostic criteria.

Key words:
epidemiology; prevalence; dementia; Alzheimer disease; review.

Resumo

A população idosa vem aumentando em todo o mundo, levando a um impacto nos transtornos psiquiátricos, principalmente os quadros de demência. Contudo, revisões e meta-análises prévias têm mostrado alta variabilidade nas taxas mundiais de prevalência de demência. Objetivo: O objetivo deste estudo foi realizar uma ampla revisão de trabalhos recentes de prevalência de demência. Métodos: O levantamento foi feito em três bases de dados, Medline, Lilacs e EMBASE, no período de 1994 a 2000. Os principais critérios de inclusão foram: uso de critérios diagnósticos padronizados e investigação de amostra comunitária. Resultados: A seleção final incluiu 42 artigos, de todos os continentes. A taxa média de prevalência de demência, na idade maior ou igual a 65 anos, entre continentes, variou de 2.2% na África, até 8.9% na Europa, e entre países, de 1.3% na Índia, até 14.9% na Espanha. Contudo, a maioria dos estudos reportou taxas entre 4.2% e 7.2% (³65 anos). A idade exerceu influência direta sobre as taxas de prevalência, com taxas médias de 1.2% na faixa etária 65-69 anos, e 39.9% na faixa etária 90-94 anos, mostrando, no entanto, um efeito menos pronunciado nos idosos muito idosos. A população de procedência urbana teve taxas significativamente maiores, e não houve diferença significativa entre os sexos. Conclusão: A influência da idade sobre as taxas de prevalência de demência diminuiu entre os idosos mais "idosos", e a tendência de resultados similares em todo o mundo provavelmente foi influenciada pela homogeneidade nos critérios diagnósticos.

Palavras-chave:
epidemiologia; prevalência; demência; doença de Alzheimer; revisão.

