“Public Health England (PHE) published their life expectancy report today. It shows life expectancy increasing. In parallel the latest data from the Framingham study showing the decreasing incidence of dementia. This Framingham data confirms recent dementia trends in the UK. Will this apply to MS? Will pwMS be living longer with a lower incidence of dementia? I don’t know. I suspect that life expectancy in pwMS will have been increased by the impact of DMTs. We know already that simply being treated with interferon-beta 3-years earlier increases your chances of being alive at 21-years by close to 50%, compared to pwMS with delayed access to IFNbeta. However, survival, or mortality, data says nothing about the state of cognition in pwMS in old age. How many pwMS when the get to 60 have dementia? How should we manage pwMS when they are old? How healthy are their bones? Have they all signed-up to an advanced directive? And the list goes on. These issues raise the thorny philosophical question about whether ageing is a comorbidity or disease, or is a physiological process? These issues are not trivial; if ageing is a disease it becomes a druggable problem that pharma can commercialise. If it is not a disease then pharma will have no incentive to develop drugs to target ageing; healthcare payers only pay for drugs and services linked to diseases. This is why pharma are lobbying so hard to get old-age classified as a disease.”
“What about pwMS? What happens to them when they get older? Because MS reduces brain and spinal cord reserve pwMS are more susceptible to the ravages of ageing. This is something people with MS should think about now. How do you want to live your life when you are older? It makes sense to do everything in your power in the now to optimise your brain health for later. This rallying call should be a general one to everyone reading this post. How healthy are you and what are you doing to improve your brain health? Have you joined the brain health challenge?”
Public Health England. Recent Trends in Life Expectancyat Older Ages. February 2015
- Over the last 30 years there has been an upward trend in life expectancy at older
ages in England. Life expectancy among those aged 65 has increased at an
average rate of 1.2% per year for men and 0.7% per year for women
- within England, although female life expectancy at age 65, 75, 85 and 95 fell in
2012, and for males it fell at ages 85 and 95 and remained static at ages 65 and 75,
it is too early to say whether this represents a slowing down in the upward trend or
the start of a downward trend
- the overall upward trend and the fall described for 2012 in England were reflected
across many of the countries of the European Union
- between 2008 to 2010 and 2011 to 2013, 89% of lower tier and unitary local
authorities had an increase in male life expectancy at 65 years, and 81% had an
increase in female life expectancy at this age. There does not appear to be a
relationship between change in life expectancy at age 65 and the level of life
expectancy in 2008 to 2010 or level of deprivation for a local authority. Local
authorities that did not show an increase are not confined to specific areas of the
- PHE will continue to monitor life expectancy and mortality in England and other
geographies, and will make the findings available in future reports
Satizabal et al. Incidence of Dementia over Three Decades in the Framingham Heart Study. N Engl J Med. 2016 Feb 11;374(6):523-32.
METHODS: Participants in the Framingham Heart Study have been under surveillance for incident dementia since 1975. In this analysis, which included 5205 persons 60 years of age or older, we used Cox proportional-hazards models adjusted for age and sex to determine the 5-year incidence of dementia during each of four epochs. We also explored the interactions between epoch and age, sex, apolipoprotein E ε4 status, and educational level, and we examined the effects of these interactions, as well as the effects of vascular risk factors and cardiovascular disease, on temporal trends.
RESULTS: The 5-year age- and sex-adjusted cumulative hazard rates for dementia were 3.6 per 100 persons during the first epoch (late 1970s and early 1980s), 2.8 per 100 persons during the second epoch (late 1980s and early 1990s), 2.2 per 100 persons during the third epoch (late 1990s and early 2000s), and 2.0 per 100 persons during the fourth epoch (late 2000s and early 2010s). Relative to the incidence during the first epoch, the incidence declined by 22%, 38%, and 44% during the second, third, and fourth epochs, respectively. This risk reduction was observed only among persons who had at least a high school diploma (hazard ratio, 0.77; 95% confidence interval, 0.67 to 0.88). The prevalence of most vascular risk factors (except obesity and diabetes) and the risk of dementia associated with stroke, atrial fibrillation, or heart failure have decreased over time, but none of these trends completely explain the decrease in the incidence of dementia.
CONCLUSIONS: Among participants in the Framingham Heart Study, the incidence of dementia has declined over the course of three decades. The factors contributing to this decline have not been completely identified. (Funded by the National Institutes of Health.).