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DEMENTIA A Public Health Priority
Online appendix
Table of contents
1. Methodology for dementia prevalence estimate 2
2. Full list of studies included and excluded from the systematic review of dementia prevalence 4
3. The quality of the studies included in the survey 25
4. Strategies used to generate prevalence estimates within global burden of disease regions 27
5. Methodology for dementia incidence estimate 31
6. Full list of studies included and excluded from the systematic review of dementia incidence 33
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1. Methodology for dementia prevalence estimate We conducted a systematic review of the global literature on the prevalence of dementia (1980‐2009) and
a meta‐analysis to estimate prevalence and numbers affected, aged 60 years and over in 21 Global Burden
of Disease regions.
Search strategy:
We searched PubMed/ Medline databases using the search terms ("Dementia"[Mesh] AND
(("Prevalence"[Mesh]) OR "Epidemiology"[Mesh])).
Inclusion criteria:
Population‐based studies of the prevalence of dementia among people aged 60 years and over (according
to DSM‐IV or ICD‐10 criteria, or similar clinical criteria), for which the field work started on or after 1st
January 1980.
Exclusion criteria:
Studies of prevalence from the follow‐up phase of on an incidence cohort; out‐of‐date population registers
(more than three years prior to the survey); nursing home or residential care populations, primary care
attendees or other unrepresentative service‐user populations; ascertainment based on help‐seeking and/
or receipt of dementia care services; studies where ‘dementia’ was diagnosed purely on the basis of
cognitive impairment; two phase studies, in which screening procedures were inadequate and two phase
methodology was not properly applied; studies of the prevalence of Alzheimer’s disease or other subtypes.
Technical notes:
For China, we relied on a recently published systematic review and meta‐analysis that included both English
language and Chinese publications from 1980‐20041, supplemented with studies published in English and
not included in that meta‐analysis2‐4. All eligible studies were systematically coded for their study design
and quality (sample size, study design, response proportion and diagnostic assessment)
Data extraction:
We extracted, or calculated from data provided, numerators and denominators for each age and gender
group reported.
Meta‐analytical methods for estimating dementia prevalence within regions
Within each GBD region, where there were sufficient data to conduct a meta‐analysis, we used a random
effect exponential (Poisson) model to assess effects of age and sex on dementia prevalence. Age was coded
as the mean for each age group reported. Random effects are assumed to have a gamma distribution – the
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alpha coefficient is an estimate of overdispersion and an index of between study heterogeneity. For each
region we ran two models, one for the effect of age, and one for the main effects of age and sex, and an
interaction between age and sex. We then applied the relevant mean ages and sex codings to the
coefficients estimated from the models, to estimate prevalence in five year age‐bands from 60‐89 years,
and for those aged 90 and over, for both sexes combined (from the age only model), and for men and
women separately (from the age and sex model).
(1) Gurvit H et al. The prevalence of dementia in an urban Turkish population. American Journal of Alzheimer’s Disease and Other Dementias, 2008, 23 (1): 67–76.
(2) World Alzheimer’s Report 2009. London, Alzheimer’s Disease International, 2009.
(3) Molero AE, Pino‐Ramirez G, Maestre GE. High prevalence of dementia in a Caribbean population. Neuroepidemiolog, 2007;29(1‐2):107‐12.
(4) Canadian Study of Health and Ageing. Canadian study of health and aging: study methods and prevalence of dementia. Canadian Medical Association Journal, 1994, 5, 150 (6): 899–913.
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2. Full list of studies included and excluded from the systematic review of dementia prevalence
A. INCLUDED STUDIES Table 1 List of studies included in the review, by global disease of burden region and country
Asia Pacific Paper ID Author (reference) Year District Pubmed ID
Japan 1.1.5 Ueda K1 1992 Hisayama 1595095
Japan 1.1.7 Komahashi T2 1994 Ohiro 7891413
Japan 1.1.10 Ogura C3 1995 Okinawa Prefecture 7635599
Japan 1.1.11 Asada T4 1996 Yamanashi Prefecture 8576504
Japan 1.1.15 Hatada K5 1999 Nagasaki Prefecture 11475427
Japan 1.1.17 Yamada T6 2001 Amino‐cho 11235852
Japan 1.1.18 Ikeda M7 2001 Nakayama 11552014
Republic of Korea 1.2.2 Woo JI8 1998 Yonchon County 9706887
Republic of Korea 1.2.3 Lee DY9 2002 Seoul 12133018
Republic of Korea 1.2.4 Suh GH10 2003 Yonchon County 14511090
Republic of Korea 1.2.5 Kim J11 2003 Busan 12833306
Republic of Korea 1.2.6 Jhoo JH12 2008 Seongnam 18841012
Singapore 1.3.1 Kua EH13 1991 Singapore (Chinese) 1853727
Singapore 1.3.2 Kua EH14 1995 Singapore (Chinese and Malay)
8821351
Asia, East Paper ID Author (reference) Year District Pubmed ID
China 2.2.1 Chen XS15 1987 Beijing 3652848
China 2.2.2 Gao SR16 1989 Beijing .
China 2.2.3 Li G17 1989 Beijing 2788352
China 2.2.4 Zhang MY18 1990 Shanghai 2353798
China 2.2.7 Mao RH19 1993 Longyan .
China 2.2.10 Wang D20 1995 Shanghai .
China 2.2.11 Xue GH21 1997 Guangdong .
China 2.2.12 Li ZJ22 1997 Dongcheng/ Beijing .
China 2.2.13 Chen ZY23 1998 Shihezi/ Xinjiang .
China 2.2.14 Zhang J24 1998 Haidian District/ Beijing 10322700
China 2.2.15 Tang MN25 1999 Sichuan .
China 2.2.16 Gao ZX26 1999 Shanghai .
China 2.2.17 Xiao ZJ27 1999 Furong District/Changsha .
China 2.2.18 Li SR28 1999 Beijing urban .
China 2.2.19 Wang TX29 1999 Anhui province (rural) .
China 2.2.20 Wang W30 2000 Beijing urban 10859498
China 2.2.21 Fan JX31 2000 Nanjing .
China 2.2.22 Zhang ZX32 2000 Baoshan district/ Shanghai
.
China 2.2.23 Tang MN33 2001 Chengdu (rural) .
China 2.2.24 Zhou B34 2001 Shanghai (urban and rural)
11769695
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China 2.2.25 Qu QM35 2001 Xi'an .
China 2.2.26 Zhang GC36 2001 Shanghai .
China 2.2.27 Tang Z37 2002 Beijing (urban and rural) .
China 2.2.28 Zou KL38 2002 Yuzhong/ Chongqing .
China 2.2.29 Li WB39 2003 Inner Mongolia .
