This is a revision of an application (1 R29 AG11862, """"""""Epidemiology of Alzheimer's Disease in Women: Risk and Impact"""""""") which was not funded. Alzheimer's disease poses a large and growing public health problem for the U.S. and other developed countries. Because occurrence of the disease is very strongly related to age and because women live substantially longer than men, many more women are affected than are men. Gender differences both in risk of this disease and its consequences have received relatively little formal attention in epidemiologic studies, however. The proposed research will compare occurrence rates and disease consequences in women and men and provide projections of the growth in the numbers of affected women and men in the U.S. population. Existing data sets to which the investigators have full access will be used for these analyses. The hypothesis that the age-specific incidence and prevalence of Alzheimer's disease are higher among women than men will be tested in data from a defined community population. Possible gender differences in several important consequences of the disease will be examined: Hypotheses that the rate of decline in physical function is larger among women with Alzheimer's disease than men but that mortality is lower among women with the disease will each be tested in three different settings (community, institutional long-term care, non-institutional long-term care). The hypothesis that rates of aggressive behaviors are lower among women with Alzheimer's disease than among men will be examined in two of these settings (community, institutional long-term care). Use of medical services by persons with Alzheimer's disease will be examined in data from a defined community with the hypotheses that women with Alzheimer's disease are more likely to use acute care hospital services than men controlling for level of disease and other risk factors and also more likely to enter institutional long-term care. Finally, the growth of Alzheimer's disease among women in the U.S. population in the future will be examined, using a range of demographic projects. Women comprise the largest segment of all persons over age 65 and of the oldest old, and the size of these groups is growing rapidly. Accurate description of differences in risk and disease consequences is an essential first step in identifying both resource needs and potential avenues for intervention.
