Vad händer med demens i Sverige och globalt? Laura Fratiglioni

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1 Vad händer med demens i Sverige och globalt? Laura Fratiglioni

2 No conflict of interest Acknowledgements Ministry of Health & Social Affair Local Municipalities & Counties Swedish Council for Working Life & Social Research (FORTE) Swedish Research Council (VR) SBP, Private Foundations, etc. EU Cheng Xuan Qiu, Giola Santoni, Mozhu Ding Anders Wimo, Sölve Elmståhl, Johan Berglund

3 American artist William Utermohlen Diagnosed with AD 1995 L Fratiglioni, SNAC Conference, May 2015

4 30 years: five major results 1. The majority of persons affected by AD are very old people 70% of patients with dementia are 75+ years old

5 30 years: five major results 1. The majority of persons affected by AD are very old people 2. Most of dementia cases are mixed cases The UK MRC CFAS (Stephan et al, 2012) The Rush Memory & Aging Project (Schneider et al, Neurology 2007)

6 30 years: five major results 1. The majority of persons affected by AD are very old people 2. Most of dementia cases are mixed cases 3. Importance of life-long exposure to multiple factors L Fratiglioni, SNAC Conference, May 2015

7 30 years: five major results 1. The majority of persons affected by AD are very old people 2. Most of dementia cases are mixed cases 3. Importance of life-long exposure to multiple factors 4. Not all old persons get dementia L Fratiglioni, SNAC Conference, May 2015

8 30 years: five major results 1. The majority of persons affected by AD are very old people 2. Most of dementia cases are mixed cases 3. Importance of life-long exposure to multiple factors 4. Not all old persons get dementia 5. Three possible preventive strategies L Fratiglioni, SNAC Conference, May 2015

9 Preventive strategies against dementia Promoting healthy lifestyles - non-smoking - moderate alcohol intake - physical activity - (diet) Decreasing vascular burden - hypertension - heart disease - diabetes - stroke Increasing brain reserve

10 30 years: five major results 1. The majority of persons affected by AD are very old people 2. Most of dementia cases are mixed cases 3. Importance of life-long exposure to multiple factors 4. Not all old persons get dementia 5. Three possible preventive strategies A: INTERVENTION B: DECLINING INCIDENCE??? L Fratiglioni, SNAC Conference, May 2015

11 Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability A 2-year multi-domain life-style intervention Kivipelto et al., Lancet 2015 Overall cognition (NTB composite Z score) Difference between intervention and control groups (p=0.039)

12 30 years: five major results 1. The majority of persons affected by AD are very old people 2. Most of dementia cases are mixed cases 3. Importance of life-long exposure to multiple factors 4. Not all old persons get dementia 5. Three possible preventive strategies A: INTERVENTION B: DECLINING INCIDENCE??? L Fratiglioni, SNAC Conference, May 2015

13 13 years intervall participants (75+) Kungsholmsprojektet SNAC- Kungsholmen participants (75+)

14 75+ old Swedish urban population: Prevalence of dementia in & Stable prevalence, but also longer survival Decreased incidence Qiu et al, Neurology 2013 Age-specific prevalence per 100

15 Other studies - Trends of dementia occurrence in Europe AGE_adj PREVALENCE PER 100 Stockholm study (75+) Gothenburg study (70) Gothenburg study (75) Zaragoza study (65+) CFAS (65+) Wu, Fratiglioni et al, Lancet Neurol 2015

16 Trends of dementia occurrence Declining incidence USA: Rocca 2011 Europe: Schijvers 2012 Declining disability K Christensen et al, Lancet July Physical and cognitive functioning of people older than 90 years: a comparison of two Danish cohorts born 10 years apart. S Angelman, Stable/declining disability in Stockholm---longer survival only among non disable person

17 Prevalence of dementia in Sweden, : The Swedish National Study on Aging and Care (SNAC) Preliminary results L Fratiglioni, SNAC Conference, May 2015

18 Methods - population Nordanstig 766 participants at baseline 77% participation rate Kungsholmen 3363 participants at baseline 73% participation rate Blekinge 1402 participants at baseline 62% participation rate Skåne 2931 participants at baseline 60% participation rate

19 Preliminary results from SNAC Prevalence of dementia increases with age, and is higher in women than in men Prevalence of dementia declined in older cohorts (age 84+) in Sweden, while remained stable in younger cohorts from 2001 to L Fratiglioni, SNAC Conference, May 2015

20 Dementia risk is decreasing & can be further decreased Aging without dementia may be not only a dream Thank you for you attention