China 2.2.30 Zhang ZX40 2005 Beijing; Xian; Shanghai; Chengdu
15767510
China 2.2.321 Llibre Rodrigues J41 2008 Beijing urban 18657855
China 2.2.322 Llibre Rodrigues J41 2008 Beijing rural 18657855
China 2.2.33 Shen YC42 1994 Beijing 8187576
China 2.2.34 Dong MJ43 2007 Systematic Review 17965036
Hong Kong SAR 2.3.1 Chiu HF44 1998 Hong‐Kong 9566386
Taiwan, China 2.1.1 Liu HC45 1995 urban and rural 7836638
Taiwan, China 2.1.2 Liu CK46 1996 Saa‐Min/Kaohsiung City 8961673
Taiwan, China 2.1.3 Liu HC47 1998 Kinmen 9772013
Taiwan, China 2.1.4 Lin RT48 1998 Kaokaoping 9804120
Asia, South Paper ID Author (reference) Year District Pubmed ID
India 3.1.1 Shaji S49 1996 Emakulam (rural) 8773818
India 3.1.2 Rajkumar S50 1997 Madras 9251930
India 3.1.3 Chandra V51 1998 Ballabgarh 9781520
India 3.1.4 Vas CJ52 2001 Mumbai (urban) 12003250
India 3.1.5 Shaji S53 2005 Emakulam (urban) 15684237
India 3.1.71 Llibre Rodriguez J41 2008 Chennai 18657855
India 3.1.72 Llibre Rodriguez J41 2008 Vellore 18657855
Asia, South East Paper ID Author (reference) Year District Pubmed ID
Sri Lanka 4.1.1 de Silva HA54 2003 Ragama 12891639
Thailand 4.2.1 Phanthumchinda k55 1991 Bangkok (urban slum) .
Thailand 4.2.2 Senanarong V56 2000 Bangkok .
Thailand 4.2.4 Wangtongkum S57 2008 Chiang Mai 19127790
Malaysia 4.3.1 Krishnaswamy S58 1997 Kuala Lumpur (urban) .
Australasia Paper ID Author (reference) Year District Pubmed ID
New Zealand 5.1.1 Campbell AJ59 1983 Gisborne 6846087
Australia 5.2.1 Kay DW60 1985 Hobart 4080881
Australia 5.2.3 Henderson AS61 1994 Canberra/ Queanbeyan 8084942
Australia 5.2.4 Smith K62 2008 Kimberley 18799785
Europe, Central Paper ID Author (reference) Year District Pubmed ID
Poland 7.1.4 Gabryelewicz T63 1999 Mokotol 10786235
Poland 7.1.5 Bdzan LB64 2007 Gdansk 17598428
Europe, West Paper ID Author (reference) Year District Pubmed ID
Israel 9.1.2 Bowirrat A65 2001 Wadi Ara 11284991
Israel 9.1.3 Kahana E66 2003 Ashkelon 12700906
France 9.2.1 Obadia Y67 1997 Southeastern ‐ Marseille 9258521
France 9.2.9 Ritchie K68 1994 Aquitaine 8296946
Netherlands 9.3.1 Heeren TJ69 1991 Leiden 2071805
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Netherlands 9.3.2 Ott A70 1995 Ommoord/ Rotterdam 7728032
Netherlands 9.3.5 Thomassen R71 1998 One Dutch town 9443495
Netherlands 9.3.6 Boersma F72 1998 Zwolle 9495684
Netherlands 9.3.7 Blansjaar BA73 2000 Three Dutch Towns 10713579
Sweden 9.4.1 Fratiglioni L74 1991 Stockholm (Kungsholmen)
1745343
Sweden 9.4.2 Skoog I75 1993 Gothenburg 8417380
Sweden 9.4.4 Borjesson‐Hanson A76 2004 Gothenburg 15623723
Sweden 9.4.6 Von Strauss E77 1999 Stockholm 10328254
Germany 9.5.2 Meller I78 1993 Munich 8499498
Germany 9.5.3 Wernicke TF79 1994 Berlin 8309568
Germany 9.5.4 Riedel‐Heller SG80 2001 Leipzig 11532803
Finland 9.6.6 Juva K81 1993 Helsinki 8442392
Denmark 9.7.2 Andersen K82 1997 Odense 9272182
Denmark 9.7.3 Andersen‐Ranberg K83
2001 Nationally Represented 11316833
Spain 9.8.1 Coria F84 1993 Turegano 8410037
Spain 9.8.2 Lobo A85 1995 Zaragoza 7771920
Spain 9.8.3 Manubens JM86 1995 Pamplona 7643949
Spain 9.8.5 Pi J87 1996 Catalunya 8719047
Spain 9.8.6 Vilalta‐Franch J88 2000 Girona 10904947
Spain 9.8.7 Garcia Garcia FJ89 2001 Toledo 11333686
Spain 9.8.9 Gascon‐Bayarri J90 2007 El Prat de Llobregat/ Barcelona
17878737
Spain 9.8.10 Fernandez M91 2008 Mungialde/ Vizcaya 18247280
Spain 9.8.11 Lobo A92 2007 Zaragoza 17803760
Italy 9.9.1 Rocca WA93 1990 Appignano 2320236
Italy 9.9.3 D'Alessandro R94 1996 Troina, Sicily 8982619
Italy 9.9.4 Ferini‐Strambi L95 1997 Vescovato 9085005
Italy 9.9.6 Azzimondi G96 1998 S Agata Militello, Sicily 9701834
Italy 9.9.7 De Ronchi D97 1998 Ravenna 9595968
Italy 9.9.9 Ravaglia G98 1999 Bologna; Ravenna 10430440
Italy 9.9.10 Cristina S99 2001 Pavia 11784344
Italy 9.9.11 Ravaglia G100 2002 Conselice 12145456
Italy 9.9.12 Benedetti MD101 2002 Buttapietra/ Verona 11901276
Italy 9.9.13 Tognoni G102 2005 Tuscany, Vecchiano 16008529
Italy 9.9.15 Prencipe M103 1996 rural villages near L'Aquila
8648328
Italy 9.9.16 Francesconi P104 2006 Tuscany, Dicomano 17176938
Italy 9.9.17 Francesconi P105 2006 Tuscany, Impruneta 17176938
Italy 9.9.18 Francesconi P106 2006 Tuscany, Greve/ Bagno 17176938
Belgium 9.10.1 Roelands M107 1994 Antwerp 8090257
Norway 9.11.1 Engedal K108 1993 Oslo .