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References

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Jorm AF, Korten AE, Henderson AS. The prevalence of dementia: a quantitative integration of the literature. Acta Psychiatr Scand 1987;76:465-479.
²
Fratiglioni L, Ronchi D, Agüero-Torres H. Worldwide prevalence and incidence of dementia. Drugs Aging 1999;15:365-375
³
Lobo A, Launer LJ, Fratiglioni L et al. Prevalence of dementia and major subtypes in Europe: a collaborative study of population-based cohorts. Neurology 2000;54(Suppl 5):S4-S9.
⁴
Lopes MA, Bottino CMC. Prevalence of dementia in several regions of the world: analysis of epidemiologic studies from 1994 to 2000. Arq Neuropsiquiatr 2002;60:61-69.
⁵
Ritche K, Kildea D. Is senile dementia "age-related" or "ageing-related"? evidence from meta-analysis of dementia prevalence in the oldest old. Lancet 1995; 346:931-934.
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Hachinski VC, Iliff LD, Zihkla E et al. Cerebral blood flow in dementia. Arch Neurol 1975;32:632-637.
¹⁰
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¹⁴
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Roelands M, Wostyn P, Dom H, Baro F. The Prevalence of Dementia in Belgium: A population-based door-to-door survey in a rural community. Neuroepidemiology 1994;13:155-161.
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¹⁸
Pousa SL, Regla JL, Franch V, Pinedo LF. The prevalence of dementia in Girona. Neurologia 1995;10:189-193.
¹⁹
Pi J, Olivé JM, Roca J, Masana L. Prevalence of dementia in a semi-rural population of Catalunya, Spain. Neuroepidemiology 1996;15:33-41
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Manubens JM, Martinez-Lage JM, Lacruz F et al. Prevalence of Alzheimer's disease and other dementia disorders in Pamplona, Spain. Neuroepidemiology 1995;14:155-164.
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Wernicke TF, Reischies FM. Prevalence of dementia in old age: clinical diagnoses in subjects aged 95 years and older. Neurology 1994;44:250-253.
²²
D'Alessandro R, Pandolfo G, Azzimondi G, Feruglio FS. Prevalence of dementia among elderly people in Troina, Sicily. Eur J Epidemiol 1996;12:595-599.
²³
Azzimondi G , D'Alessandro R, Pandolfo G , Feruglio FS . Comparative study of the prevalence of dementia in two Sicilian communities with different psychosocial backgrounds. Neuroepidemiology 1998;17:199-209.
²⁴
Strauss E, Viitanen M, Ronchi D, Winblad B, Fratiglioni L. Aging and the occurrence of dementia. Findings from a population-based cohort with a large sample of nonagenarians. Arch Neurol 1999;56:587-592.
²⁵
Fichter MM, Meller I, Schröppel H, Steinkirchner R. Dementia and cognitive impairment in the oldest old in the community. Prevalence and comorbidity. Br J Psychiatry 1995;166:621-629.
²⁶
Ravaglia G, Forti P, Ronchi D et al. Prevalence and severity of dementia among northern Italian centenarians. Neurology 1999;53:416-418.
²⁷
Shaji S, Promodu K, Abraham T, Roy KJ, Verghese A. An epidemiological study of dementia in a rural community in Kerala, Índia. Br J Psychiatry 1996;168:745-749.
²⁸
Yamada M, Sasaki H, Mimori Y et al. Prevalence and risks of dementia in the Japanese population: RERF'S adult health study Hiroshima subjects. J Am Geriatr Soc 1999;47:189-195.
²⁹
Komahashi T, Ohmori K, Nakano T et al. Epidemiological survey of dementia and depression. Jpn J Psychiatry Neurol 1994;48:517-526.
³⁰
Kiyohara Y, Yoshitake T, Kato I et al. Changing patterns in the prevalence of dementia in a Japanese community: The Hisayama study. Gerontology 1994; 40(suppl 2):229-235.
³¹
Ogura C, Nakamoto H, Uema T et al. COSEOUP GROUP. Prevalence of senile dementia in Okinawa, Japan. Int J Epidemiol 1995;24:373-380.
³²
Shiba M, Shimogaito J, Kose A et al. Prevalence of dementia in the rural village of Hanazono-mura, Japan. Neuroepidemiology 1999;18:32-36.
³³
Chandra V, Ganguli M, Pandav R, Johnston J, Belle S, De Kosky ST. Prevalence of Alzheimer's disease and other dementias in rural India. The Indo-US study. Neurology 1998;51:1000-1008.
³⁴
Park J, Ko HJ, Park YN, Jung C. Dementia among the elderly in a Korean community. Br J Psychiatry 1994;164:796-801.
