title: Dementia in western Europe: epidemiological evidence and implications for policy making.
abstract: Dementia is receiving increasing attention from governments and politicians. Epidemiological research based on western European populations done 20 years ago provided key initial evidence for dementia policy making, but these estimates are now out of date because of changes in life expectancy, living conditions, and health profiles. To assess whether dementia occurrence has changed during the past 20-30 years, investigators of five different studies done in western Europe (Sweden [Stockholm and Gothenburg], the Netherlands [Rotterdam], the UK [England], and Spain [Zaragoza]) have compared dementia occurrence using consistent research methods between two timepoints in well-defined geographical areas. Findings from four of the five studies showed non-significant changes in overall dementia occurrence. The only significant reduction in overall prevalence was found in the study done in the UK, powered and designed explicitly from its outset to detect change across generations (decrease in prevalence of 22%; p=0.003). Findings from the study done in Zaragoza (Spain) showed a significant reduction in dementia prevalence in men (43%; p=0.0002). The studies estimating incidence done in Stockholm and Rotterdam reported non-significant reductions. Such reductions could be the outcomes from earlier population-level investments such as improved education and living conditions, and better prevention and treatment of vascular and chronic conditions. This evidence suggests that attention to optimum health early in life might benefit cognitive health late in life. Policy planning and future research should be balanced across primary (policies reducing risk and increasing cognitive reserve), secondary (early detection and screening), and tertiary (once dementia is present) prevention. Each has their place, but upstream primary prevention has the largest effect on reduction of later dementia occurrence and disability.
authors: Department of Public Health and Primary Care, Cambridge Institute of Public Health, School of Clinical Medicine, University of Cambridge, Cambridge, UK.
authors: Yu-Tzu
authors: YT
authors: Wu
authors: Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet-Stockholm University, Stockholm, Sweden.
authors: Laura
authors: L
authors: Fratiglioni
authors: Medical Research Council Biostatistics Unit, Institute of Public Health, Cambridge, UK; Institute of Health and Society, Newcastle University, Newcastle, UK.
authors: Fiona E
authors: FE
authors: Matthews
authors: Department of Psychiatry, Universidad de Zaragoza, and Instituto de Investigación Sanitaria Aragón, Zaragoza, and Centro de Investigación Biomédica En Red de Salud Mental, Madrid, Spain.
authors: Antonio
authors: A
authors: Lobo
authors: German Center for Neurodegenerative Diseases, Bonn, Germany.
authors: Monique M B
authors: MM
authors: Breteler
authors: Centre for Ageing and Health, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
authors: Ingmar
authors: I
authors: Skoog
authors: Department of Public Health and Primary Care, Cambridge Institute of Public Health, School of Clinical Medicine, University of Cambridge, Cambridge, UK. Electronic address: carol.brayne@medschl.cam.ac.uk.
authors: Carol
authors: C
authors: Brayne
mesh_terms: D003704:Dementia / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D005060:Europe / Q000453:epidemiology; D006291:Health Policy / Q000639:trends*; D006801:Humans; D015994:Incidence; D011050:Policy Making; D015995:Prevalence