San Marino 9.12.1 D'Alessandro R109 1988 San Marino 3255434
United Kingdom 9.13.1 O'Connor DW110 1989 Cambridge 2923012
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United Kingdom 9.13.2 Brayne C111 1989 East Cambridgeshire 2597917
United Kingdom 9.13.3 Livingston G112 1990 London, Gospel Oak 2284396
United Kingdom 9.13.4 Clarke M113 1991 Melton Mowbray 1776585
United Kingdom 9.13.5 Saunders PA114 1993 Liverpool 8282463
United Kingdom 9.13.7 MRC CFAS115 1998 Liverpool, Newcastle, Nottingham, Oxford
9572090
Switzerland 9.14.1 Gostynski M116 2002 Zurich 12512226
North America Paper ID Author (reference) Year District Pubmed ID
Canada 15.1.2 Canadian Study of Health and Aging Working Group117
1994 Nationally representative 8131123
Canada 15.1.4 Newman SC118 1998 Edmonton/ Alberta 9825162
United States of America
15.2.2 Pfeffer RI119 1987 California 3812449
United States of America
15.2.6 Folstein MF120 1991 Baltimore 2071834
United States of America
15.2.10 Hendrie HC121 1995 Indianapolis 7573588
United States of America
15.2.13 Graves AB122 1996 King County/ Washington 8857825
United States of America
15.2.14 Fillenbaum GG123 1998 Piedmont/ North Carolina 9674666
United States of America
15.2.18 Breitner JC124 1999 Cache County/ Utah 10430421
United States of America
15.2.22 Haan MN125 2003 Sacramento Valley/ California
12558712
United States of America
15.2.24 Plassman BL126 2007 Nationally representative 17975326
Oceania Paper ID Author (reference) Year District Pubmed ID
Guam, United States of America
16.1.1 Galasko D127 2007 Indigenous (Chamorros) 17515539
Caribbean Paper ID Author (reference) Year District Pubmed ID
Cuba 6.1.1 Llibre JJ128 1999 Marianao/ Habana 10637837
Cuba 6.1.2 Llibre Rodrigues J41 2008 Havana/ Matanzas 18657855
Cuba 6.1.3 Llibre JJ129 2009 Havana .
Dominican Republic
6.2.1 Llibre Rodrigues J41 2008 Santo Domingo 18657855
Latin America, Andean
Paper ID Author (reference) Year District Pubmed ID
Peru 10.1.11 Llibre Rodrigues J41 2008 Urban ‐ Lima 18657855
Peru 10.1.12 Llibre Rodrigues J41 2008 Rural ‐ Canete 18657855
Peru 10.1.2 Custodio N130 2008 Cercado de Lima .
Latin America, Central
Paper ID Author (reference) Year District Pubmed ID
Venezuela 11.1.1 Molero AE131 2007 Maracaibo 17940342
Venezuela 11.1.2 Llibre Rodrigues J41 2008 Caracas 18657855
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Mexico 11.3.11 Llibre Rodrigues J41 2008 Mexico City 18657855
Mexico 11.3.12 Llibre Rodrigues J41 2008 Rural ‐ Morelos 18657855
Latin America, Southern
Paper ID Author (reference) Year District Pubmed ID
Chile 12.1.1 Albala C132 1997 Concepcion .
Latin America, Tropical
Paper ID Author (reference) Year District Pubmed ID
Brazil 13.1.1 Herrera E Jr133 2002 Catanduva 12040305
Brazil 13.1.2 Scazufca M134 2008 Sao Paulo 17559708
Brazil 13.1.3 Bottino CMC135 2008 Sao Paulo 18843181
North Africa/ Middle East
Paper ID Author (reference) Year District Pubmed ID
Turkey 14.1.3 Gurvit H136 2008 Istanbul 18276959
Egypt 14.2.1 Farrag A137 1998 Assiut 9769445
Sub‐Saharan Afrca, West
Paper ID Author (reference) Year District Pubmed ID
Nigeria 18.1.2 Hendrie HC138 1995 Ibadan 7573588
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B. EXCLUDED STUDIES We provide details of all studies that were considered for inclusion in the review, on the basis of review of the study abstracts, but were not finally included. This was because, either a) on reading the paper, the study was found not to meet inclusion criteria, or b) the study may have, or did meet inclusion criteria, but we were not able to obtain the required prevalence data for the review (‘pending’ papers). This circumstance arose when
i) we could not obtain a copy of the paper, and had only the abstract to go on ii) the required information was not provided in the paper
We have collated information about excluded papers (Table 2) and pending papers (Table 3) separately, by region, country and year of publication. Studies excluded, because they did not meet inclusion criteria Ninety‐eight papers were excluded after detailed review of the publication. The most common reasons for exclusion were; duplicate or overlapping publications (45 publications); the outcome was not a clinical diagnosis of dementia syndrome (21 publications); prevalence estimate from the follow‐up phase of a cohort study (12 publications); data collection pre‐1980 (8 publications); not a population‐based representative sample (5 publications); ascertainment of dementia diagnosis from service contact or registers (4 publications). Some studies were excluded for more than one of these reasons. Table 2 Studies excluded because they did not meet the inclusion criteria, with reasons for exclusion, by region and country
Region/ country First Author Year
of pub.
Reason for exclusion
ASIA
Asia Pacific
Ichinowatari N 1987 Data collection pre‐1980
Ohkuni M 1993 Prevalence estimate in a follow‐up wave of a cohort study
Oshiro H 1994 Not population based ‐ sample was drawn from hospital services
Kiyohara Y 1994 Duplicate publication see study 1.1.5 (Ueda K, et al, 1992)
Kawano H 1990 Duplicate publication see study 1.1.5 (Ueda K, et al, 1992)
Kawano H 1993 Duplicate publication see study 1.1.5 (Ueda K, et al, 1992)
Kiyohara Y 1999 Duplicate publication see study 1.1.5 (Ueda K, et al, 1992)
Kiyohara Y 1994 Duplicate publication see study 1.1.5 (Ueda K, et al, 1992)
Fujishima M 2002 Duplicate publication see study 1.1.5 (Ueda K, et al, 1992) – Incidence study
Wakisaka Y 2003 Duplicate publication see study 1.1.5 (Ueda K, et al, 1992) – Incidence study
Ikeda M 2004 Duplicate publication see study 1.1.18 (Ikeda et al, 2001)
Japan
Meguro K 2002 Duplicate publication see study 1.1.16 (Ishii H, 1999)
Asia, East
Chen CH 1992 Duplicate publication see study 2.1.33 (Shen YC, 1994)
Gao ZH 1993 Duplicate publication see study 2.1.16 (Gao ZX, 1999)
Shen YC 1994 Incidence study
Wang Z 1995 AD only
China
Zhou DF 2006 Prevalence estimate in a follow‐up wave of a cohort study. AD only.
Hong Kong SAR Lam LC 2008 Prevalence of very mild and mild dementia only
Asia South
10
India Das SK 2006 Neurological disorders study with inadequate screening for dementia
Asia, South East
Thailand Jitapunkul S 2001 Diagnosis based on cognitive screening test only
Australasia
Australia Mowry BJ 1988 Not population‐based. Mild dementia only.
