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Causes and Patterns of Dementia: An Update in the Era of Redefining Alzheimer's Disease

Authors
  • James, Bryan D.
  • Bennett, David A.
Type
Published Article
Journal
Annual Review of Public Health
Publisher
Annual Reviews
Publication Date
Apr 01, 2019
Volume
40
Pages
65–84
Identifiers
DOI: 10.1146/annurev-publhealth-040218-043758
Source
Annual Reviews
Keywords
License
Yellow

Abstract

The burden of dementia continues to increase as the population ages, with no disease-modifying treatments available. However, dementia risk appears to be decreasing, and progress has been made in understanding its multifactorial etiology. The 2018 National Institute on Aging–Alzheimer's Association (NIA-AA) research framework for Alzheimer's disease (AD) defines AD as a biological process measured by brain pathology or biomarkers, spanning the cognitive spectrum from normality to dementia. This framework facilitates interventions in the asymptomatic space and accommodates knowledge that many additional pathologies (e.g., cerebrovascular) contribute to the Alzheimer's dementia syndrome. The framework has implications for how we think about risk factors for “AD”: Many commonly accepted risk factors are not related to AD pathology and would no longer be considered risk factors for AD. They may instead be related to other pathologies or resilience to pathology. This review updates what is known about causes, risk factors, and changing patterns of dementia, addressing whether they are related to AD pathology/biomarkers, other pathologies, or resilience.

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