³⁵
Woo JI, Lee JH, Yoo K, Kim C, Kim Y, Shin YS. Prevalence estimation of dementia in a rural area of Korea. J Am Geriatr Soc 1998;46:983-987.
³⁶
Liu C, Lin R, Chen Y, Tai C, Yen Y, Howng S. Prevalence of dementia in a urban area in Taiwan. J Formos Assoc 1996;95:762-768.
³⁷
Lin R, Lai C, Tai C, Liu C, Yen Y, Howng S. Prevalence and subtypes of dementia in southern Taiwan: impact of age, sex, education, and urbanization. J Neurol Sci 1998;160:67-75.
³⁸
Liu H, Lin K, Teng EL et al. Prevalence and subtypes of dementia in Taiwan: a commmunity survey of 5297 individuals. J Am Geriatr Soc 1995;43:144-149.
³⁹
Chiu HFK, Lam LCW, Chi I et al. Prevalence of dementia in Chinese elderly in Hong Kong. Neurology 1998;50:1002-1009.
⁴⁰
Asada T, Yamagata Z, Kinoshita T et al. Prevalence of dementia and distribution of apoE alelles in Japanese centenarians: an almost-complete survey in Yamanashi Prefecture, Japan. J Am Geriatr Soc 1996;44:151-156.
⁴¹
Hendrie HC, Osuntokun B, Hall K et al. Prevalence of Alzheimer's disease and dementia in two communities: Nigerian Africans and African Americans. Am J Psychiatry 1995;152:1485-1492.
⁴²
Beard CM, Kokmen E, O'Brien PC, Kurland LT. The prevalence of dementia is changing over time in Rochester, Minnesota. Neurology 1995;45:75-79.
⁴³
Graves AB, Larson EB, Edland SD et al. Prevalence of dementia and its subtypes in the Japanese American population of King County, Washington State. The Kame Project. Am J Epidemiol 1996;144:760-771.
⁴⁴
Fillenbaum GG, Heyman A, Huber MS et al. The prevalence and 3-year incidence of dementia in older black and white community residents. J Clin Epidemiol 1998;51:587-595.
⁴⁵
Breitner JCS, Wyse BW, Anthony JC et al. APOE-e4 count predicts age when prevalence of AD increases, then declines. The Cache County Study. Neurology 1999;53:321-331.
⁴⁶
McDowel I, Hill G, Lindsay J et al. Canadian Study of Health and Aging: study methods and prevalence of dementia. Can Med Assoc J 1994;150:899-913.
⁴⁷
Ebly EM, Parhad IM, Hogan DB, Fung TS. Prevalence and types of dementia in the very old: results from the Canadian study of health and aging. Neurology 1994;44:1593-1600.
⁴⁸
Powell A. Senile dementia of extreme aging: a common disorder of centenarians. Dementia 1994;5:106-109.
⁴⁹
Farrag AF, Farwiz HM, Khedr EH, Mahfouz RM, Omran SM. Prevalence of Alzheimer's disease and other dementing Disorders: assiut-upper Egypt study. Dement Geriatr Cogn Disord 1998;9:323-328.
⁵⁰
Ogunniyi A, Gureje O, Baiyewu O et al. Profile of dementia in a Nigerian community: types, pattern of impairment, and severity rating. J Natl Med Assoc 1997;89:392-396.
⁵¹
Herrera Jr E, Caramelli P, Nitrini R. Estudo epidemiológico populacional de demência na cidade de Catanduva - Estado de São Paulo - Brasil. Rev Psiq Clín (São Paulo) 1998;25:70-73.
⁵²
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⁵³
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⁵⁴
Roth M, Tym E, Mountjoy CQ et al. CAMDEX A standardised instrument for the diagnosis of mental disorders in the elderly with special reference to the early detection of dementia. Br J Psychiatry 1986;149:698-709.
⁵⁵
Hughes CP, Berg L, Danziger WL. A new clinical scale for the stating of dementia. Br J Psychiatry 1982;140:566-572.
⁵⁶
Blessed G, Tomlinson B, Roth M. The association between quantitative measures of dementia and of senile change in the cerebral grey matter of elderly subjects. Br J Psychiatry 1968;114:797-811.
⁵⁷
Román GC, Tatemichi TK, Erkinjuntti T et al. Vascular dementia: Diagnostic criteria for research studies: report of the NINDS-AIREN International Wokshop. Neurology 1993;43:250-260.
⁵⁸
Morris JC, Heyman A, Mohs RC et al. The consortium to establish a registry for Alzheimer's disease (CERAD). Part I. Clinical and neuropsychological assessment of Alzheimer's disease. Neurology 1989;39:1159-1165.
⁵⁹
Copeland JRM, Dewey ME, Griffiths-Jones HM. Computerised psychiatric diagnostic system and case nomenclature for elderly subjects: GMS and AGECAT. Psychol Med 1986;16:89-99.
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Publication Dates