EUROPE
Europe, Central
Wender M 1990 Alzheimer’s Disease only
Bidzan L 2005 Study of cognitive functions only and not dementia
Poland
Parnowski T 1993 Validation of MMSE
Hungary Sipos K 2008 Dementia ascertained by MMSE only
Czech Republic Koukolik F 1986
Does not describe research carried out in Czech Republic (EURODEM prevalence applied to Czech population)
Europe, West
Israel Treves T 1986 Early onset AD only. Data collection pre‐1980
Campion D 1999 Early onset AD only
Dartigues JF 1991 Duplicate publication see study 9.2.9 (Ritchie et al, 1994)
Ramaroson H 2003 Prevalence of dementia assessed in a follow‐up phase of a cohort study
Salamon R 1999 Duplicate publication see study 9.2.9 (Ritchie et al, 1994) – descriptive paper
Barberger‐Gateau P
1992 Study of instrumental activities of daily living as screening tool for dementia in the PAQUID sample. Duplicate publication see study 9.2.9 (Ritchie et al, 1994)
Dartigues JF 1992 Duplicate publication see study 9.2.9 (Ritchie et al, 1994) – descriptive paper
Letenneur L 1999 Prevalence of dementia assessed in a follow up phase of a cohort study
Helmer C 2006 Prevalence of dementia assessed in a follow‐up phase of a cohort study
Letenneur 1993 Article in French and difficult to obtain – primary data obtained from (Ritchie et al AJPH, 1994 – study 9.2.9)
France
Gagnon M 1990 Does not report prevalence data (validation only) ‐ see study 9.2.9 (Ritchie et al AJPH, 1994) for primary publication
Eefsting JA 1996 Duplicate publication see study 9.3.6 (Boersma et al JCE,1998) for primary
Boersma F 1997 Duplicate publication study 9.3.6 (Boersma 1998)
Netherlands
Rosso SM 2003 FTD only
Andreasen N 1999 Dementia cases identified only after referral to health services
Grut M 1993 Duplicate publication see study 9.4.1 (Fratiglioni et al, 1991)
Fratiglioni L 1994 Duplicate publication see study 9.4.1 (Fratiglioni et al, 1991)
Von Strauss E 1999 Duplicate publication see study 9.4.1 (Fratiglioni et al, 1991)
Guo Z 1996 Duplicate publication see study 9.4.1 (Fratiglioni et al, 1991)
Forsell Y 1997 Duplicate publication see study 9.4.1 (Fratiglioni et al, 1991)
Aevarsson O 1996 Duplicate publication see study 9.4.2 (Skoog I, 1993)
Sweden
Aevarsson O 1997 Duplicate publication see study 9.4.2 (Skoog I, 1993)
Germany Cooper B 1989 Data collection pre‐1980
11
Molsa PK 1982 Data collection pre‐1980. Ascertainment on the basis of service contact
Sulkava R 1985 Data collection pre‐1980
Juva K 1992 Duplicate publication ‐ see study 9.6.6 (Juva et al Acta N Scand, 1993) for primary data
Kuusisto J 1994 Prevalence from follow‐up phase of cohort study
Finland
Rahkonen T 2003 Lewy Body Dementia only
Lauritzen LU 1996 Dementia ascertained by MMSE only Denmark
Andersen K 2000 Duplicate publication see study 9.7.2 (Andersen K, 1997)
Lopez Pousa S 1995 Apparently a pilot on the same sample as paper 9.8.6 (Vilalta Franch et al)
Lobo A 1992 Duplicate publication see study 9.8.2 (Lobo et a, 1995)
Spain
Sicras A 2005 Dementia case ascertainment from health service contact
Corso EA 1992 Register 9 years out of date (1981 for 1989/1990 survey)
Bonaiuto S 1995 Duplicate publication see study 9.9.1 (Rocca WA, 1990)
Prencipe M 1997 Duplicate publication ‐ see study 9.9.15 (Prencipe JNNP, 1996)
Italy
Baldereschi M 1998 AD prevalence only, by HRT use
Belgium Kurz X 2001 Not population‐based – primary health care consultees only
Norway Engedal K 1988 Duplicate publication ‐ see study 9.11.1 (Engedal et al IJGP, 1993) for primary
Newens AJ 1993 Early onset dementia only
Ratnavalli E 2002 Early onset dementia only
United Kingdom
Harvey RJ 2003 Early onset dementia only
THE AMERICAS
Latin America Central
Colombia Pradilla AG 2003 Neurological disorders study with inadequate screening for dementia
Latin America, Southern
Uruguay Ketzoian C 1997 Neurological disorders study with inadequate screening for dementia
North America
Hogan DB 1995 Duplicate publication see study 15.1.2 (CSHA, 1994)
Erkinjuntti T 1997 Duplicate publication see study 15.1.2 (CSHA, 1994)
Newman SC 1999 Duplicate publication see study 15.1.2 (CSHA, 1994)
Rockwood K 2000 Duplicate publication see study 15.1.2 (CSHA, 1994) Graham JE 1997 Duplicate publication see study 15.1.2 (CSHA, 1994)
Robertson D 1989 Cognitive screening only
Canada
Ebly EM 1994 Duplicate publication – part of the wider CSHA study (see study 15.1.2)
Herbert LE 2003 AD only. Prevalence calculated indirectly from incidence.
Schoenberg BS 1981 Duplicate publication see study 15.2.1 (Schoenberg, 1985)
Fitzpatrick AL 2004 Prevalence estimate in a follow‐up wave of a cohort study.
Schoenberg BS 1985 Data collection pre‐1980. Severe dementia only
Copeland J 1987 Data collection pre‐1980
Kokmen E 1989 Dementia ascertainment based on clinical records. Data collection pre‐1980
Evans DA 1989 AD only
Aronson MK 1991 Prevalence estimate in a follow‐up wave of a cohort study.
Bachman DL 1992 Prevalence estimate in a follow‐up wave of a cohort study.
United States of America
Prineas RJ 1995 Duplicate publication, see study 15.2.19 (Demirovic J, 2003)
12
White L 1996 Prevalence estimate in a follow‐up wave of a cohort study
Holder J 1998 Amish community only. Dubious validity of phase 1 screening procedure.
Albert SM 1999 Not population based and recruitment was based on health care finance administration files and case reporting health system for the elderly
Pressley JC 2003 Comparison of dementia diagnosis based on self‐reported diagnosis, Medicare claims or cognitive screening only
Lopez OL 2003 Prevalence estimate in a follow‐up wave of a cohort study.
Corrada MM 2008 Prevalence estimate in a follow‐up wave of a cohort study.
AFRICA
West Africa
Gureje O 2006 Duplicate publication see study 18.1.2 (Hendrie et al, 1995)
Baker FM 1995 Duplicate publication see study 18.1.2 (Hendrie et al, 1995)
Nigeria
Ogunniyi A 1997 Duplicate publication see study 18.1.2 (Hendrie et al, 1995)
North Africa/ Middle East
Harmanci H 2003 Duplicate publication see study 14.1.3 (Gurvit H, 2008) Turkey
Keskinoglu P 2006 Dementia ‘diagnosis’ by MMSE cutpoint only
13
‘Pending’ studies Twenty studies were potentially eligible, but could not be used in this review. In three cases we were not able to obtain the publication referred to in the abstract. In one case, a prevalence study appeared to have been conducted, but we were not able to identify the index publication containing prevalence data. In one case we were not able to determine eligibility from information contained in the publication. For the remaining 15 studies, the data presented was not in the form that allowed us to extract and use it, usually because no age‐specific estimates were provided. In all of thee cases we have attempted to contact authors for further information. Table 3 List of ‘Pending’ studies (potentially eligible studies, but data could not be used in the review), by region and country
Region/ country Study code
First Author Year of pub.
