Epidemiology of dementia
Dementia affects 17–25 million people worldwide, with an
estimated four million in the US and an estimated 800,000 people in the UK
[Ritchie, 1995; Keefover, 1996]. It affects predominantly elderly people,
and as population growth increases in this age range, the numbers affected
by dementia are expected to rise significantly. The prevalence of dementia
in people over the age of 65 is 5% and in people over 80, it is 20%. It has
been estimated that 26% of women and 21% of men over the age of 85 have some
form of dementia, of whom approximately 50% have Alzheimer’s disease (AD)
[Melzer, 1997].
Causes of dementia
Aetiology of dementia
- Degenerative disorders: Alzheimer’s disease (AD); fronto-temporal
dementias (FTD); dementia with Lewy bodies (DLB); Parkinson disease
dementia; Huntington’s disease; progressive supranuclear palsy.
- Vascular causes: multi-infarct dementia (MID); lacunar infarcts;
Binswanger’s disease; cerebral autosomal dominant arteriopathy with
subcortical infarcts and leukoencephalopathy (CADASIL); vasculitis (eg,
lupus erythematosus).
- Trauma: major head injury; subdural haematoma; boxing.
- Intracranial tumours: primary tumours; metastatic tumours.
- Infection: bacterial (eg, Spirochetal spp. – causing Lyme disease
and syphilis); fungal (eg, Cryptococcus); viral (eg, subacute sclerosing
panencephalitis [SSPE]; progressive multifocal leukoencephalopathy;
post-encephalitic HIV). Other infectious agents (eg, Creutzfeldt-Jakob
disease [CJD], variant CJD [vCJD]; neurocysticercosis; tuberculosis).
- Hydrostatic causes: hydrocephalus (obstructive or communicating);
normal pressure hydrocephalus (NPH).
- Toxic, endocrine and metabolic causes: heavy metals; drug intoxication;
hypothyroidism; hypercalcaemia; B12 and folate deficiencies; hepatic and
renal failure; paraneoplastic/limbic encephalitis; inherited metabolic
disorders (eg, Wilson’s disease, leukodystrophies).
- Anoxia: post-cardiac arrest; carbon monoxide poisoning.