Publication in this collection
Jul-Sep 2007

This is an open-access article distributed under the terms of the Creative Commons Attribution License

[1] ¹
Jorm AF, Korten AE, Henderson AS. The prevalence of dementia: a quantitative integration of the literature. Acta Psychiatr Scand 1987;76:465-479.

[2] ²
Fratiglioni L, Ronchi D, Agüero-Torres H. Worldwide prevalence and incidence of dementia. Drugs Aging 1999;15:365-375

[3] ³
Lobo A, Launer LJ, Fratiglioni L et al. Prevalence of dementia and major subtypes in Europe: a collaborative study of population-based cohorts. Neurology 2000;54(Suppl 5):S4-S9.

[4] ⁴
Lopes MA, Bottino CMC. Prevalence of dementia in several regions of the world: analysis of epidemiologic studies from 1994 to 2000. Arq Neuropsiquiatr 2002;60:61-69.

[5] ⁵
Ritche K, Kildea D. Is senile dementia "age-related" or "ageing-related"? evidence from meta-analysis of dementia prevalence in the oldest old. Lancet 1995; 346:931-934.

[6] ⁶
American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 3rd ed. Washington, DC: American Psychiatric Association; 1980.

[7] ⁷
American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 3rd ed (review). Washington, DC, American Psychiatric Association; 1987.

[8] ⁸
American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 4th ed. Washington, DC, American Psychiatric Association; 1994.

[9] ⁹
Hachinski VC, Iliff LD, Zihkla E et al. Cerebral blood flow in dementia. Arch Neurol 1975;32:632-637.

[10] ¹⁰
McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM. Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA Work Group under the auspice of the department of health and human services task force on Alzheimer's disease. Neurology 1984;34:939-944.

[11] ¹¹
Ott A, Breteler MMB, Harskamp F et al. Prevalence of Alzheimer's disease and vascular dementia: association with education. The Rotterdam Study. BMJ 1995; 310:970-973.

[12] ¹²
Prencipe M, Casini AR, Ferretti C, Lattanzio MT, Fiorelli M, Culasso F. Prevalence of dementia in a elderly rural population: effects of age, sex, and education. J Neurol Neurosurg Psychiatry 1996;60:628-633.

[13] ¹³
Boersma F, Eefsting JA, van den Brink W, Koeter M, van Tilburg W. Prevalence of dementia in a rural netherlands population and the influence of DSM-III-R and CAMDEX criteria for the prevalence of mild and more severe forms. J Clin Epidemiol 1998;51:189-197.

[14] ¹⁴
Brayne C, Nickson J, McCraken C, Gill C, Johnson AL. Cognitive function and dementia in six areas of England and Wales: distribution of MMSE and prevalence of GMS organicity level in the MRC CFA Study. Psychol Med 1998;28:319-335.

[15] ¹⁵
Andersen K, Lolk A, Nielsen H, Andersen J, Olsen C, Kragh-Sorensen P. Prevalence of very mild to severe dementia in Denmark. Acta Neurol Scand 1997; 96:82-87.

[16] ¹⁶
Roelands M, Wostyn P, Dom H, Baro F. The Prevalence of Dementia in Belgium: A population-based door-to-door survey in a rural community. Neuroepidemiology 1994;13:155-161.

[17] ¹⁷
Lobo A, Saz P, Marcos G, Dia JL, de la Camara C. The prevalence of dementia and depression in the elderly community in a southern european population. The Zaragoza Study. Arch Gen Psychiatry 1995;52:497-506.

[18] ¹⁸
Pousa SL, Regla JL, Franch V, Pinedo LF. The prevalence of dementia in Girona. Neurologia 1995;10:189-193.

[19] ¹⁹
Pi J, Olivé JM, Roca J, Masana L. Prevalence of dementia in a semi-rural population of Catalunya, Spain. Neuroepidemiology 1996;15:33-41

[20] ²⁰
Manubens JM, Martinez-Lage JM, Lacruz F et al. Prevalence of Alzheimer's disease and other dementia disorders in Pamplona, Spain. Neuroepidemiology 1995;14:155-164.

[21] ²¹
Wernicke TF, Reischies FM. Prevalence of dementia in old age: clinical diagnoses in subjects aged 95 years and older. Neurology 1994;44:250-253.

[22] ²²
D'Alessandro R, Pandolfo G, Azzimondi G, Feruglio FS. Prevalence of dementia among elderly people in Troina, Sicily. Eur J Epidemiol 1996;12:595-599.