Reason for inability to use data
ASIA
Asia Pacific
1.1.16 Ishii H 1999 ‘Analysis 3’ may be eligible as a very small subsample survey with extensive clinical ascertainment. Otherwise dementia diagnosed on the basis of cognitive impairment only. More information needed on sampling (representativeness)
1.1.1 Shibayama H 1986 Overall prevalence estimates only; neither age‐ nor gender‐ specific prevalence provided
1.1.3 Mutou T 1989 Overall prevalence estimates only; neither age‐ nor gender‐ specific prevalence provided
1.1.4 Fukunishi I 1989 Overall prevalence estimates only; neither age‐ nor gender‐ specific prevalence provided
1.1.12 Nakajima K 1998 Overall prevalence estimates only; neither age‐ nor gender‐ specific prevalence provided
1.1.13 Urakami K 1998 Overall prevalence estimates only; neither age‐ nor gender‐ specific prevalence provided
Japan
1.1.14 Shiba M 1999 Overall prevalence estimates only; neither age‐ nor gender‐ specific prevalence provided
Republic of Korea
1.2.1 Kim E 1993 Have not been able to obtain publication
EUROPE
Europe, Central
Poland 7.1.3 Rossa G 1997 Insufficient information to extract data.
Albania 7.4.1 Kruja J 2002 Have not been able to obtain publication
Europe, East
Russian Federation
8.1.1 Gavrilova SI 1987 Have not been able to obtain publication
Europe, West
Israel 9.1.4 Wertman E 2007 Insufficient information to estimate precision. No numerators, denominators, 95% CI or SE
Netherlands 9.3.4 Schmand B 1997 AMSTEL study. Prevalence survey apparently conducted, but no prevalence publication yet identified
Sweden 9.4.5 Wancata J 2007 Overall prevalence estimates only; neither age‐
14
nor gender‐ specific prevalence provided
Italy 9.9.19 Italian Longitudinal Study on Aging Working Group
1997 Overall prevalence estimates only; neither age‐ nor gender‐ specific prevalence provided .
THE AMERICAS
North America
15.2.8 Heyman A 1991 Overall prevalence estimates by gender only; no age‐specific prevalence provided
15.2.17 Gurland BJ 1999 Overall prevalence estimates by gender only; no age‐specific prevalence provided
United States of America
15.2.19 Demirovic J 2003 Overall prevalence estimates by gender only; no age‐specific prevalence provided
AFRICA
Sub‐Saharan Africa, West
Nigeria 18.1.1 Ogunniyi AO 1992 Overall prevalence estimates only; neither age‐ nor gender‐ specific prevalence provided
Sub‐Saharan Africa, South
South Africa 17.1.1 Ben‐Arie O 1983 Overall prevalence estimates only; neither age‐ nor gender‐ specific prevalence provided
15
Reference List (included studies only)
(1) Ueda K, Kawano H, Hasuo Y, Fujishima M. Prevalence and etiology of dementia in a Japanese community. Stroke. 1992;23:798‐803.
(2) Komahashi T, Ohmori K, Nakano T et al. Epidemiological survey of dementia and depression among the aged living in the community in Japan. Japanese Journal of Psychiatry & Neurology. 1994;48:517‐526.
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3. The quality of the studies included in the survey a. Study design. 70% of dementia prevalence studies used two or more phases. Unfortunately, most did not
sample screen negatives, and those that did often did not weight back appropriately. For 79% of multiphase
studies (49% of all studies) the design was not correctly applied and/ or analysed appropriately.
b. Scope of diagnostic assessment. Dementia diagnosis requires cognitive impairment (and decline) in
memory and other domains of intellectual function, with consequent social or occupational impairment.
Other causes including psychosis, depression and delirium should be excluded. Only 43% of studies
included multidomain cognitive testing, disability assessment, clinical interview and informant interview.
Informant interviews were most likely to be omitted.
c. Sample size. A study of 500 participants could estimate a true prevalence of 6% with a precision of +/‐
2.1%. Precision increases to +/‐ 1.2% for a sample size of 1500 and to +/‐ 0.8% for a sample size of 3000.
Most studies had sample sizes smaller than 1500. Nearly a third of Western European studies had sample
sizes smaller than 500. Sample sizes tended to be larger in East Asia and in LMIC studies generally.
d. Response proportion. Participation in studies of dementia prevalence was generally adequate to good;
only six studies (4%) reported fewer than 60% of eligible participants responding, while more than half
reported 80% or more responding. However, 15% of studies did not report response rates.
e. Overall quality. Mean scores for the ad hoc quality index varied significantly between regions. Overall study quality was high for the Latin American region, and particularly poor for Asia Pacific High Income and South East Asia studies. Study quality did not differ significantly between HIC and LMIC. Study had improved over time – from a mean of 7.3 for studies conducted in the 1980s, to 7.8 for the 1990s, to 9.0 for studies conducted this century.
