Clinical Epidemiology (Sep 2018)
Is dementia incidence declining in high-income countries? A systematic review and meta-analysis
Abstract
Susanne Roehr,1,2,* Alexander Pabst,1,* Tobias Luck,3 Steffi G Riedel-Heller1 1Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Leipzig, Germany; 2LIFE – Leipzig Research Center for Civilization Diseases, University of Leipzig, Leipzig, Germany; 3Department of Economic and Social Sciences, Institute of Social Medicine, Rehabilitation Sciences and Healthcare Research (ISRV), University of Applied Sciences Nordhausen, Nordhausen, Germany *These authors contributed equally to this work Purpose: To perform a systematic review and quantitative synthesis of studies on recent trends in dementia incidence in high-income countries (HIC), considering study quality.Methods: PubMed and Web of Science were searched for eligible studies, that is, population-based/community-based prospective cohort studies investigating dementia incidence with similar methods over time, published after 1990. Study selection, data extraction, and quality assessment were performed independently by two investigators. Random-effect meta-analysis and meta-regression were used to estimate incidence change (IC) and to explore associations with study attributes. PRISMA standards were followed.Results: The systematic review included seven studies (42,485 individuals), and the meta-analysis included five studies of sufficient quality. Relating dementia incidence of later cohorts to earlier cohorts (reference) yielded a nonsignificant decrease across HIC (IC =0.82; 95% CI 0.51–1.33), with high heterogeneity (I²=94.9%, P<0.001) and without publication bias (Egger’s t=–1.77; P=0.18). Excluding the Japanese Hisayama study, the only study suggesting an increase, indicated borderline evidence for a decrease across Western HIC (IC =0.69; 95% CI 0.47–1.00; I²=88.1%, P<0.001; Egger’s t=–0.34, P=0.77), again with high heterogeneity. Meta-regression did not reveal an association of incidence rate with calendar year or study attributes; however, analyses were low powered.Conclusion: There is evidence of favorable trends in dementia incidence in Western HIC (stabilizing/decreasing). Reverse trends may occur in HIC of other regions, as exemplified by Japan. However, study number was small and heterogeneity was high. Further cohort studies using consistent methods are needed to draw definite conclusions. Our work may inform such future studies. Keywords: dementia, Alzheimer’s disease, cohort study, incidence, trends, epidemiology
