Gender and incidence of dementia in the Framingham Heart Study from mid-adult life

Alzheimers Dement. 2015 Mar;11(3):310-320. doi: 10.1016/j.jalz.2013.10.005. Epub 2014 Jan 10.


Background: Gender-specific risks for dementia and Alzheimer's disease (AD) starting in midlife remain largely unknown.

Methods: Prospectively ascertained dementia/AD and cause-specific mortality in Framingham Heart Study (FHS) participants was used to generate 10- to 50-year risk estimates of dementia/AD on the basis of the Kaplan-Meier method (cumulative incidence) or accounting for competing risk of death (lifetime risk [LTR]).

Results: Overall, 777 cases of incident dementia (601 AD) occurred in 7901 participants (4333 women) over 136,266 person-years. Whereas cumulative incidences were similar in women and men, LTRs were higher in women older than 85 years of age. LTR of dementia/AD at age 45 was 1 in 5 in women and 1 in 10 in men. Cardiovascular mortality was higher in men with rate ratios decreasing from approximately 6 at 45 to 54 years of age to less than 2 after age 65.

Conclusion: Selective survival of men with a healthier cardiovascular risk profile and hence lower propensity to dementia might partly explain the higher LTR of dementia/AD in women.

Keywords: Alzheimer's disease; Cardiovascular risk profile; Cohort/population-based cohort; Gender; Incidence of dementia; Mortality; Prevention; Selective survival.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Age Factors
  • Aged
  • Aged, 80 and over
  • Cardiovascular Diseases / mortality
  • Dementia / epidemiology*
  • Female
  • Humans
  • Incidence
  • Longitudinal Studies
  • Male
  • Massachusetts / epidemiology
  • Middle Aged
  • Prospective Studies
  • Risk Assessment
  • Sex Factors
  • Survival Analysis