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Dementia and ‘borderline dementia’ in Britain: 8-year incidence and post-screening outcomes

Published online by Cambridge University Press:  09 July 2009

D. Clarke
Affiliation:
Department of Health Care of the Elderly, The Medical School, University of Nottingham
K. Morgan*
Affiliation:
Department of Health Care of the Elderly, The Medical School, University of Nottingham
J. Lilley
Affiliation:
Department of Health Care of the Elderly, The Medical School, University of Nottingham
T. Arie
Affiliation:
Department of Health Care of the Elderly, The Medical School, University of Nottingham
R. Jones
Affiliation:
Department of Health Care of the Elderly, The Medical School, University of Nottingham
J. Waite
Affiliation:
Department of Health Care of the Elderly, The Medical School, University of Nottingham
R. Prettyman
Affiliation:
Department of Health Care of the Elderly, The Medical School, University of Nottingham
*
1Address for correspondence: Dr Kevin Morgan, Department of Health Care for Elderly People, University of Sheffield, Community Sciences Centre, Northern General Hospital, Sheffield S5 7AU.

Synopsis

Survivors from a nationally representative sample of elderly people originally screened in 1985 were reassessed in 1989 and again in 1993. On each occasion respondents were rated as cognitively impaired, borderline impaired or unimpaired (using a brief information/orientation scale), with the validity of these ratings assessed in subsequent clinical interviews. Where follow-up screening was not possible, information was derived from death certificates and hospital case-notes. Over 8 years (1985–93) the overall incidence rate per person–year at risk was 1·58%, giving age-specific rates of 0·72, 1·32, 1·63, 3·46, 2·55 and 1·41% for the age groups 65–69, 70–74, 75–79, 80–84, 85–89 and ≥ 90 respectively. Of 43 individuals classified at screening as borderline impaired in 1985 and 1989, 19 were diagnosed as demented at clinical interviews conducted within 16 weeks of screening. Four-year follow-ups among the remaining 24 showed that 15 had died, while 6 showed a worsened cognitive status. Controlling for both age and sex, aggregated 4-year mortality was significantly higher among those defined at screening in 1985 and 1989 as either impaired or borderline, when compared with the unimpaired.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 1996

