Methods Inf Med 2002; 41(03): 224-229
DOI: 10.1055/s-0038-1634440
Original Article
Schattauer GmbH

Vicissitudes of Preventive Medicine and a New Challenge

M. F. Collen
1   Kaiser Permanente Medical Care Program, Oakland, CA, USA
› Author Affiliations
Further Information

Publication History

Publication Date:
08 February 2018 (online)


Objectives: Significant changes in mortality patterns are part of the changing population demographics. This paper explores their implications for health evaluation and screening programs.

Methods: A review of selected age-adjusted mortality rates from the National Vital Statistics Reports of the USA was undertaken and their change over the last five decades analyzed.

Results: The review shows a continued decline in mortality rates from leading causes of death, such as heart disease, cancer, stroke, pneumonia and influenza, and a sharp rise in the death rates from Alzheimer’s disease. Available means for detection of Alzeimer’s disease are summarized.

Conclusion: Given the emerging possibilities for the treatment and prevention of the progression of Alzheimer’s disease, tests for early detection of Alzheimer’s should be included in health screening examinations.

  • References

  • 1 Centers for Disease Control and Prevention, National Center for Health Statistics US.. Department of Health and Human Services. Births and Deaths: Preliminary data for 1998. National Vital Statistics Reports 1999; 47 (Suppl. 25) 471-5.
  • 2 Centers for Disease Control and Prevention, National Center for Health Statistics US.. Department of Health and Human Services. Deaths: Final Data for 1997. National Vital Statistics Reports 1999; 47 (Suppl. 19) 1-104.
  • 3 Centers for Disease Control and Prevention, National Center for Health Statistics US.. Department of Health and Human Services. Mortality from Alzheimer’s disease:An update. National Vital Statistics Reports 1999; 47: 1-5.
  • 4 Centers for Disease Control and Prevention, National Center for Health Statistics US.. Department of Health and Human Services. United States Life Tables, 1997. National Vital Statistics Reports 1999; 47: 1-33.
  • 5 Nusseder W, Mackenback J. Lack of improvement of life expectancy at advanced ages in the Netherlands. Internatnl J Epidemiol 2000; 29: 140-8.
  • 6 Report of the U.S.. Preventive Services Task Force. Screening for Dementia. In: Guide to Clinical Preventive Services. 2 ed; 1996. p. 531-40.
  • 7 Cummings J, Khachaturian Z. Definitions and diagnostic criteria. In: Clinical Diagnosis and Management of Alzheimer’s Disease. Boston: Butterworth-Heinemann; 1996
  • 8 Recognition and Initial Assessment of Alzheimer’s Disease and Related Dementias.. Clinical Practice Guideline No. 19. Rockville, MD: Agency for Health Care & Policy Research, US DHHS, AHCPR; Pub No. 97-0702; 1996. November.
  • 9 Fratiglioni L, DeRonchi D, Aguero-Torres H. Worldwide prevalence and incidence of dementia. Drugs & Aging 1999; 5: 365-75.
  • 10 Anderson K, Launer L, Dewey M. et al. gender differences in the incidence of AD and vascular dementia:The EURODEM Studies. Neurology 2000; 53: 1992-7.
  • 11 Gao S, Hendrie H, Hall K, Hui S. The relationship between age, sex, and the incidence of dementia and Alzheimer’s disease. Arch Gen Psychiatry 1998; 55: 809-15.
  • 12 Berteler M, Ott A, Hofman A. The new epidemic: Frequency of dementia in the Rotterdam study. Haemostasis 1998; 28: 117-23.
  • 13 Lobo A, Launer L, Frataglioni L. et al. Prevalence of dementia and major subtypes in Europe: A collaborative study of population-based cohorts. Neurology 2000; 54 Suppl 5 S4-S9.
  • 14 Gangula M, Dodge H, Chen P. et al. Ten-year incidence of dementia in a rural elderly U.S. community population: The MOVIES Project. Neurology 2000; 54: 1109-16.
  • 15 Rocca W, Cha R, Waring S, Kokmen E. Incidence of dementia and Alzheimer’s disease: An analysis from Rochester, Minnesota, 1975-1984. Am J Epidemiol 1998; 148: 51-62.
