[Skip to Content]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address 18.206.194.83. Please contact the publisher to request reinstatement.
[Skip to Content Landing]
1 Credit CME
Key Points

Question  Has the prevalence of dementia among older adults in the United States changed between 2000 and 2012?

Findings  In this observational cohort study of more than 21 000 US adults 65 years or older from the nationally representative Health and Retirement Study, dementia prevalence declined significantly, from 11.6% in 2000 to 8.8% in 2012.

Meaning  Population brain health seemed to improve between 2000 and 2012; increasing educational attainment and better control of cardiovascular risk factors may have contributed to the improvement, but the full set of social, behavioral, and medical factors contributing to the improvement is still uncertain.

Abstract

Importance  The aging of the US population is expected to lead to a large increase in the number of adults with dementia, but some recent studies in the United States and other high-income countries suggest that the age-specific risk of dementia may have declined over the past 25 years. Clarifying current and future population trends in dementia prevalence and risk has important implications for patients, families, and government programs.

Objective  To compare the prevalence of dementia in the United States in 2000 and 2012.

Design, Setting, and Participants  We used data from the Health and Retirement Study (HRS), a nationally representative, population-based longitudinal survey of individuals in the United States 65 years or older from the 2000 (n = 10 546) and 2012 (n = 10 511) waves of the HRS.

Main Outcomes and Measures  Dementia was identified in each year using HRS cognitive measures and validated methods for classifying self-respondents, as well as those represented by a proxy. Logistic regression was used to identify socioeconomic and health variables associated with change in dementia prevalence between 2000 and 2012.

Results  The study cohorts had an average age of 75.0 years (95% CI, 74.8-75.2 years) in 2000 and 74.8 years (95% CI, 74.5-75.1 years) in 2012 (P = .24); 58.4% (95% CI, 57.3%-59.4%) of the 2000 cohort was female compared with 56.3% (95% CI, 55.5%-57.0%) of the 2012 cohort (P < .001). Dementia prevalence among those 65 years or older decreased from 11.6% (95% CI, 10.7%-12.7%) in 2000 to 8.8% (95% CI, 8.2%-9.4%) (8.6% with age- and sex-standardization) in 2012 (P < .001). More years of education was associated with a lower risk for dementia, and average years of education increased significantly (from 11.8 years [95% CI, 11.6-11.9 years] to 12.7 years [95% CI, 12.6-12.9 years]; P < .001) between 2000 and 2012. The decline in dementia prevalence occurred even though there was a significant age- and sex-adjusted increase between years in the cardiovascular risk profile (eg, prevalence of hypertension, diabetes, and obesity) among older US adults.

Conclusions and Relevance  The prevalence of dementia in the United States declined significantly between 2000 and 2012. An increase in educational attainment was associated with some of the decline in dementia prevalence, but the full set of social, behavioral, and medical factors contributing to the decline is still uncertain. Continued monitoring of trends in dementia incidence and prevalence will be important for better gauging the full future societal impact of dementia as the number of older adults increases in the decades ahead.

Sign in to take quiz and track your certificates

Buy This Activity

JN Learning™ is the home for CME and MOC from the JAMA Network. Search by specialty or US state and earn AMA PRA Category 1 CME Credit™ from articles, audio, Clinical Challenges and more. Learn more about CME/MOC

Article Information

Corresponding Author: Kenneth M. Langa, MD, PhD, Division of General Medicine, University of Michigan, 2800 Plymouth Rd, Building 16, Room 430W, Ann Arbor, MI 48109-2800 (klanga@umich.edu).

Accepted for Publication: September 6, 2016.

Published Online: November 21, 2016. doi:10.1001/jamainternmed.2016.6807

Author Contributions: Dr Langa and Mr Kabeto had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Langa, Larson, Faul, Levine, Kabeto, Weir.

Acquisition, analysis, or interpretation of data: Langa, Larson, Crimmins, Faul, Kabeto, Weir.

Drafting of the manuscript: Langa, Kabeto.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Langa, Crimmins, Faul, Kabeto, Weir.

Administrative, technical, or material support: Larson, Faul, Levine, Weir.

Study supervision: Langa, Faul.

Conflict of Interest Disclosures: None reported.

Funding/Support: This work was supported by cooperative agreement U01 AG009740 (Dr Weir) from the National Institute on Aging (NIA), National Institutes of Health. Additional support was provided by grants K23 AG040278 (Dr Levine), P30 AG053760 (Dr Langa), and P30 AG024824 (Dr Langa) from the NIA. The Health and Retirement Study is performed at the Institute for Social Research, University of Michigan, Ann Arbor.

