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OBJECTIVES: Little is known about the prevalence and incidence of dementia in Aboriginal communities in Canada. As with the Canadian population, dementia in Aboriginal people is expected to be an increasing challenge for federal, provincial and community health care systems. To respond to a dearth of information concerning the prevalence of dementia in First Nations, this paper reports population-level data on dementia in the First Nations population in Alberta, Canada. METHODS: Aggregate data obtained from Alberta Health and Wellness were analyzed. Physician-treated prevalence rates for dementia were calculated for First Nations and non-First Nations populations seeking treatment in Alberta (1998-2009). Trends in age-adjusted rates over time were compared using linear regression models. Age and sex effects were also examined. RESULTS: In 2009, the age-standardized prevalence of dementia in First Nations in Alberta was 7.5 per 1,000 (95% CI: 6.6 to 8.5 per 1,000) compared to non-First Nations, at 5.6 per 1,000 (95% CI: 5.5 to 5.6). The prevalence of dementia rose more quickly for First Nations (p=0.032). The data suggest that dementia disproportionately affects younger age groups and males (p=0.017) in First Nations populations compared to non-First Nations. CONCLUSIONS: Dementia represents an emerging health concern for First Nations. This increase may be driven by parallel trends, such as population aging, changing perceptions of dementia, and disproportionately higher rates of associated risk factors, impacts of the social determinants of health, and co-morbid illnesses. The unique epidemiological profile supports the need for responsive policies, programs and care geared specifically to First Nations. KEY WORDS: Dementia; Alzheimer disease; First Nations; epidemiology; Canada OBJECTIFS : On sait peu de choses sur la prevalence et l'incidence de la demence dans les communautes autochtones au Canada. Comme dans la population canadienne, on s'attend a ce que la demence chez les Autochtones presente un defi croissant pour les systemes de sante federal, provinciaux et locaux. Pour combler le manque d'information sur la prevalence de la demence chez les Premieres Nations, nous presentons des donnees populationnelles sur la demence dans la population des Premieres Nations de l'Alberta, au Canada. METHODE : Nous avons analyse les donnees globales du ministere albertain de la Sante et du Bien-etre. Les taux de prevalence de la demence traitee par un medecin ont ete calcules pour les populations des Premieres Nations et hors Premieres Nations en quete de soins en Alberta (1998-2009). A l'aide de modeles de regression lineaire, nous avons compare l'evolution dans le temps des taux ajustes selon l'age. Nous avons aussi examine les effets selon l'age et le sexe. RESULTATS : En 2009, la prevalence de la demence, standardisee pour l'age, chez les Premieres Nations de l'Alberta etait de 7,5 p. 1 000 (IC de 95 % : 6,6 a 8,5 p. 1 000), tandis qu'hors des Premieres Nations, elle etait de 5,6 p. 1 000 (IC de 95 % : 5,5 a 5,6). La prevalence de la demence a augmente plus rapidement chez les Premieres Nations (p=0,032). Les donnees montrent que la demence touche les jeunes et les hommes de facon demesuree (p=0,017) dans les populations des Premieres Nations comparativement aux populations hors Premieres Nations. CONCLUSION : La demence est un probleme de sante emergent pour les Premieres Nations. Son augmentation pourrait etre alimentee par des tendances paralleles, comme le vieillissement de la population, l'evolution des perceptions a l'egard de la demence, ainsi que les taux demesurement plus eleves des facteurs de risque associes, les impacts des determinants sociaux de la sante et les comorbidites. Ce profil epidemiologique singulier appelle a des politiques, des programmes et des soins plus specifiquement adaptes aux Premieres Nations. MOTS CLES : demence; maladie d'Alzheimer; Premieres Nations; epidemiologie; Canada, In Canada, the number of people with Alzheimer's disease and related dementias is projected to more than double to 1,125,184 over the next 30 years. (1) Little is known about [...]

Purpose: The purpose of this study was to quantify the effect of specific nursing home features and state Medicaid policies on the risk of hospitalization among cognitively impaired nursing home residents. Design and Methods: We used multilevel logistic regression to estimate the odds of hospitalization among long-stay (>90 days) nursing home residents against the odds of remaining in the nursing home over a 5-month period, controlling for covariates at the resident, nursing home, and county level. We stratified analyses by resident diagnosis of dementia. Results: Of 359,474 cognitively impaired residents, 49% had a diagnosis of dementia. Of those, 16% were hospitalized. The probability of hospitalization was negatively associated with the presence of a dementia special care unit (adjusted odds ratio [AOR] = 0.90, 95% confidence interval [CI] = 0.86-0.94) and with a high prevalence of dementia in the nursing home (AOR = 0.96, 95% CI = 0.88-1.03). Higher Medicaid payment rates were associated with reduced likelihood of hospitalization (AOR -- 0.95, 95% CI = 0.90-1.00), whereas any bed-hold policy substantially increased that likelihood (AOR = 1.44, 95% CI = 1.12-1.86). We observed similar results for residents without a dementia diagnosis. Implications: Directed management of chronic conditions, as indicated by facilities' investment in special care units, reduces the risk of hospitalization, but the effect of bed-hold policies illustrates how fragmentation in the financing system impedes these efforts. Key Words: Medicare, Nursing homes, Long-term care, Risk of hospitalization, Medicaid

Some researchers and many in the lay public believe the ageist myth that the older you get the sicker you get. If this were true, it would follow that most if not all centenarians should have Alzheimer's disease. Numerous centenarian studies disprove this assumption given that a small percentage (~15-25%) of centenarians are functionally cognitively intact. Among those who are not cognitively intact at 100, ~90% delayed the onset of clinically evident impairment at least until an average age of 92 years. Neuropsychological and neuropathological correlations thus far suggest that there are centenarians who demonstrate no evidence of neurodegenerative disease. There also appear to be centenarians who, despite the substantial presence of neuropathological markers of Alzheimer's disease, do not meet clinical criteria for having dementia, thus suggesting the existence of cognitive reserve. Centenarians are therefore of scientific interest as a human model of relative resistance to dementia.