The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association · 2026
Dementia incidence trends in rural Spain: Ten-year cohort findings from NEDICES cohort.
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Vega-Quiroga Saturio, Bermejo-Pareja Félix, Martín-Arriscado Cristina, Benito-León Julián
Аннотация
PURPOSE: To estimate dementia incidence in the rural population enrolled in the Neurological Diseases in Central Spain (NEDICES) cohort and to evaluate the impact of ascertainment strategies on temporal trend estimates.
METHODS: Residents aged ≥65 years were examined at baseline (1994-1995), in 1997-1998, and in 2004-2005. Incident dementia was identified through clinical reassessment, medical record review, and, for decedents between waves, via linkage to the Spanish National Death Registry. Person-time accrued from baseline to dementia, death, or censoring; incidence rates (per 1000 person-years) with 95% confidence intervals (CIs) were estimated using exact Poisson methods; incidence rate ratios (IRRs) contrasted 1994-1998 with 1999-2005.
FINDINGS: Of 2148 eligible residents in the 1993 census, 1937 were screened; 113 prevalent cases were excluded, leaving 1824 dementia-free participants. In 1994-1998, 60 incident cases occurred over 4427.3 person-years (13.6; 95% CI, 10.5-17.5): 41 detected at first follow-up, 13 reclassified at the third wave, and 6 identified from death certificates. In 1999-2005, 76 cases accrued over 2584.9 person-years (29.4; 95% CI, 23.3-36.9); 23 were actively ascertained, and 53 were registry-only, resulting in an IRR of 2.17 (95% CI, 1.55-3.04; p < 0.001). Restricting to actively ascertained cases, rates were 12.2 versus 8.9 (IRR = 0.73; 95% CI, 0.45-1.19; p = 0.20). Alzheimer's disease was the most frequent subtype.
CONCLUSIONS: The incidence increased only when death certificate diagnoses were included; active follow-up suggested stability. This higher incidence may reflect older age structure, lower educational attainment/cognitive reserve, heavier vascular risk burden, and constrained diagnostic access that shifts detection to death certification.
METHODS: Residents aged ≥65 years were examined at baseline (1994-1995), in 1997-1998, and in 2004-2005. Incident dementia was identified through clinical reassessment, medical record review, and, for decedents between waves, via linkage to the Spanish National Death Registry. Person-time accrued from baseline to dementia, death, or censoring; incidence rates (per 1000 person-years) with 95% confidence intervals (CIs) were estimated using exact Poisson methods; incidence rate ratios (IRRs) contrasted 1994-1998 with 1999-2005.
FINDINGS: Of 2148 eligible residents in the 1993 census, 1937 were screened; 113 prevalent cases were excluded, leaving 1824 dementia-free participants. In 1994-1998, 60 incident cases occurred over 4427.3 person-years (13.6; 95% CI, 10.5-17.5): 41 detected at first follow-up, 13 reclassified at the third wave, and 6 identified from death certificates. In 1999-2005, 76 cases accrued over 2584.9 person-years (29.4; 95% CI, 23.3-36.9); 23 were actively ascertained, and 53 were registry-only, resulting in an IRR of 2.17 (95% CI, 1.55-3.04; p < 0.001). Restricting to actively ascertained cases, rates were 12.2 versus 8.9 (IRR = 0.73; 95% CI, 0.45-1.19; p = 0.20). Alzheimer's disease was the most frequent subtype.
CONCLUSIONS: The incidence increased only when death certificate diagnoses were included; active follow-up suggested stability. This higher incidence may reflect older age structure, lower educational attainment/cognitive reserve, heavier vascular risk burden, and constrained diagnostic access that shifts detection to death certification.