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Cognitive impairment in the U.S.: Lifetime risk, age at onset, and years impaired.

Authors
  • Hale, Jo Mhairi1, 2
  • Schneider, Daniel C2
  • Mehta, Neil K3
  • Myrskylä, Mikko2, 4, 5
  • 1 University of St Andrews, Scotland, United Kingdom. , (United Kingdom)
  • 2 Max Planck Institute for Demographic Research, Rostock, Germany. , (Germany)
  • 3 University of Michigan, MI, USA.
  • 4 London School of Economics and Political Science, UK.
  • 5 University of Helsinki, Finland. , (Finland)
Type
Published Article
Journal
SSM - population health
Publication Date
Aug 01, 2020
Volume
11
Pages
100577–100577
Identifiers
DOI: 10.1016/j.ssmph.2020.100577
PMID: 32300635
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Prior studies have analyzed the burden of cognitive impairment, but often use potentially biased prevalence-based methods or measure only years lived with impairment, without estimating other relevant metrics. We use the Health and Retirement Study (1998-2014; n = 29,304) and the preferred incidence-based Markov-chain models to assess three key measures of the burden of cognitive impairment: lifetime risk, mean age at onset, and number of years lived impaired. We analyze both mild and severe cognitive impairment (dementia) and gender, racial/ethnic, and educational variation in impairment. Our results paint a multi-dimensional picture of cognitive health, presenting the first comprehensive analysis of the burden of cognitive impairment for the U.S. population age 50 and older. Approximately two out of three Americans experience some level of cognitive impairment at an average age of approximately 70 years. For dementia, lifetime risk for women (men) is 37% (24%) and mean age at onset 83 (79) years. Women can expect to live 4.2 years with mild impairment and 3.2 with dementia, men 3.5 and 1.8 years. A critical finding is that for the most advantaged groups (i.e., White and/or higher educated), cognitive impairment is both delayed and compressed toward the very end of life. In contrast, despite the shorter lives of disadvantaged subgroups (Black and/or lower educated), they experience a younger age of onset, higher lifetime risk, and more years cognitively impaired. For example, men with at least an Associate degree have 21% lifetime dementia risk, compared to 35% among men with less than high school education. White women have 6 years of cognitively-impaired life expectancy, compared to 12 and 13 years among Black women and Latinas. These educational and racial/ethnic gradients highlight the very uneven burden of cognitive impairment. Further research is required to identify the mechanisms driving these disparities in cognitive impairment. © 2020 The Authors.

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