  • 16 Elias M, Beiser A, Wolf P. et al. The preclinical phase of Alzheimer’s disease; A 22-year prospective study of the Framingham cohort. Arch Neurol 2000; 57: 808-13.
  • 17 Jorm A, Jolley D. The incidence of dementia: A meta-analysis. Neurology 1998; 51: 728-33.
  • 18 Thomassen R, van Schaick H, Blansjaar B. Prevalence of dementia over age 100. Neurology 1998; 50: 283-6.
  • 19 Aguero-Torres H, Frataglioni L, Guo Z. et al. Mortality from dementia in advanced age: A 5-year follow-up study of incident dementia cases. J Clin Epidmiol 1999; 52 (Suppl. 08) 737-43.
  • 20 Liu H, Fuh J, Wang S. et al. Prevalence and subtypes of dementia in a rural Chinese population. Alzheimer’s Dis & Assoc Disorders 1998; 12: 127-34.
  • 21 O’Hara R, Mumenthaler M, Yesavage J. Update on Alzheimer’s disease: Recent findings and treatments. West J Med 2000; 172: 115-20.
  • 22 Rocca W. Dementia, Parkinson’s disease, and stroke in Europe: A commentary. Neurology 2000; 54 Suppl 5 S38-S40.
  • 23 Daly E, Zaitchik D, Copeland M. et al. Predicting conversion to Alzheimer’s disease using standardized clinical information. Arch Neurol 2000; 57: 675-44.
  • 24 Office of Disease Prevention and Health Promotion, Public Health Service, Services US Department of Health and Human Services.. Cognitive and Functional Impairment. In: Clinician’s Handbook of Preventive Services. Put Prevention into Practice. Washington, DC: US Govt Print Office; 1994
  • 25 Office of Disease Prevention and Health Promotion, US Department of Health and Human Services.. Clinical preventive services for normal-risk adults. Prevention Report 1998; 13: 12.
  • 26 Canadian Task Force in the Periodic Health Examination.. Canadian Guide to Preventive Health Care. Ottawa: Canadian Communication Group; 1994
  • 27 Fletcher A. Multidimensional assessment of elderly people in the community. Brit Med Bull 1998; 54: 945-60.
  • 28 Froelich T, Robison J, Inouye S. Screening for dementia in the outpatient setting: The time and change test. J Am Geriatr Soc 1998; 46: 1506-11.
  • 29 Katzman R, Brown T, Fuld P. et al. Validation of a short orientation-memory-concentration test of cognitive impairment. Am J Psychiatry 1983; 140: 734-9.
  • 30 Folstein M, Folstein S, McHugh P. “Mini-Mental State”: A practical method for grading the cognitive state of patients for the clinician. J Psychiat Res 1975; 25: 189-98.
  • 31 McDowell I, Kristjanssen B, Hill G, Hebert R. Community screening for dementia: The Mini-Mental State Exam (MMSE) and Modified Mini-Mental State Exam (3MS) compared. J Clin Epidmiol 1997; 50: 377-83.
  • 32 Hogan D, Ebly E. Predicting who will develop dementia in a cohort of Canadian survivors. Can J Neurol Sc. 2000; 27: 18-24.
  • 33 Small B, Frataglioni L, Vitanen M. et al. The course of cognitive impairment in pre-clinical Alzheimer’s disease; three and six year followup of a population-based sample. Arch Neurol 2000; 57: 839-44.
  • 34 Sahadevan S, Lim P, Li Tan N, Chan S. Diagnostic performance of two mental status tests in the older Chinese: Influence of education and age in cut-off values. Int J Geriat Psychiatry 2000; 15: 234-41.
  • 35 Zhang M, Katzman R, Salmon D. et al. The prevalence of dementia and Alzheimer’s disease in Shanghai, China: Impact of age, gender, and education. Ann Neurology 1990; 27: 428-37.
  • 36 Tariot P, Solomon P, Morris J. et al. A 5-month randomized, placebo-controlled trial of galantamine in AD. Neurology 2000; 54: 2269-76.
  • 37 Raskind M, Peskind E, Wessel T. et al. Galanta-mine in AD. Neurology 2000; 54: 2261-8.
  • 38 Patterson C. Detecting cognitive impairment in the elderly. In: Preventing Disease: Beyond the Rhetoric. New York: Springer-Verlag; 1990
  • 39 Warner J, Butler R. Alzheimer’s Disease. Clinical Evidence. London: BMJ Pub Group; 2000