Cognitive decline in the elderly : epidemiologic studies on cognitive function and dementia
1993
textabstractIn 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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