Prevalence study characteristics, by region (for those regions within which meta‐analyses were conducted), and by country income level
Europe North America
Latin America and Caribbean
Asia Pacific High Income
Australasia
Asia, East
Asia, South
Asia, South East
High‐ income countries
Low‐ and middle‐ income countries
All regions
Number of studies1
51 13 15 20 4 34 7 5 93 64 157
Year of research
1980‐1989 13 (26%)
3 (23%) 0 7 (35%) 2 (50%) 5 (15%) 0 1 (20%) 25 (27%)
8 (13%) 33 (21%)
1990‐1999 34 (67%)
9 (69%) 3 (20%) 10 (50%)
1 (25%) 25 (74%)
4 (57%) 2 (40% 59 (63%)
32 (50%)
91 (58%)
After 2000 4 (8%) 1 (8%) 12 (80%)
3 (15%) 1 (25%) 4 (12%) 3 (43%) 2 (40%) 9 (10%) 24 (38%)
33 (21%)
Sample size
<500 16 (31%)
0 0 3 (16%) 2 (50%) 0 1 (14%) 1 (20%) 21 (23%)
3 (5%) 24 (16%)
500‐1499 19 (37%)
4 (31%) 5 (36%) 7 (37%) 2 (50%) 10 (29%)
3 (43%) 4 (80%) 34 (37%)
24 (38%)
58 (37%)
1500‐2999 9 (18%) 5 (39%) 8 (57%) 5 (26%) 0 10 (29%)
2 (29%) 0 21 (23%)
22 (34%)
43 (28%)
>=3000 7 (14%) 4 (31%) 1 (7%) 4 (21%) 0 14 1 (14%) 0 16 15 31
26
(41%) (17%) (23%) (20%)
Outcome
ICD‐10 1 (2%) 0 (0%) 0 1 (5%) 0 1 (7%) 1 (14%) 0 3 (3%) 2 (5%) 5 (4%)
DSM‐IV/ IIIR 37 (73%)
9 (69%) 8 (53%) 17 (85%)
2 (67%) 10 (71%)
4 (57%) 4 (80%) 69 (75%)
25 (60%)
94 (70%)
GMS/ AGECAT 2 (4%) 1 (8%) 0 0 (0%) 0 0 0 (0%) 1 (20%) 3 (3%) 1 (2%) 4 (3%)
CAMDEX 6 (12%) 0 (0%) 0 0 (0%) 0 0 0 0 6 (7%) 1 (2%) 7 (5%)
Other 5 (10%) 3 (23%) 7 (47%) 2 (10%) 1 (33%) 3 (21%) 2 (29%) 0 11 (12%)
13 (31%)
24 (18%)
Design
One phase 16 (31%)
2 (15%) 10 (67%)
3 (15%) 3 (75%) 3 (21%) 3 (43%) 0 25 (27%)
16 (36%)
41 (30%)
Two or more phases
36 (69%)
11 (85%)
5 (33%) 17 (85%)
1 (25%) 11 (89%)
4 (57%) 5 (100%)
69 (73.%)
20 (46%)
97 (70%)
Multiphase design applied and analysed correctly 2
22% 55% 20% 12% 100% 9% 0% 0% 25% 11% 21%
Response proportion
<60% 5 (10%) 0 0 0 0 0 0 0 5 (5.3%) 1 (2%) 6 (4%)
60‐79% 16 (31%)
6 (46%) 2 (13%) 3 (15%) 2(50%) 4 (29%) 1 (14%) 1 (20%) 29 (31%)
8 (18%) 37 (27%)
80‐100% 28 (54%)
5 (39%) 10 (67%)
10 (50%)
2 (50%) 10 (71%)
5 (71%) 1 (20%) 48 (51%)
26 (59%)
74 (54%)
Not specified 3 (6%) 2 (15%) 3 (20%) 7 (35%) 0 0 1 (14%) 3 (60%) 12 (13%)
9 (21%) 21 (15%)
Assessment quality
Comprehensive diagnostic assessment 3
28 (55%)
5 (39%) 11 (73%)
2 (10%) 0 4 (31%) 3 (43%) 1 (20%) 36 (39%)
21 (51%)
57 (43%)
Overall quality score 4
Mean (SD) 8.2 (1.8)
8.2 (1.7)
9.7 (2.0)
6.6 (1.6)
8.3 (0.9)
8.0 (1.9)
8.4 (2.2)
5.5 (0.7)
7.8 (1.8)
8.3 (2.5)
7.9 (2.0)
1. These numbers differ from the totals listed elsewhere, as we were not able to ascertain some or all
study characteristics for some of the ‘pending’ studies, about which we were seeking further information from authors. Also full details on methodology were not available from several of the Chinese language publications, summarised in a previous published meta‐analysis1
2. As a proportion of all studies using a multiphase design (i.e. with two or more phases, with screening performed on all in the first phase, and definitive diagnostic assessment on a sub‐sample based on screening score)
3. Defined as a multidomain cognitive battery, an informant interview, a formal assessment of disability, and a clinical interview
4. Derived from sample size, design, response proportion and assessment quality (see text for details)
(1) Dong MJ et al. The prevalence of dementia in the People's Republic of China: a systematic analysis of
1980–2004 studies. Age and Ageing, 2007, 36 (6): 619–264.
27
4. Strategies used to generate prevalence estimates within global burden of disease regions
Table 1 Strategies used within regions in which it was possible to carry out a quantitative meta‐analysis
GBD Region Countries (those with one or more studies underlined)
Relationship to WHO regions used for ADI/ Lancet estimates
Approach used to generate regional prevalence and numbers
ASIA
Asia Pacific, High Income
Brunei Darussalam, Japan, Republic of Korea, Singapore
WPRO A except for Republic of Korea (WPRO B)
Apply estimates from meta‐analysis.
Asia, East
China, (including Hong Kong Special Administrative Region and Taiwan), Democratic People’s Republic of Korea
WPRO B except for Democratic People’s Republic of Korea (SEARO D)
Apply estimates from meta‐analysis.
Asia, South
Afghanistan, Bangladesh, Bhutan, India, Nepal, Pakistan
SEARO D except for Afghanistan and Pakistan (EMRO D)
Apply estimates from meta‐analysis.
Asia, Southeast
Cambodia, Christmas Island, Cocos Islands, Indonesia, Lao People's Democratic Republic, Malaysia, Maldives, Mauritius, Myanmar, Philippines, Reunion, Seychelles, Sri Lanka, Thailand, Timor‐Leste, Viet Nam
Mainly SEARO B and WPRO B.
Apply estimates from meta‐analysis.
Australasia Australia, New Zealand WPRO A Apply estimates from meta‐analysis.
EUROPE
Europe, Western
Akrotiri and Dhekelia, Aland Islands, Andorra, Austria, Belgium, Channel Islands, Cyprus, Denmark, Faeroe Islands, Finland, France, Germany, Gibraltar, Greece, Greenland, Holy See, Iceland, Ireland, Isle of Man, Israel, Italy, Jersey, Liechtenstein, Luxembourg, Malta, Monaco, Netherlands, Norway, Portugal, San Marino, Spain, Svalbard, Sweden, Switzerland, United Kingdom
EURO A Apply estimates from meta‐analysis.
THE AMERICAS
North America
Canada, Saint Pierre et Miquelon, United States of America
AMRO A Conduct meta‐analysis for United States of America. Apply CSHA data for Canada, then aggregate
Latin America, Andean
Bolivia, Ecuador, Peru
AMRO D
Latin America, Central
Colombia, Costa Rica, El Salvador, Guatemala, Honduras, Mexico, Nicaragua, Panama, Venezuela
AMRO B except for Guatemala and Nicaragua
Apply estimates from meta‐analysis conducted across all four regions. There were insufficient studies in any of the
28
(AMRO D)
Latin America, Southern
Argentina, Chile, Falkland Islands (Malvinas), Uruguay
AMRO B
Latin America, Tropical
Brazil, Paraguay AMRO B
individual regions. Our judgment was that compositional and contextual variation was unlikely to be marked, and the heterogeneity observed in the meta‐analysis was less than for any other GBD region.
List is relevant as of January 2009.
