In the last decades, the awareness has grown among the public, as well as among health politicians, that dementia is highly prevalent in older age, that it causes much distress to patients and their families, and that it poses a large burden on public health care resources.Initially, research focused chiefly on Alzheimer's disease, the most frequent type of dementia. In recent years, there is also increasing interest in vascular dementia. The reasons for this are that vascular dementia may be more prevalent than previously recognized, that vascular causes may be involved in the clinical picture of other dementia syndromes as well, and, perhaps most importantly, that vascular causes of cognitive decline can potentially be influenced by available measures of intervention. In studies of the frequency and etiology of dementia, much emphasis has been put on differentiating demented subjects from cognitively unimpaired individuals. However, there is little evidence to support the idea of a sharp distinction between demented and non-demented persons. Cognitive impairment is a quantitative rather than a qualitative characteristic, and consequently its distribution in the population shows a continuum of severity. The fact that cognitive dysfunction is common in old age does not imply that it is intrinsic to aging; it may be normal in the sense of usual, not in the sense of natural This thesis focuses on epidemiologic studies on cognitive function and dementia. The main part is devoted to investigations of the relation between vascular risk factors and cognitive function; in these studies cognitive function was evaluated as a continuously distributed variable. In the other studies in this thesis, risk factors for dementia were investigated with dementia as a dichotomous outcome variable.

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The publication of this thesis was financially supported by The Netherlands Alzheimer Foundation, the Rotterdam Medical Research Foundation, Glaxo BV, Merck, Sharp & Dohme Nederland BV, and UCB-Pharma BV.
A. Hofman (Albert)
Erasmus University Rotterdam
Erasmus MC: University Medical Center Rotterdam

Breteler, M. (1993, June 18). Cognitive decline in the elderly : epidemiologic studies on cognitive function and dementia. Retrieved from