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Time, Sex, Gender, History, and Dementia

Rocca, Walter A. MD, MPH

Alzheimer Disease & Associated Disorders: January-March 2017 - Volume 31 - Issue 1 - p 76–79
doi: 10.1097/WAD.0000000000000187
Review Article

A growing body of epidemiologic evidence indicates a decline in the incidence or prevalence of dementia in high income countries in the past 25 years. In this commentary, I first suggest that the decline in the incidence or prevalence of dementia is not explained completely by the factors considered so far, and that a broader historical perspective may be needed. Second, I suggest that the overall declining trend may conceal trends in opposite directions for the two major subtypes of dementia, the neurovascular and the neurodegenerative type. Third, I suggest some areas of future research to further elucidate the trends. The future of dementia remains somewhat unclear. Even if the incidence continues to decline, the prevalence may remain the same or increase if survival of persons affected by dementia increases. In addition, even if the prevalence declines, the total number of persons affected by dementia may remain the same or increase if the size of the elderly population expands. Finally, we cannot be sure that the decline in incidence will continue in the coming decades. With cautious optimism, we may conclude that the burden of dementia may be modified over time by human practices, including public health and medicine.

Departments of *Health Sciences Research, Division of Epidemiology


Women’s Health Research Center, Mayo Clinic, Rochester, MN

Supported in parts by the National Institutes of Health (grants R01 AG034676, P50 AG044170, U01 AG006786, and P01 AG004875).

The author declares no conflicts of interest.

Reprints: Walter A. Rocca, MD, MPH, Department of Health Sciences Research, Division of Epidemiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 (e-mail:

Received December 14, 2016

Accepted December 19, 2016

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