29
Table 2 ‐ Strategies used within regions in which it was not possible to carry out a quantitative meta‐analysis
Region Countries (those with one or more studies underlined)
Relationship to WHO regions used in ADI/ Lancet
Approach
ASIA
Asia, Central
Armenia, Azerbaijan, Georgia, Kazakhstan, Kyrgyzstan, Mongolia, Tajikistan, Turkmenistan, Uzbekistan
EURO B, except for Kazakhstan (EURO C)
Apply relevant Lancet/ ADI estimates to each country and aggregate
Oceania American Samoa, Cook Islands, Fiji, French Polynesia, Guam, Kiribati, Marshall Islands, Micronesia, Nauru, New Caledonia, Niue, Norfolk Island, Northern Mariana Islands, Palau, Papua New Guinea, Pitcairn, Samoa, Solomon Islands, Tokelau, Tonga, Tuvalu, Vanuatu, Wallis and Futuna Islands
WPRO B Data from one study in Guam only (indigenous Chamorros islanders. Therefore use Lancet/ ADI WPRO B for all countries
EUROPE
Europe, Central
Albania, Bosnia and Herzegovina, Bulgaria, Croatia, Czech Republic, Hungary, Montenegro, Poland, Romania, Serbia, Slovakia, Slovenia, The former Yugoslav Republic of Macedonia
EURO B, except for Croatia, Czech Republic and Slovenia (EURO A)
Apply relevant Lancet/ ADI estimates to each country and aggregate
Europe, Eastern
Belarus, Estonia, Latvia, Lithuania, Republic of Moldova, Russian Federation, Ukraine
EURO C Apply Lancet/ ADI EURO C estimates
THE AMERICAS
Caribbean Anguilla, Antigua and Barbuda, Aruba, Bahamas, Barbados, Belize, Bermuda, British Virgin Islands, Cayman Islands, Cuba, Dominica, Dominican Republic, French Guiana, Grenada, Guadeloupe, Guyana, Haiti, Jamaica, Martinique, Montserrat, Netherlands Antilles, Puerto Rico, Saint Barthelemy, Saint Kitts and Nevis, Saint Lucia, Saint Vincent and the Grenadines, Suriname, Trinidad and Tobago, Turks and Caicos Islands, US Virgin Islands
AMRO B, other than Haiti (AMRO D) and Cuba (AMRO A)
Use 10/66 Cuba and Dominican Republic prevalence for those countries. Apply relevant Lancet/ ADI estimates to other countries and aggregate
AFRICA
North Africa / Middle East
Algeria, Bahrain, Egypt, Iran, Iraq, Jordan, Kuwait, Lebanon, Libya, Morocco, Occupied Palestinian Territory, Oman, Qatar, Saudi Arabia, Syrian Arab Republic, Tunisia, Turkey, United Arab Emirates, Western Sahara, Yemen
EMRO B, except for Egypt, Iraq, Morocco and Yemen (EMRO D), Algeria (AFRO D) and Turkey (EURO B)
Apply Turkey study estimates to Turkey. Apply Egypt study estimates to Egypt and other EMRO D countries. Apply relevant Lancet/ ADI estimates to other countries and
30
aggregate
Sub‐Saharan Africa, Central
Angola, Central African Republic, Congo, Democratic Republic of the Congo, Equatorial Guinea, Gabon
A mixture of AFRO D and AFRO E
Apply relevant Lancet/ ADI estimates to each country and aggregate
Sub‐Saharan Africa, East
Burundi, Comoros, Djibouti, Eritrea, Ethiopia, Kenya, Madagascar, Malawi, Mayotte, Mozambique, Rwanda, Somalia, Sudan, Uganda, United Republic of Tanzania, Zambia
AFRO E except for Comoros (AFRO D) and Somalia and Sudan (EMRO D)
Apply relevant Lancet/ ADI estimates to each country and aggregate
Sub‐Saharan Africa, Southern
Botswana, Lesotho, Namibia, South Africa, Swaziland, Zimbabwe
AFRO E
Apply Lancet/ ADI AFRO E estimates
Sub‐Saharan Africa, West
Benin, Burkina Faso, Cameroon, Cape Verde, Chad, Côte d'Ivoire, Gambia, Ghana, Guinea, Guinea‐Bissau, Liberia, Mali, Mauritania, Niger, Nigeria, Saint Helena, Sao Tome and Principe, Senegal, Sierra Leone, Togo
AFRO D Apply Nigeria (Hendrie) prevalence estimates to all countries in this region
List is relevant as of January 2009.
31
5. Methodology for dementia incidence estimate
We conducted a systematic review of the global literature on the incidence of dementia (1980‐2011) and a
meta analysis to estimate the incidence and numbers of new cases, aged 60 years and over in 21 Global
Burden of Disease regions.
Search strategy: We updated a search conducted in 2009 for the revision of the Global Burden of Disease
report to 15th November 2011, using PubMed/ Medline databases and the following search terms ‐
("Dementia"[Mesh] AND (("Incidence"[Mesh]) OR "Epidemiology"[Mesh])).
Inclusion criteria: Population‐based studies of the incidence of dementia among people aged 60 years and
over (according to DSM‐IV or ICD‐10 criteria, or similar clinical criteria), for which the baseline cohort
recruitment started on or after 1st January 1980.
Exclusion criteria: Studies of incidence from the follow‐up phase of on an incidence cohort; out‐of‐date
population registers (more than three years prior to the survey); nursing home or residential care
populations, primary care attendees or other unrepresentative service‐user populations; ascertainment
based on help‐seeking and/ or receipt of dementia care services; studies where ‘dementia’ was diagnosed
purely on the basis of cognitive impairment; two phase studies, in which screening procedures were
inadequate and two phase methodology was not properly applied; studies of the incidence of Alzheimer’s
disease or other subtypes.
Technical notes: Five potentially eligible studies had to be excluded, because case (numerator) and person
years (denominator) data could not be extracted1‐5.
Data extraction: We extracted, or attempted to calculate from the data provided, number of incident cases
and person years denominators for each age group reported.
Meta‐analytical methods for estimating dementia prevalence within regions
As for the meta‐analysis of prevalence data we used a random effect exponential (Poisson) model to assess
the effect of age on the incidence of dementia. We conducted separate meta‐regressions on all studies
combined, and then separately for HIC, LMIC, and for regions where there was sufficient data to attempt a
meta‐analysis (Western Europe, North America and Latin America and the Caribbean combined). We then
applied relevant mean ages to the coefficients estimated from the models, to estimate incidence in five
year age‐bands from 60‐95 years, and for those aged 95 and over. We further estimated the effect of
region and of HIC vs. LMIC location.
Estimating numbers of incident cases for each GBD world region
We estimated the numbers of annual incident cases by first estimating the numbers at risk (total
population in each age group, minus numbers with prevalent dementia), and then by applying the
appropriate annual incidence rate (we used the Western Europe rate for the European regions, the North
American rate for the North American region and the Latin American rate for the Latin American and
Caribbean regions, and the HIC or LMIC rates as appropriate for other regions).
32
(1) Acosta et al. The epidemiology of dependency among urban‐dwelling older people in the Dominican Republic; a cross‐sectional survey. BMC Public Health, 2008, 8: 285.
(2) Kokmen E et al. Prevalence of medically diagnosed dementia in a defined United States population: Rochester, Minnesota, January 1, 1975. Neurology, 1989, 39 (6): 773–776.
(3) Ott A et al. Prevalence of Alzheimer's disease and vascular dementia: association with education. The Rotterdam study. British Medical Journal, 1995, 310 (6985): 970–973.