Role of the Funder/Sponsor: Representatives of the NIA reviewed the manuscript but were not directly involved in the collection, management, analysis, or interpretation of the data, or the decision to submit the manuscript for publication.

Disclaimer: The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the NIA or the Department of Veterans Affairs.

References
1.
Plassman  BL, Langa  KM, Fisher  GG,  et al.  Prevalence of dementia in the United States: the aging, demographics, and memory study.  Neuroepidemiology. 2007;29(1-2):125-132.PubMedGoogle ScholarCrossref
2.
Hurd  MD, Martorell  P, Delavande  A, Mullen  KJ, Langa  KM.  Monetary costs of dementia in the United States.  N Engl J Med. 2013;368(14):1326-1334.PubMedGoogle ScholarCrossref
3.
Prince  M, Bryce  R, Albanese  E, Wimo  A, Ribeiro  W, Ferri  CP.  The global prevalence of dementia: a systematic review and meta-analysis.  Alzheimers Dement. 2013;9(1):63-75.Google ScholarCrossref
4.
Larson  EB, Yaffe  K, Langa  KM.  New insights into the dementia epidemic.  N Engl J Med. 2013;369(24):2275-2277.PubMedGoogle ScholarCrossref
5.
Gerstorf  D, Hülür  G, Drewelies  J,  et al.  Secular changes in late-life cognition and well-being: towards a long bright future with a short brisk ending?  Psychol Aging. 2015;30(2):301-310.PubMedGoogle ScholarCrossref
6.
Wu  YT, Fratiglioni  L, Matthews  FE,  et al.  Dementia in western Europe: epidemiological evidence and implications for policy making.  Lancet Neurol. 2016;15(1):116-124.PubMedGoogle ScholarCrossref
7.
Satizabal  CL, Beiser  AS, Chouraki  V, Chêne  G, Dufouil  C, Seshadri  S.  Incidence of dementia over three decades in the Framingham Heart Study.  N Engl J Med. 2016;374(6):523-532.PubMedGoogle ScholarCrossref
8.
Matthews  FE, Arthur  A, Barnes  LE,  et al; Medical Research Council Cognitive Function and Ageing Collaboration.  A two-decade comparison of prevalence of dementia in individuals aged 65 years and older from three geographical areas of England: results of the Cognitive Function and Ageing Study I and II.  Lancet. 2013;382(9902):1405-1412.PubMedGoogle ScholarCrossref
9.
Ogden  CL, Carroll  MD, Kit  BK, Flegal  KM.  Prevalence of childhood and adult obesity in the United States, 2011-2012.  JAMA. 2014;311(8):806-814.PubMedGoogle ScholarCrossref
10.
Ogden  C, Carroll  M. Prevalence of overweight, obesity, and extreme obesity among adults: United States, trends 1960-1962 through 2007-2008. June 2010. http://www.cdc.gov/nchs/data/hestat/obesity_adult_07_08/obesity_adult_07_08.pdf. Accessed August 8, 2016.
11.
Gregg  EW, Li  Y, Wang  J,  et al.  Changes in diabetes-related complications in the United States, 1990-2010.  N Engl J Med. 2014;370(16):1514-1523.PubMedGoogle ScholarCrossref
12.
Federal Interagency Forum on Aging-Related Statistics. Older Americans 2012: Key Indicators of Well-Being. Washington, DC: US Government Printing Office. June 2012. http://www.agingstats.gov/docs/PastReports/2012/OA2012.pdf. Accessed August 8, 2016.
13.
Langa  KM, Larson  EB, Karlawish  JH,  et al.  Trends in the prevalence and mortality of cognitive impairment in the United States: is there evidence of a compression of cognitive morbidity?  Alzheimers Dement. 2008;4(2):134-144.PubMedGoogle ScholarCrossref
14.
Vemuri  P, Lesnick  TG, Przybelski  SA,  et al.  Association of lifetime intellectual enrichment with cognitive decline in the older population.  JAMA Neurol. 2014;71(8):1017-1024.PubMedGoogle ScholarCrossref
15.
Stern  Y, Albert  S, Tang  MX, Tsai  WY.  Rate of memory decline in AD is related to education and occupation: cognitive reserve?  Neurology. 1999;53(9):1942-1947.PubMedGoogle ScholarCrossref
16.
Sonnega  A, Faul  JD, Ofstedal  MB, Langa  KM, Phillips  JW, Weir  DR.  Cohort Profile: the Health and Retirement Study (HRS).  Int J Epidemiol. 2014;43(2):576-585.PubMedGoogle ScholarCrossref
17.