[23] ²³
Azzimondi G , D'Alessandro R, Pandolfo G , Feruglio FS . Comparative study of the prevalence of dementia in two Sicilian communities with different psychosocial backgrounds. Neuroepidemiology 1998;17:199-209.

[24] ²⁴
Strauss E, Viitanen M, Ronchi D, Winblad B, Fratiglioni L. Aging and the occurrence of dementia. Findings from a population-based cohort with a large sample of nonagenarians. Arch Neurol 1999;56:587-592.

[25] ²⁵
Fichter MM, Meller I, Schröppel H, Steinkirchner R. Dementia and cognitive impairment in the oldest old in the community. Prevalence and comorbidity. Br J Psychiatry 1995;166:621-629.

[26] ²⁶
Ravaglia G, Forti P, Ronchi D et al. Prevalence and severity of dementia among northern Italian centenarians. Neurology 1999;53:416-418.

[27] ²⁷
Shaji S, Promodu K, Abraham T, Roy KJ, Verghese A. An epidemiological study of dementia in a rural community in Kerala, Índia. Br J Psychiatry 1996;168:745-749.

[28] ²⁸
Yamada M, Sasaki H, Mimori Y et al. Prevalence and risks of dementia in the Japanese population: RERF'S adult health study Hiroshima subjects. J Am Geriatr Soc 1999;47:189-195.

[29] ²⁹
Komahashi T, Ohmori K, Nakano T et al. Epidemiological survey of dementia and depression. Jpn J Psychiatry Neurol 1994;48:517-526.

[30] ³⁰
Kiyohara Y, Yoshitake T, Kato I et al. Changing patterns in the prevalence of dementia in a Japanese community: The Hisayama study. Gerontology 1994; 40(suppl 2):229-235.

[31] ³¹
Ogura C, Nakamoto H, Uema T et al. COSEOUP GROUP. Prevalence of senile dementia in Okinawa, Japan. Int J Epidemiol 1995;24:373-380.

[32] ³²
Shiba M, Shimogaito J, Kose A et al. Prevalence of dementia in the rural village of Hanazono-mura, Japan. Neuroepidemiology 1999;18:32-36.

[33] ³³
Chandra V, Ganguli M, Pandav R, Johnston J, Belle S, De Kosky ST. Prevalence of Alzheimer's disease and other dementias in rural India. The Indo-US study. Neurology 1998;51:1000-1008.

[34] ³⁴
Park J, Ko HJ, Park YN, Jung C. Dementia among the elderly in a Korean community. Br J Psychiatry 1994;164:796-801.

[35] ³⁵
Woo JI, Lee JH, Yoo K, Kim C, Kim Y, Shin YS. Prevalence estimation of dementia in a rural area of Korea. J Am Geriatr Soc 1998;46:983-987.

[36] ³⁶
Liu C, Lin R, Chen Y, Tai C, Yen Y, Howng S. Prevalence of dementia in a urban area in Taiwan. J Formos Assoc 1996;95:762-768.

[37] ³⁷
Lin R, Lai C, Tai C, Liu C, Yen Y, Howng S. Prevalence and subtypes of dementia in southern Taiwan: impact of age, sex, education, and urbanization. J Neurol Sci 1998;160:67-75.

[38] ³⁸
Liu H, Lin K, Teng EL et al. Prevalence and subtypes of dementia in Taiwan: a commmunity survey of 5297 individuals. J Am Geriatr Soc 1995;43:144-149.

[39] ³⁹
Chiu HFK, Lam LCW, Chi I et al. Prevalence of dementia in Chinese elderly in Hong Kong. Neurology 1998;50:1002-1009.

[40] ⁴⁰
Asada T, Yamagata Z, Kinoshita T et al. Prevalence of dementia and distribution of apoE alelles in Japanese centenarians: an almost-complete survey in Yamanashi Prefecture, Japan. J Am Geriatr Soc 1996;44:151-156.

