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Risk factors for cognitive decline and dementia

Eric B Larson, MD, MPH
Section Editor
Steven T DeKosky, MD, FAAN, FACP, FANA
Deputy Editor
April F Eichler, MD, MPH


Dementia is a disorder that is characterized by impairment of cognition, typically involving memory and at least one other cognitive domain (language, visuospatial, executive function). These must represent a decline from previous level of function and be severe enough to interfere with daily function and independence.

This topic will review the risk factors associated with cognitive decline and dementia. The risk factors for Alzheimer disease (AD) and the diagnosis, prevention, and treatment of dementia are discussed separately. (See "Epidemiology, pathology, and pathogenesis of Alzheimer disease" and "Prevention of dementia" and "Treatment of dementia" and "Treatment and prevention of vascular dementia".)


Age remains the strongest risk factor for dementia, particularly for Alzheimer disease (AD). The incidence of AD approximately doubles every 10 years after the age of 60 years. Dementia is estimated to be present in one-half to two-thirds of nursing home residents. (See "Epidemiology, pathology, and pathogenesis of Alzheimer disease", section on 'Incidence and prevalence' and "Palliative care: Nursing home", section on 'Patient characteristics, care needs, and clinical course'.)

Studies estimating dementia incidence in the very old have been limited by low numbers in this age group. A number of studies have found that dementia incidence continues to increase with age after 85 years [1-5]. These cumulative increases in incidence rates result in the prevalence of dementia approaching or exceeding 50 percent in individuals over 90 years [1,2,5-7].

AD and other neurodegenerative dementias also occur, albeit rarely, in younger patients. The reported incidence of AD in one study from England was 4.2 cases per 100,000 person years among individuals aged 45 to 64 years [8], while the overall incidence of early onset dementia in this and another study was 11 to 13 cases per 100,000 for adults younger than 64 years [8,9]. Among 235 individuals aged 17 to 45 years diagnosed with dementia in Rochester, Minnesota, neurodegenerative disease accounted for 31 percent [10].


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Literature review current through: Feb 2017. | This topic last updated: Mar 20, 2017.
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