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References

REFERENCE

Bergmann, K., Kay, D. W., Foster, E. M., McKechnie, A. A. & Roth, M. (1971). A follow-up study of randomly selected community residents to assess the effects of chronic brain syndrome and cerebrovascular disease. In Excerpta Medica International Congress Series No. 274 Psychiatry (Part II), pp. 856865. Proceedings of the 5th World Congress of Psychiatry.Excerpta Medica:Amsterdam.Google Scholar
Biekel, H. & Cooper, B. (1994). Incidence and relative risk of dementia in an urban elderly population – findings of a prospective field study. Psychological Medicine 24, 179192.CrossRefGoogle Scholar
Black, S. E., Blessed, G., Edwardson, J. A. & Kay, D. W. K. (1990). Prevalence rates of dementia in an ageing population: are low rates due to the use of insensitive instruments? Age and Aging 19, 8490.CrossRefGoogle Scholar
Boothby, H., Blizard, R., Livingston, G. & Mann, A. H. (1994). The Gospel Oak Study Stage III – the incidence of dementia. Psychological Medicine 24, 8996.CrossRefGoogle ScholarPubMed
Copeland, J. R. M., Davidson, I. A., Dewey, M. E., Gilmore, C., Larkin, B. A., McWilliams, C., Saunders, P. A., Scott, A., Sharma, V. & Sullivan, C. (1992). Alzheimer's disease, other dementias, depression and pseudo-dementia: prevalence, incidence and three-year outcome in Liverpool. British Journal of Psychiatry 161, 230239.CrossRefGoogle Scholar
Dartigues, J. F., Gagnon, M., Barberger-Gateau, P., Letenneur, L., Commenges, D., Sauvel, C., Michel, P. & Salamon, R. (1992). The Paquid epidemiological program on brain ageing. Neuroepidemiology 11 (supplement 1), 1418.CrossRefGoogle ScholarPubMed
Dawe, B., Procter, A. & Philpot, M. (1992). Concepts of mild memory impairment in the elderly and their relationship to dementia – a review. International Journal of Geriatric Psychiatry 7, 473480.CrossRefGoogle Scholar
Folstein, M. F., Folstein, S. E. & McHugh, P. R. (1975). Mini-mental state: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research 12, 189198.CrossRefGoogle Scholar
Jagger, C., Clarke, M. & Anderson, J. (1992). Screening for dementia – a comparison of two tests using receiver operating characteristic (ROC) analysis. International Journal of Geriatric Psychiatry 7, 659665.CrossRefGoogle Scholar
Jorm, A. F., Korten, A. E. & Jacomb, P. A. (1988). Projected increases in the number of dementia cases for 29 developed countries: application of a new method for making projections. Acta Psychiatrica Scandinavica 78, 493500.CrossRefGoogle ScholarPubMed
Kahn, H. A. & Sempos, C. T. (1989). Statistical Methods in Epidemiology. Monographs in Epidemiology and Biostatistics, Volume 12. Oxford University Press: Oxford.Google Scholar
Kay, D. W. K. (1991). The epidemiology of dementia: a review of recent work. Reviews in Clinical Gerontology 1, 5556.CrossRefGoogle Scholar
Launer, L. J. (1992). Overview of incidence studies of dementia conducted in Europe. Neuroepidemiology 11, suppl. 1, 213.CrossRefGoogle ScholarPubMed
Magnusson, H. & Helgason, T. (1993). The course of mild dementia in a birth cohort. International Journal of Geriatric Psychiatry 8, 639647.CrossRefGoogle Scholar
Mann, A. H., Livingston, G., Boothby, H. & Blizard, R. (1992). The Gospel Oak Study: the prevalence and incidence of dementia in an inner city area of London. Neuroepidemiology 11 (suppl. 1), 7679.CrossRefGoogle Scholar
Morgan, K. & Clarke, D. (1995). To what extent is dementia under-reported on British death certificates? International Journal of Geriatric Psychiatry 10, 987990.CrossRefGoogle Scholar
Morgan, K., Dallosso, H. M., Arie, T., Byrne, E. J., Jones, R. & Waite, J. (1987). Mental health and psychological well-being among the old and very old living at home. British Journal of Psychiatry 150, 801807.CrossRefGoogle ScholarPubMed
Morgan, K., Lilley, J. M., Arie, T. H., Byrne, E. J., Jones, R. & Waite, J. (1993). Incidence of dementia in a representative British sample. British Journal of Psychiatry 163, 467470.CrossRefGoogle Scholar
Newens, A. J., Forster, D. P. & Kay, D. W. K. (1993). Death certification after a diagnosis of presenile dementia. Journal of Epidemiology and Community Health 47, 293297.CrossRefGoogle ScholarPubMed
Norušis, M. J. (1993). SPSS for Windows: Professional Statistics, Release 6.0. SPSS Inc.: Chicago.Google Scholar
O'Connor, D. W., Pollitt, P. A., Hyde, J. B., Fellowes, J. L., Miller, N. D. & Roth, M. (1991 a). Follow-up study of dementia diagnosed in the community using the Cambridge Mental Disorders of the Elderly Examination. Acta Psychiatrica Scandinavica 81, 7882.CrossRefGoogle Scholar
O'Connor, D. W., Pollitt, P. A., Hyde, J. B., Fellowes, J. L., Miller, N. D. & Roth, M. (1991 b). The progression of mild idiopathic dementia in a community population. Journal of the American Geriatrics Society 39, 246251.CrossRefGoogle Scholar
Office of Population Censuses and Surveys (1983). Census 1981: Sex, Age and Marital Status, Great Britain. HMSO: London.Google Scholar
Office of Population Censuses and Surveys (1988). General Household Survey 1985. HMSO: London.Google Scholar
Pattie, A. H. & Gilleard, C. J. (1979). Manual of the Clifton Assessment Procedures for the Elderly (CAPE), Hodder & Stoughton: Sevenoaks, Kent.Google Scholar
Paykel, E. S., Brayne, C., Huppert, F. A., Gill, C., Barkley, C., Gehlhaar, E., Beardsall, L., Girling, D. M., Pollitt, P. & O'Connor, D. (1994). Archives of General Psychiatry 51, 325332.CrossRefGoogle Scholar
Ritchie, K., Kildea, D. & Robine, J.-M. (1992). The relationship between age and the prevalence of senile dementia: a meta-analysis of recent data. International Journal of Epidemiology 21, 763769.CrossRefGoogle ScholarPubMed
Rosenman, B. (1991). The validity of the diagnosis of mild dementia. Psychological Medicine 21, 923934.CrossRefGoogle ScholarPubMed
Roth, M., Huppert, F. A., Tym, E. & Mountjoy, C. Q. (1988). CAMDEX: The Cambridge Examination for Mental Disorders of the Elderly. Cambridge University Press: Cambridge.Google Scholar
Ryan, D. H. (1992). Death in dementia: a study of the causes of death in dementia patients and their spouses. International Journal of Geriatric Psychiatry 7, 465472.CrossRefGoogle Scholar
Strohle, A., Richert, A., Maier, H. & Gutzmann, H. (1995). Improving the clinical recognition of very mild dementia using multiple levels of assessment. American Journal of Geriatric Psychiatry 3, 3442.CrossRefGoogle ScholarPubMed
Weinberger, M., Gold, D. T., Divine, G. W., Cowper, P. A., Hodgson, L. G., Schreiner, P. J. & George, L. K. (1993). Social service interventions for caregivers of patients with dementia – impact on health care utilization and expenditures. Journal of the American Geriatrics Society 41, 153156.CrossRefGoogle ScholarPubMed