(4) Knapp M, Prince M. Dementia UK – A report into the prevalence and cost of dementia prepared by the Personal Social Services Research Unit (PSSRU) at the London School of Economics and the Institute of Psychiatry at King's College London, for Alzheimer's Society. London, Alzheimer's Society, 2007.
(5) Ratnavalli E et al. The prevalence of frontotemporal dementia. Neurology, 2002, 58 (11): 1615–1621.
33
6. Full list of studies included and excluded from the systematic review of dementia incidence
A. INCLUDED STUDIES Table 1 – List of studies included in the review, by region and country
Study Setting Country Mid‐year of baseline survey
Follow‐up
period
Lower age limit
Criterion Institutions included in sampling?
Cohort at risk
Person years
Western Europe
1. Odense study; Andersen et al 1999 (1)
Odense Denmark Not given
65 DSM‐III‐R Yes 3086 4916
2. Helsinki; Polvikoski et al 2006 (2)
Vantaa Finland 1991 Up to 10 years
85 DSM‐III‐R Not stated 328 1242
3. PAQUID; Letenneur et al 1999 (3)
Gironde and Dordogne
France 1987 5.0 65 DSM‐III‐R No 3675 11989
4. LEILA 75+; Riedel‐Heller et al, 2001 (4)
Leipzig Germany 1997 1.6 75 ICD10 and DSM‐III‐R
Yes 1187 1310
5. Munich; Fichter et al 1996 (5)
Munich Germany 1990‐1991
85 DSM‐III‐R Not stated 358 181
6. ILSA; Di et al, 2002 (6)
Genoa, Segrate, Selvazzano‐Rubia, Impruneta, Fermo, Naples, Casamassima, and Catania
Italy 1992 3 65 DSM‐III‐R Yes 3208 9524
7. Conselice; Ravaglia et al 2005 (7)
Conselice Italy 1999 4 65 DSM‐IV Not stated
937 3044
8. Leiden; Gussekloo et al 1995 (8)
Leiden Netherlands
1986 4.1 85 DSM‐III Yes 618 808
9. Rotterdam study;Ott et al, 1998 (9)
Rotterdam Netherlands
1991 2.1 55 DSM‐III‐R Yes 7046 15135
10. NEDICES; Bermejo‐Pareja et al 2008 (10)
Las Margaritas, Lista, Arevalo
Spain 1994 3.2 65 DSM‐IV Not stated
4972 12552
11. Girona cohort study; Lopez‐Pousa et al 2004 (11)
Girona Spain 1990‐1995
80 DSM‐III‐R 1260 5257
12. ZARADEMP; Lobo et al, 2011 (12)
Zaragoza Spain 1994 4.5 55 DSM‐IV 15353
13. Kungsholmen project; Fratiglioni et al 1997 (13)
Kungsholmen Sweden 1987 3.0 75 DSM‐III‐R Yes 1473 3697
14. MRC Alpha; Copeland et al 1999(14)
Liverpool United Kingdom
1989 65 ICD‐10 Yes 4778 7202
15. Cambridge; Cambridge United 1986 2.4 75 DSM‐III‐R Yes 1778 2809
34
Paykel et al 1994 (15)
Kingdom
16. MRC CFA Study; Matthews et al, 2005 (16)
Cambridgeshire, North Wales, Nottingham, Newcastle, Oxford
United Kingdom
1992 2 65 DSM‐III‐R Yes 17627
North America
1,2. EPESE; Fillenbaum et al 1998 (17)
Piedmont county, North Carolina. White and African American sub‐samples
United States of America
1986 3 65 DSM‐IV No 4136 6867
3. Cache County study; Miech et al, 2002 (18)
Cache County, Utah
United States of America
1995 3 65 DSM‐III‐R Not stated 4614 10541
4. The 90+ study (19)
Laguna Woods, California
United States of America
2003 2.3 90 DSM‐IV Yes 330 769
5. Canadian Study of Health and Aging; Canadian Study of Health and Aging Working Group, 2000 (20)
Nationally representative
Canada 1991 5.0 65 DSM‐III‐R Yes, but excluded for this analysis
7733 27352
Latin America
1. Brazil; Nitrini et al, 2004 (21)
Catanduva, Sao Paulo
Brazil 1997 3.3 65 DSM‐IV Not stated 1538 3649
2. 10/66 Cuba Havana, Matanzas
Cuba 2004 4.5 65 10/66 Dementia/ DSM‐IV
No 2517 8679
3. 10/66 Dominican Republic
Santo Domingo Dominican Republic
2005 5.1 65 10/66 Dementia/ DSM‐IV
No 1769 5561
4. 10/66 Peru Lima, Canete Peru 2005 2.9‐3.7 65 10/66 Dementia/ DSM‐IV
No 1767 3913
5. 10/66 Mexico Mexico City, Morelos
Mexico 2006 3.0 65 10/66 Dementia/ DSM‐IV
No 1823 4164
6. 10/66 Venezuela Caracas Venezuela 2005 4.3 65 10/66 Dementia/ DSM‐IV
No 1820 5269
Australasia
1. Sydney Older Persons Study; Waite et al 2001 (22)
Sydney Australia 1992 3.2 75 DSM‐IV No 383 1052
East Asia
1. Beijing; Li et al 2007 (23)
Beijing China 1997 2.0 60 ICD10/ DSM‐IV
No 1553 2781
2. Beijing; Li et al 1991 (24)
Beijing China 1986 3.0 70 DSM‐III No 825 2309
3. 10/66 China Xicheng, Daxin China 2004 5.0 65 10/66 Dementia/ DSM‐IV
No 2022 7109
35
4. Taiwan, China; Liu et al, 1998 (25)
Kaohsiung, Pingtung
Taiwan, China
Not given
2.0 65 ICD‐10NA No 2807 4679
Asia Pacific
1. Yonchon County Survey; Lee et al 2008 (26)
Yonchon County
Republic of Korea
1996 7.0 65 DSM‐III‐R 658 3526
Sub‐Saharan Africa (West)
1. Ibadan Study of Aging (27)
Ibadan Nigeria 2004 3.3 65 Clinical/ NS
No 1225 3890
36
B. EXCLUDED STUDIES Table 2 ‐ List of ‘Pending’ studies Potentially eligible studies had to be excluded, because case (numerator) and person years (denominator) data could not be extracted (28‐32).
Study Setting Country West Europe
Rural Cambridgeshire study Brayne et al 1997 (31)
Rural Cambridgeshire United Kingdom
The MRC Alpha Study Copeland et al, 1999 (32)
Liverpool United Kingdom
North America
United States of America / Nigeria study Hendrie et al 2001 (30)
Indianapolis United States of America
Manitoba Study of Health and Aging Tyas et al, 2006 (29)
Manitoba Canada
Asia Pacific
Hisayama Study Fujishima et al 2002 (28)
Hisayama Japan
Sub‐Saharan Africa West
United States of America / Nigeria study Hendrie et al 2001 (30)
Ibadan Nigeria
37
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