Twenty-seven-year time trends in dementia incidence in Europe and the United States : The Alzheimer Cohorts Consortium

The present study was supported by an unrestricted grant from Janssen Prevention Center, Leiden, the Netherlands. Funding for individual cohorts: Age, Gene/Environment Susceptibility (AGES) is supported by National Institute of Aging contracts (N01-AG-12100 and HHSN271201200022C) with contributions from the National Eye Institute, National Institute on Deafness and Other Communication Disorders, the National Heart, Lung and Blood Institute, the National Institute of Aging Intramural Research Program, Hjartavernd (the Icelandic Heart Association), and the Althingi (the Icelandic Parliament). Cognitive Function and Ageing Studies (CFAS): Medical Research Council (MRC) CFAS I was funded by the MRC (Research Grant: G9901400) and the National Health Service (NHS). CFAS II has been supported by the UK Medical Research Council (Research Grant: G06010220) and received additional support from the National Institute for Health Research (NIHR), comprehensive clinical research networks in West Anglia, Nottingham City, and Nottinghamshire County NHS Primary Care trusts, and the Dementias and Neurodegenerative Disease Research Network (DeNDRoN) in Newcastle. Framingham Heart Study (FHS) was supported by the National Heart, Lung, and Blood Institute’s Framingham Heart Study (contracts N01- HC-25195 and HHSN268201500001I). This study was also supported by grants from the National Institute on Aging (AG054076, U01-AG049505, and AG008122, R01AG049607, AG033193, AG033040, AG052409, AG59421) and the National Institute of Neurologic Disorders and Stroke (R01- NS017950, NS100605). The Gothenburg study was supported by grants from The Swedish Research Council 2012-5041, 2015-02830, 2013-8717, Swedish Research Council for Health, Working Life and Welfare (no. 2001-2646, 2003-0234, 2004- 0150, 2006-0020, 2008-1229, 2012-1138, 2004-0145, 2006- 0596, 2008-1111, 2010-0870, 2013-1202, 2001-2849, 2005- 0762, 2008-1210, 2013-2300, 2013-2496), Konung Gustaf V:s och Drottning Victorias Frimurarestiftelse, Hj¨arnfonden, Swedish State Support for Clinical Research (ALF V¨astra G¨otalandsregionen), the Swedish state under the agreement between the Swedish Government and the county councils, the ALF-agreement (ALFGBG-813921, ALFGBG-65930, ALFGBG-716681), The Alzheimer’s Association Zenith Award (ZEN-01-3151), The Alzheimer’s Association Stephanie B. Overstreet Scholars (IIRG-00-2,159), Alzheimer’s Association (IIRG-03-6,168), The Alzheimer’s Association (IIRG-09- 131338), Eivind och Elsa K:son Sylvans stiftelse, Stiftelsen S¨oderstr¨om-K¨onigska Sjukhemmet, Stiftelsen f¨or Gamla Tj¨anarinnor, Handlanden Hjalmar Svenssons Forskningsfond, Stiftelsen Professor Bror Gadelius’ Minnesfond, and Swedish Alzheimer foundation. The PAQUID cohort was supported by IPSEN France, NOVARTIS Pharma France, and the CNSA (Caisse Nationale de Solidarit´e et d’Autonomie). The research presented in this manuscript is original. The contents of this article are solely the responsibility of the authors. IPSEN, NOVARTIS, and the CNSA did not fund this specific study. The funders had no role in the collection, management, analysis, or interpretation of the data and had no role in the preparation, review, or approval of the manuscript. The Rotterdam Study is supported by the Erasmus Medical Centre and Erasmus University Rotterdam, The Netherlands Organization for Scientific Research (NWO), The Netherlands Organization for Health Research and Development (ZonMW), the Research Institute for Diseases in the Elderly (RIDE), The Netherlands Genomics Initiative, the Ministry of Education, Culture and Science, the Ministry of Health, Welfare and Sports, the European Commission (DG XII), and the Municipality of Rotterdam. This research was further supported by funding from the European Union Seventh Framework Program (FP7/2007e2013) under grant agreement no. 601055, VPH-Dare@IT (FP7-ICT-2011-9e601055) and funding from the European Union’s Horizon 2020 research and innovation program under grant agreement no. 667375 (Co-STREAM) and under grant agreement no. 678543 (European Research Council [ERC] funded project: ORACLE). None of the funding organizations or sponsors were involved in study design, in collection, analysis, and interpretation of data, in writing of the report, or in the decision to submit the article for publication. The Three-City Study is conducted under a partnership agreement among INSERM, Bordeaux School of Public Health (ISPED) of the University of Bordeaux, and SanofiAventis. The “Fondation pour la Recherche M´edicale” funded the preparation and initiation of the study. The Three-City e528 Neurology | Volume 95, Number 5 | August 4, 2020 Neurology.org/N Publisher Copyright: Copyright © 2020 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.OBJECTIVE: To determine changes in the incidence of dementia between 1988 and 2015. METHODS: This analysis was performed in aggregated data from individuals >65 years of age in 7 population-based cohort studies in the United States and Europe from the Alzheimer Cohort Consortium. First, we calculated age- and sex-specific incidence rates for all-cause dementia, and then defined nonoverlapping 5-year epochs within each study to determine trends in incidence. Estimates of change per 10-year interval were pooled and results are presented combined and stratified by sex. RESULTS: Of 49,202 individuals, 4,253 (8.6%) developed dementia. The incidence rate of dementia increased with age, similarly for women and men, ranging from about 4 per 1,000 person-years in individuals aged 65-69 years to 65 per 1,000 person-years for those aged 85-89 years. The incidence rate of dementia declined by 13% per calendar decade (95% confidence interval [CI], 7%-19%), consistently across studies, and somewhat more pronouncedly in men than in women (24% [95% CI 14%-32%] vs 8% [0%-15%]). CONCLUSION: The incidence rate of dementia in Europe and North America has declined by 13% per decade over the past 25 years, consistently across studies. Incidence is similar for men and women, although declines were somewhat more profound in men. These observations call for sustained efforts to finding the causes for this decline, as well as determining their validity in geographically and ethnically diverse populations.Peer reviewe