[41] ⁴¹
Hendrie HC, Osuntokun B, Hall K et al. Prevalence of Alzheimer's disease and dementia in two communities: Nigerian Africans and African Americans. Am J Psychiatry 1995;152:1485-1492.

[42] ⁴²
Beard CM, Kokmen E, O'Brien PC, Kurland LT. The prevalence of dementia is changing over time in Rochester, Minnesota. Neurology 1995;45:75-79.

[43] ⁴³
Graves AB, Larson EB, Edland SD et al. Prevalence of dementia and its subtypes in the Japanese American population of King County, Washington State. The Kame Project. Am J Epidemiol 1996;144:760-771.

[44] ⁴⁴
Fillenbaum GG, Heyman A, Huber MS et al. The prevalence and 3-year incidence of dementia in older black and white community residents. J Clin Epidemiol 1998;51:587-595.

[45] ⁴⁵
Breitner JCS, Wyse BW, Anthony JC et al. APOE-e4 count predicts age when prevalence of AD increases, then declines. The Cache County Study. Neurology 1999;53:321-331.

[46] ⁴⁶
McDowel I, Hill G, Lindsay J et al. Canadian Study of Health and Aging: study methods and prevalence of dementia. Can Med Assoc J 1994;150:899-913.

[47] ⁴⁷
Ebly EM, Parhad IM, Hogan DB, Fung TS. Prevalence and types of dementia in the very old: results from the Canadian study of health and aging. Neurology 1994;44:1593-1600.

[48] ⁴⁸
Powell A. Senile dementia of extreme aging: a common disorder of centenarians. Dementia 1994;5:106-109.

[49] ⁴⁹
Farrag AF, Farwiz HM, Khedr EH, Mahfouz RM, Omran SM. Prevalence of Alzheimer's disease and other dementing Disorders: assiut-upper Egypt study. Dement Geriatr Cogn Disord 1998;9:323-328.

[50] ⁵⁰
Ogunniyi A, Gureje O, Baiyewu O et al. Profile of dementia in a Nigerian community: types, pattern of impairment, and severity rating. J Natl Med Assoc 1997;89:392-396.

[51] ⁵¹
Herrera Jr E, Caramelli P, Nitrini R. Estudo epidemiológico populacional de demência na cidade de Catanduva - Estado de São Paulo - Brasil. Rev Psiq Clín (São Paulo) 1998;25:70-73.

[52] ⁵²
Henderson AS, Jorm AF, Mackinnon A et al. A survey of dementia in the Canberra population: experience with ICD-10 and DSM-III-R criteria. Psychol Med 1994; 24:473-482.

[53] ⁵³
World Health Organization. International classification of diseases, 10th ed. Mental and behavioral disorders. Geneva: World Health Organization; 1987.

[54] ⁵⁴
Roth M, Tym E, Mountjoy CQ et al. CAMDEX A standardised instrument for the diagnosis of mental disorders in the elderly with special reference to the early detection of dementia. Br J Psychiatry 1986;149:698-709.

[55] ⁵⁵
Hughes CP, Berg L, Danziger WL. A new clinical scale for the stating of dementia. Br J Psychiatry 1982;140:566-572.

[56] ⁵⁶
Blessed G, Tomlinson B, Roth M. The association between quantitative measures of dementia and of senile change in the cerebral grey matter of elderly subjects. Br J Psychiatry 1968;114:797-811.

[57] ⁵⁷
Román GC, Tatemichi TK, Erkinjuntti T et al. Vascular dementia: Diagnostic criteria for research studies: report of the NINDS-AIREN International Wokshop. Neurology 1993;43:250-260.

[58] ⁵⁸
Morris JC, Heyman A, Mohs RC et al. The consortium to establish a registry for Alzheimer's disease (CERAD). Part I. Clinical and neuropsychological assessment of Alzheimer's disease. Neurology 1989;39:1159-1165.

[59] ⁵⁹
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