Health and Retirement Study (HRS) Sample Sizes and Response Rates. 2011; http://hrsonline.isr.umich.edu/sitedocs/sampleresponse.pdf. Accessed August 8, 2016.
18.
Crimmins  EM, Kim  JK, Langa  KM, Weir  DR.  Assessment of cognition using surveys and neuropsychological assessment: the Health and Retirement Study and the Aging, Demographics, and Memory Study.  J Gerontol B Psychol Sci Soc Sci. 2011;66(suppl 1):i162-i171.PubMedGoogle ScholarCrossref
19.
Langa  KM, Plassman  BL, Wallace  RB,  et al.  The Aging, Demographics, and Memory Study: study design and methods.  Neuroepidemiology. 2005;25(4):181-191.PubMedGoogle ScholarCrossref
20.
Ofstedal  MB, Fisher  GG, Herzog  AR. Documentation of cognitive functioning measures in the Health and Retirement Study. 2005; http://hrsonline.isr.umich.edu/sitedocs/userg/dr-006.pdf. Accessed August 8, 2016.
21.
Norton  S, Matthews  FE, Barnes  DE, Yaffe  K, Brayne  C.  Potential for primary prevention of Alzheimer’s disease: an analysis of population-based data.  Lancet Neurol. 2014;13(8):788-794.PubMedGoogle ScholarCrossref
22.
Rietveld  CA, Medland  SE, Derringer  J,  et al; LifeLines Cohort Study.  GWAS of 126,559 individuals identifies genetic variants associated with educational attainment.  Science. 2013;340(6139):1467-1471.PubMedGoogle ScholarCrossref
23.
Rietveld  CA, Esko  T, Davies  G,  et al.  Common genetic variants associated with cognitive performance identified using the proxy-phenotype method.  Proc Natl Acad Sci U S A. 2014;111(38):13790-13794.PubMedGoogle ScholarCrossref
24.
Deary  IJ, Yang  J, Davies  G,  et al.  Genetic contributions to stability and change in intelligence from childhood to old age.  Nature. 2012;482(7384):212-215.PubMedGoogle Scholar
25.
Fitzpatrick  AL, Kuller  LH, Lopez  OL,  et al.  Midlife and late-life obesity and the risk of dementia: cardiovascular health study.  Arch Neurol. 2009;66(3):336-342.PubMedGoogle ScholarCrossref
26.
Hughes  TF, Borenstein  AR, Schofield  E, Wu  Y, Larson  EB.  Association between late-life body mass index and dementia: the Kame Project.  Neurology. 2009;72(20):1741-1746.PubMedGoogle ScholarCrossref
27.
Tolppanen  AM, Ngandu  T, Kåreholt  I,  et al.  Midlife and late-life body mass index and late-life dementia: results from a prospective population-based cohort.  J Alzheimers Dis. 2014;38(1):201-209.PubMedGoogle Scholar
28.
Schrijvers  EM, Verhaaren  BF, Koudstaal  PJ, Hofman  A, Ikram  MA, Breteler  MM.  Is dementia incidence declining? trends in dementia incidence since 1990 in the Rotterdam Study.  Neurology. 2012;78(19):1456-1463.PubMedGoogle ScholarCrossref
29.
Qiu  C, von Strauss  E, Bäckman  L, Winblad  B, Fratiglioni  L.  Twenty-year changes in dementia occurrence suggest decreasing incidence in central Stockholm, Sweden.  Neurology. 2013;80(20):1888-1894.PubMedGoogle ScholarCrossref
30.
Christensen  K, Thinggaard  M, Oksuzyan  A,  et al.  Physical and cognitive functioning of people older than 90 years: a comparison of two Danish cohorts born 10 years apart.  Lancet. 2013;382(9903):1507-1513.PubMedGoogle ScholarCrossref
31.
Dodge  HH, Zhu  J, Lee  CW, Chang  CC, Ganguli  M.  Cohort effects in age-associated cognitive trajectories.  J Gerontol A Biol Sci Med Sci. 2014;69(6):687-694.PubMedGoogle ScholarCrossref
If you are not a JN Learning subscriber, you can either:
Subscribe to JN Learning for one year
Buy this activity
jn-learning_Modal_LoginSubscribe_Purchase
If you are not a JN Learning subscriber, you can either:
Subscribe to JN Learning for one year
Buy this activity
jn-learning_Modal_LoginSubscribe_Purchase
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right

Name Your Search

Save Search
With a personal account, you can:
  • Track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
jn-learning_Modal_SaveSearch_NoAccess_Purchase

Lookup An Activity

or

My Saved Searches

You currently have no searches saved.

With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right
Topics
State Requirements