(Stroke. 2000;31:1487.)
© 2000 American Heart Association, Inc.
Original Contributions |
Vascular Dementia
Incidence and Risk Factors in the Canadian Study of Health and Aging
From the Sherbrooke Geriatric University Institute, Sherbrooke, Quebec (R.H., M.F.D.); the Laboratory Centre for Disease Control, Health Canada, Ottawa, Ontario (J.L.); Laval University, Québec City, Quebec (R.V.); Sisters of Charity of Ottawa Health Service Inc, Ottawa, Ontario (G.H.); and Dalhousie University, Halifax, Nova Scotia (K.R.), Canada.
Correspondence to Dr Réjean Hébert, Gerontology and Geriatrics Research Centre, 1036 Belvédère Sud, Sherbrooke, Quebec, J1H 4C4, Canada. E-mail rhebert{at}courrier.usherb.ca
Background and Purpose—Very few population-based studies have systematically examined incident vascular dementia (VaD). From the Canadian Study of Health and Aging cohort, incidence rates of VaD were determined and risk factors analyzed.
Methods—This was a cohort incidence study that followed 8623 subjects presumed to be free of dementia over a 5-year period. The risk factors were examined with a nested prospective case-control study. Exposure was determined by means of a risk factor questionnaire administered to the subject or a proxy at the beginning of the study.
Results—On the basis of 38 476 person-years at risk, the annual
incidence rate was estimated to be 2.52 per thousand undemented
Canadians (95% CI 2.02 to 3.02). Including an estimation of the
probability of VaD among the decedents, this figure rose to 3.79. For
the risk factors study, 105 incident cases of VaD according to the
NINCDS-AIREN criteria were compared with 802 control subjects.
Significant risk factors were: age (OR=1.05), residing in a rural area
(2.03), living in an institution (2.33), diabetes (2.15), depression
(2.41), apolipoprotein E 
4 (2.34), hypertension for women (2.05),
heart problems for men (2.52), taking aspirin (2.33), and occupational
exposure to pesticides or fertilizers (2.05). Protective factors were
eating shellfish (0.46) and regular exercise for women (0.46). There
was no relation with sex, education, or alcohol.
Conclusions—The study confirmed some previously reported risk factors but also suggested new ones. It raised concerns about the prescription of aspirin and perhaps other factors related to rural life.
Key Words: cerebrovascular disorders • epidemiology • cohort • case-control
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