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Dementia and Alzheimer disease incidence: a prospective cohort study
Kukull WA, Higdon R, Bowen JD, McCormick WC, Teri L, Schellenberg GD, van Belle G, Jolley L et al.. Archives of neurology, 2002-11-01
Topic: Risk, prevention and care in population studies
Context Age-specific incidence rates for dementia and Alzheimer disease (AD) are important for research and clinical practice. Incidence estimates for the United States are few and vary with the population sampled and study design; we present data that will contribute to a consensus of these rates. Objectives To provide age-specific incidence estimates for dementia and AD and to estimate the association of sex, educational level, and apolipoprotein E genotype with onset. Design Prospective cohort study; begun in 1994 with follow-up interviews every 2 years. Setting Members of community-based, large health maintenance organization with demographics consistent with the surrounding base population; diagnostic evaluation by university-based study clinicians. Subjects Random sample of subjects aged 65 years or older from the base population; dementia free, nonnursing home residents. Of 5422 who were eligible, 2581 were enrolled, and 2356 had at least 1 follow-up evaluation (10 591 person-years of observation). Main outcome measure Dementia and Alzheimer disease diagnoses were based on standard criteria. Age-specific incidence rates were calculated using a person-years approach with Poisson distribution confidence intervals. Cox proportional hazards model analysis was used to examine other factors. Results Two hundred fifteen cases of dementia and 151 cases of AD were diagnosed. Incidence rates for dementia and AD increase across the 5-year age groups; AD rates rise from 2.8 per 1000 person-years (age group, 65-69 years) to 56.1 per 1000 person-years in the older than 90-year age group. The rates nearly triple from the 75-to-79-year and 80-to-84-year age groups, but the relative increase is much less thereafter. Sex was not associated with AD onset. Educational level (>15 years vs Conclusions Our dementia and AD incidence rates are consistent with recent US and European cohort studies, providing clinicians and researchers new information concerning the reproducibility of incidence estimates across settings. Increased risk was associated with age and the apolipoprotein E genotype; also with a low baseline cognitive screening test score. Educational level was inversely associated with the risk of dementia and positively associated with the baseline cognitive test score; thus, detection of AD by the screening test could also be influenced by educational level.
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APA 7th
Kukull, W. A., Higdon, R., Bowen, J. D., McCormick, W. C., Teri, L., Schellenberg, G. D., et al. (2002). Dementia and Alzheimer disease incidence: a prospective cohort study. Archives of neurology. https://doi.org/10.1001/archneur.59.11.1737
Vancouver
Kukull WA, Higdon R, Bowen JD, McCormick WC, Teri L, Schellenberg GD, et al. Dementia and Alzheimer disease incidence: a prospective cohort study. Archives of neurology. 2002. doi:10.1001/archneur.59.11.1737. PMID: 12433261.
BibTeX
@article{kukull2002-12433261,
author = {Kukull, W. A. and Higdon, R. and Bowen, J. D. and McCormick, W. C. and Teri, L. and Schellenberg, G. D. and van Belle, G. and Jolley, L. and others},
title = {{Dementia and Alzheimer disease incidence: a prospective cohort study}},
journal = {Archives of neurology},
year = {2002},
doi = {10.1001/archneur.59.11.1737},
pmid = {12433261},
url = {https://doi.org/10.1001/archneur.59.11.1737}
}
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Key findings
- Results Two hundred fifteen cases of dementia and 151 cases of AD were diagnosed.
- Increased risk was associated with age and the apolipoprotein E genotype; also with a low baseline cognitive screening test score.
- Educational level was inversely associated with the risk of dementia and positively associated with the baseline cognitive test score; thus, detection of AD by the screening test could also be influenced by educational level.
Why it matters
In a US cohort of 2,356 people aged 65 and over who were free of dementia at the start (followed from 1994), new Alzheimer's cases rose steeply with age, from 2.8 per 1,000 person-years at ages 65–69 to 56.1 per 1,000 over age 90. The authors say these rates are "consistent with recent US and European cohort studies". Older age, APOE genotype and a low starting score on a cognitive screening test were linked to higher risk; sex was not linked to Alzheimer's onset. More education was linked to lower dementia risk, but the authors caution that the screening test itself "could also be influenced by educational level".
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Study details
- Study designcohort study
- Evidence strengthModerate
How this study scored 61/100
Published in a peer-reviewed journal, and it is a cohort study following people over time. Scored zero for sample size, effect reported, studied in people and randomized / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Archives of neurology) |
| Journal's citation record | 3 / 4 | Archives of Neurology: journal h-index 353 (OpenAlex, 2026-10-29) |
| Study design | 7 / 12 | A cohort study following people over time |
| Strength of evidence | 3 / 5 | Rated “moderate” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 1 / 5 | 2002 — older than 20 years, still counted |
| Sample size | 0 / 4 | Participant count not stated — scores zero (not stated in the record — scored 0) |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 0 / 3 | Not stated whether this was studied in people — scores zero (not stated in the record — scored 0) |
| Randomized / blinded | 0 / 2 | No randomization or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 6 / 7 | Cited 805 times (OpenAlex, 2026-10-10) |
| Citations per year | 4 / 5 | 31.0 citations a year over 26 year(s) since 2002 |
| Impact for its field and year | 3 / 6 | Cited 7.1× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 4 / 6 | Cited by 78 other studies in this library |
| Still being cited | 3 / 4 | Cited 93 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 4 / 4 | Last-listed author Eric B. Larson: h-index 105 (OpenAlex, whole career) |
| Institution's track record | 3 / 3 | University of Washington: institution h-index 3,540 (OpenAlex) |
| Multicenter collaboration | 1 / 3 | OpenAlex lists 3 institution(s) in 1 country |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 12433261) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Total | 61 / 100 | — |
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