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  • Review Article
  • Published:

Dementia in the oldest old

Nature Reviews Neurology volume 9, pages 382–393 (2013)Cite this article

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Abstract

People over the age of 90 years—the oldest old—are the fastest growing sector of the population. A substantial proportion of these individuals are affected by dementia, with major implications for the individual as well as society. Research on dementia in the oldest old is important for service planning, and the absence of dementia at this exceptional old age may serve as a model of successful ageing. This Review summarizes population-based epidemiological studies of dementia and its underlying neuropathology in nonagenarians and centenarians. The available data, although somewhat limited, show an age-specific and sex-specific profile of dementia status in very late life, resulting from a variety of neuropathologies that often co-occur. Extensive overlap in neuropathology between cognitively normal and cognitively impaired individuals is evident despite challenges to gathering data particular to this population. A complex picture is emerging of multiple pathogenetic mechanisms underlying dementia, and of the potential risk and protective factors for dementia that interact with genetics and lifestyle in normal and exceptional cognitive ageing.

Key Points

  • People over the age of 90 years (the oldest old) are the fastest growing sector of the population, with a substantial proportion developing dementia

  • The prevalence of dementia is age-specific: rates increase from about 25–30% in those in their early 90s to about 50% in the late 90s and 60% in centenarians

  • Prevalence of dementia is lower in men than in women, but the incidence at 90 years or over does not differ by sex, suggesting shorter survival time in men

  • Multiple neuropathologies underlie dementia, including Alzheimer disease neuropathological change and vascular pathology, which often co-occur, as well as Lewy-related pathology, hippocampal sclerosis and cerebral amyloid angiopathy

  • Diffuse neocortical neurofibrillary tangles and neocortical and hippocampal atrophy are the most consistent correlates of dementia in the oldest old

  • Neuropathology is common in cognitively normal individuals aged over 90 years, and better markers are needed to distinguish dementia from normal cognitive ageing

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Figure 1: Prevalence of all-cause dementia in population-based studies of individuals aged ≥90 years.
Figure 2: Incidence of all-cause dementia in population-based studies of individuals aged ≥90 years.

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Acknowledgements

This work was supported by the National Health & Medical Research Council (NHMRC) of Australia (Project Grant 630593 and Program Grant 568969). M. J. Slavin was supported by Dementia Collaborative Research Centre—Assessment and Better Care funding and the NHMRC as part of an Australian Government Initiative. Z. Yang is supported by funding from the China Scholarship Council for her Ph.D. candidature. We thank Mrs Angela Russell for editorial assistance.

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Authors and Affiliations

  1. Centre for Healthy Brain Ageing, School of Psychiatry, UNSW Medicine, University of New South Wales, Sydney, 2052, NSW, Australia

    Zixuan Yang

  2. Dementia Collaborative Research Centre—Assessment and Better Care, School of Psychiatry, UNSW Medicine, University of New South Wales, Sydney, 2052, NSW, Australia

    Melissa J. Slavin

  3. Neuropsychiatric Institute, Prince of Wales Hospital, Barker Street, Randwick, 2013, NSW, Australia

    Perminder S. Sachdev

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  1. Zixuan Yang
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  2. Melissa J. Slavin
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  3. Perminder S. Sachdev
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Contributions

Z. Yang researched the data for the article and wrote the manuscript. All three authors provided substantial contributions to the discussion of the content and to review and/or editing of the manuscript before submission.

Corresponding author

Correspondence to Perminder S. Sachdev.

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The authors declare no competing financial interests.

Supplementary information

Supplementary Table 1

Characteristics of population-based prevalence and incidence studies (DOC 28 kb)

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Yang, Z., Slavin, M. & Sachdev, P. Dementia in the oldest old. Nat Rev Neurol 9, 382–393 (2013). https://doi.org/10.1038/nrneurol.2013.105

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