Anne Gräsbeck

Senile dementia of the Alzheimer type in the Lundby Study. II. An attempt to identify possible risk factors.

SummaryIn recent years research on senile dementia of the Alzheimer type (SDAT) has made progress within the field of pathology and to a certain extent in that of heredity. Within epidemiology, the search for risk factors is intensifying but the findings are still inconclusive. The present study of possible risk factors concentrates on environmental and personality factors. The total population of 2612 persons from a geographically delimited area, Lundby, two neighbouring parishes in southern Sweden, was examined in 1957 by one psychiatrist (Hagnell). A follow-up study of the same population, irrespective of domicile, was performed 15 years later, in 1972. Various precipitating as well as protective personality background factors were found to be significant for the outcome of SDAT, but no environmental factors appeared to be statistically significant in this cohort.

Mortality of Anxiety Syndromes in a Normal Population

The mortality of anxiety syndromes between 1972 and 1992 was investigated in a prospective study of a normal population, the 1947 Lundby cohort. 121 persons with anxiety according to the Lundby definition (Anx), and 74 persons with panic disorder with/without agoraphobia (PD-Ag) according to the DSM-III-R, all of them developing their first episode between 1947 and 1972, were analyzed with regard to general mortality and special cause of death. Sex- and age-specific mortality rates for these groups were calculated and compared with the corresponding rates of the cohorts 1,877 remaining subjects without first episodes of Anx/PD-Ag. In contrast to the females, the annual rates of general mortality in males with Anx/PD-Ag were 1.9/2.2 times higher in the age group 65-84 years, compared with the rates of the non-Anx/PD-Ag groups. They also had an increase in death due to circulatory disorders, most pronounced in males with PD-Ag before the age of 65. There were no suicides in any of the Anx/PD-Ag groups during the observation period.

Senile dementia of the Alzheimer type in the Lundby Study. I. A prospective, epidemiological study of incidence and risk during the 15 years 1957-1972.

SummaryIn spite of the great impact of senile dementia of the Alzheimer type (SDAT) on society, far too little is known about its epidemiology. In this study of a total, normal population from a geographically delimited area in Sweden, Lundby, 2612 persons were examined in 1957 by one psychiatrist (Hagnell). In 1972 the same population was reexamined irrespective of domicile. The incidence and risk of contracting SDAT during the 15 years were calculated. No cases of SDAT were diagnosed before the age of 60 years. The lifetime risk was for men 25.7% and for women 26.2%. When only the very severely impaired were taken into account, the figures were 14.5% in men and 14.6% in women.

Mental tiredness in the Lundby study: incidence and course over 25 years.

The Lundby study is a prospective, epidemiological survey of mental health in a total population. When evaluating the material of 2550 individuals followed from 1947 to 1972, we found a large group with mental tiredness as the dominating symptom. Next to depression this was the most frequent diagnosis in the population. According to our concept of Tiredness, one third of the women ran a lifetime risk of developing a first‐ever episode of Tiredness, while the risk for men was one fifth. The incidence of Tiredness is described together with the total frequency of episodes. The course of mental illness starting with a first episode of Tiredness within the 25‐year investigation period shows that about one third of the men and half of the women relapsed into Tiredness or other mental illnesses, not infrequently with a serious outcome. However, most of the episodes of Tiredness lasted less than 2 years and were of milder impairment. We emphasize the importance of further investigations by means of epidemiological, clinical and neurochemical methods as regards the heterogeneous syndrome of mental fatigue.

Vascular Dementia in the Lundby Study

In this study, a total population, the 1957 Lundby cohort, was investigated with regard to the incidence of vascular dementia over a 15-year period, and to provide a succeeding study with basic data concerning the background factors for vascular dementia. The 1957 cohort comprises 2,612 persons who were registered in the geographically delimited Lundby area on July 1, 1957. The lifetime risk of developing vascular dementia was found to be 34.5% in men and 19.4% in women when all degrees of impairment were taken into account, the preponderance for the male sex being very obvious.

First-incidence anxiety in the Lundby Study: course and predictors of outcome

The aim of the present study was to analyse first‐incidence anxiety in the Lundby Study with regard to course and predictors of outcome between 1947 and 1972. The Lundby concept of anxiety corresponds broadly to that of anxiety disorders in DSM‐III‐R. The Lundby Study is a prospective, psychiatric study of a geographically defined total population. The present study includes 124 subjects (46 men and 78 women) who between 1947 and 1972 developed anxiety as their first mental illness in life. The median total duration of illness was 1.6 years in men and 1.4 years in women. In both sexes episodes of mild impairment dominated. In total, 54% of the men and 71% of the women were mentally healthy at the follow‐up in 1972. A minority of the probands (27%) received psychiatric treatment. They significantly more often suffered from panic disorder with agoraphobia during their first episode, and from comorbidity of other mental illnesses, than did untreated subjects. They also had a significantly longer total duration of illness, a variable with a negative predictive influence on the probability of being mentally healthy in 1972. Men with anxiety showed a 55% increase in alcoholism compared to standard values. They also displayed an increased risk of relapsing into mental illness compared to female cases, a result which, in the light of earlier findings of increased mortality rates, suggests that further investigations of men with anxiety syndromes in the general population are warranted.