Risk of dementia: The Rotterdam Study

Dementia is a frequent disorder in the elderly. It is also a distressing condition both for the patient and caregiver. Dementia puts a high claim on health care costs. In the Netherlands about one tenth of the yearly health budget is spent on nursing homes. Dementia is the. main diagnosis in 40% of nursing home patients and coexisting dementia may be the underlying. motive for admittance to a nursing home in patients with other diseases. 1•2 The need for dementia care will probably grow since the elderly population is increasing both in percentage and in absolute number. J,4 Reliable estimates of the frequency of dementia are important. Prevalence figures are used by health planners to determine the demand for disease-specific services. The incidence rate is morc informative when etiologic questions are addressed. For assessment of prevalence and incidence of dementia one cannot rely on medical registers; the disease is rarely reported on death celiificates and usually mild cases are not recognised. Therefore we studied the prevalence (chapter 2.1) and incidence (chapter 2.2) of dementia in a population-based study by active screening of participants. This study formed p31i of the Rotterdam Study, a prospective cohort study on medical disorders in the elderly.s Previous epidemiologic studies suggested that not all social layers are equally affected by dementia.6 Especially lower educated people might be more susceptible. Therefore, we examined the association between education and prevalent dementia (chapter 2.1) and also assessed if lower educated were at higher risk of incident dementia (chapter 2.3). The lack of knowledge on Causes of dementia, especially Alzheimer's disease, motivated the second pm of this thesis.7 We mainly studied associations with other COlfunon disorders of old age that have vascular implications.

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