Women's Health Surveillance Report

Dementia and Alzheimer's Disease

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Joan Lindsay, PhD (Health Canada), with Lori Anderson, BA

Health Issue

Dementia, including Alzheimer's disease (AD) (the most common type of dementia) is a problem that increases with age after age 65. With the aging of the baby boom generation, the number of people with dementia will likely increase significantly over the next three decades. While prevalence and incidence rates do not differ markedly between women and men, women live longer on average, so the number of women with dementia is greater than that of men. In addition, women are more frequently caregivers for people with dementia. Thus, dementia is an important health problem for women.

Key Findings

Findings are based on data from the Canadian Study of Health and Aging (CSHA), a large, national study that provides a great deal of detailed data on dementia in Canada. The prevalence of dementia increases markedly with age for both sexes, approximately doubling every five years from ages 65 to 84, with a lower rate of increase at older ages. Rates of AD are higher among women, whereas rates of vascular dementia are higher among men. The prospective analysis of risk factors for AD show that the risk of AD increases with increasing age, lower education, and apolipoprotein Ee4. Regular physical activity is clearly protective in women, whereas this association is less clear for men. Use of non-steroidal anti-inflammatory drugs, wine consumption, coffee consumption, and past exposure to vaccines are associated with decreased risk of AD. While estrogen replacement therapy has been seen to be protective in some studies, several studies fail to support this association, including the CSHA.

The CSHA data demonstrated women's strong caregiving role. Seventy-five per cent of all caregivers for people with dementia living in the community are women, as are 71% of caregivers for those with dementia in institutions. Daughters represented 45% of the informal caregivers of institutionalized dementia patients.

Data Gaps and Recommendations

The authors identified the following data gaps and made the following recommendations:

• Further study is needed to confirm some of the protective factors against dementia (coffee drinking, vaccinations) before policy recommendations can be made.
• The protective effect of regular physical activity for AD provides an additional reason for the promotion of regular physical activity at all ages.
• While the CSHA covers the years 1991 to 2001, ongoing surveillance of the incidence and prevalence of dementia is needed to monitor the impact of treatments as well as the aging of the population. Such surveillance is not feasible using the usual sources of data (hospitalizations, mortality, physicians' visits) since only a fairly small fraction of dementia cases would have dementia as a diagnosis.

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