DEMENTIA A Public Health Priority Online appendix · Online appendix Table of contents 1....

1

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

2

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

3

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.

4

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

5

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

7

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


15.2.6 Folstein MF120 1991 Baltimore 2071834


15.2.10 Hendrie HC121 1995 Indianapolis 7573588


15.2.13 Graves AB122 1996 King County/ Washington 8857825


15.2.14 Fillenbaum GG123 1998 Piedmont/ North Carolina 9674666


15.2.18 Breitner JC124 1999 Cache County/ Utah 10430421


15.2.22 Haan MN125 2003 Sacramento Valley/ California

12558712


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


Venezuela 11.1.1 Molero AE131 2007 Maracaibo 17940342

Venezuela 11.1.2 Llibre Rodrigues J41 2008 Caracas 18657855

8

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


Chile 12.1.1 Albala C132 1997 Concepcion .

Latin America, Tropical


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


Turkey 14.1.3 Gurvit H136 2008 Istanbul 18276959

Egypt 14.2.1 Farrag A137 1998 Assiut 9769445

Sub‐Saharan Afrca, West


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)



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


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.


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


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.

(3) Ogura C, Nakamoto H, Uema T, Yamamoto K, Yonemori T, Yoshimura T. Prevalence of senile dementia in Okinawa, Japan. COSEPO Group. Study Group of Epidemiology for Psychiatry in Okinawa. International Journal of Epidemiology. 1995;24:373‐380.

(4) Asada T, Yamagata Z, Kinoshita T et al. Prevalence of dementia and distribution of ApoE alleles in Japanese centenarians: an almost‐complete survey in Yamanashi Prefecture, Japan. Journal of the American Geriatrics Society. 1996;44:151‐155.

(5) Hatada K, Okazaki Y, Yoshitake K, Takada K, Nakane Y. Further evidence of westernization of dementia prevalence in Nagasaki, Japan, and family recognition. International Psychogeriatrics. 1999;11:123‐138.

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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)


Asia, South

Afghanistan, Bangladesh, Bhutan, India, Nepal, Pakistan

SEARO D except for Afghanistan and Pakistan (EMRO D)


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.


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)


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)


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


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)


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


1986 3 65 DSM‐IV No 4136 6867

3. Cache County study; Miech et al, 2002 (18)

Cache County, Utah


1995 3 65 DSM‐III‐R Not stated 4614 10541

4. The 90+ study (19)

Laguna Woods, California


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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