title: 20-Year prevalence projections for dementia and impact of preventive policy about risk factors.
abstract: Incidence of dementia increases sharply with age and, because of the increase in life expectancy, the number of dementia cases is expected to rise dramatically over time. Some studies suggest that controlling some modifiable risk factors for dementia like diabetes or hypertension could lower its incidence. However, as treating these vascular factors would also reduce mortality risk, the actual impact of such public-health intervention on dementia prevalence is not known. Accounting for the impact of dementia and risk factors on mortality, the aim of this work was (1) to compute projections of age- and-sex specific prevalence of dementia in France from 2010 to 2030, (2) to evaluate how public-health interventions targeting risk factors for dementia could change these projections. Age-and-sex specific incidence of dementia and mortality of demented subjects were estimated from the Paquid population-based cohort using a semi-parametric illness-death model. Future global mortality rates and population sizes were obtained from national demographic projections. Under the assumption that life expectancy will increase by 3.5 years for men and 2.8 years for women by 2030, the number of subjects with dementia was estimated to increase by about 75% from 2010 to 2030 with a 200% increase after 90 years of age. Therapeutic intervention on the whole population reducing high blood pressure prevalence would lead to a decrease in both dementia incidence rates and mortality and would have a modest impact on the number of dementia cases. On the other hand, a preventive dementia treatment targeting ApoE4 carriers would probably not improve survival and hence would decrease dementia prevalence by 15-25%.
authors.affiliation: Inserm U897,ISPED, Université Bordeaux Ségalen, 146 rue Léo Saignat, 33076 Bordeaux Cedex, France. helene.jacqmin-gadda@inserm.f
authors.forename: Hélène
authors.initials: H
authors.lastname: Jacqmin-Gadda
authors.forename: Annick
authors.initials: A
authors.lastname: Alperovitch
authors.forename: Claire
authors.initials: C
authors.lastname: Montlahuc
authors.forename: Daniel
authors.initials: D
authors.lastname: Commenges
authors.forename: Karen
authors.initials: K
authors.lastname: Leffondre
authors.forename: Carole
authors.initials: C
authors.lastname: Dufouil
authors.forename: Alexis
authors.initials: A
authors.lastname: Elbaz
authors.forename: Christophe
authors.initials: C
authors.lastname: Tzourio
authors.forename: Joël
authors.initials: J
authors.lastname: Ménard
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Dartigues
authors.forename: Pierre
authors.initials: P
authors.lastname: Joly
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003704:Dementia / Q000453:epidemiology*; D005260:Female; D005544:Forecasting; D005602:France / Q000453:epidemiology; D006291:Health Policy; D006801:Humans; D015994:Incidence; D008017:Life Expectancy / Q000639:trends*; D008297:Male; D016017:Odds Ratio; D015995:Prevalence; D011322:Primary Prevention / Q000379:methods*; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors