A comparison of the prevalence of and modifiable risk factors for cognitive impairment among community-dwelling Canadian seniors over two decades, 1991-2009

The prevalence of cognitive impairment or dementia is of public health concern globally. Accurate estimates of this debilitating condition are needed for future public health policy planning. In this study, we estimate prevalence and modifiable risk factors for cognitive impairment by sex over approximately 16 years. Canadian Study of Health and Aging (CSHA) baseline data conducted between 1991-1992 were used to measure the prevalence of cognitive impairment and dementia among adults aged 65+ years. The standard Modified Mini-Mental State Examination (3MS) was used for the screening test for cognitive impairment. We compared the CSHA data with Canadian Community Health Survey-Healthy Aging (CCHS-HA) conducted between 2008-2009. The CCHS-HA used a four-dimension cognitive module to screen for cognitive impairment. Only survey community-dwelling respondents were included in the final sample. After applying exclusion criteria, final samples of (N = 8504) respondents in the CSHA sample and (N = 7764) respondents for CCHS-HA sample were analyzed. To account for changes in the age structure of the Canadian population, prevalence estimates were calculated using age-sex standardization to the 2001 population census of Canada. Logistic regression analyses were used to examine predictors of cognitive impairment. A sex stratified analysis was used to examine risk factors for cognitive impairment in the survey samples. We found that prevalence of cognitive impairment among respondents in CSHA sample was 15.5% in 1991 while a prevalence of 10.8% was reported in the CCHS-HA sample in 2009, a 4.7% reduction [15.5% (CI = 14.8-16.3), CSHA vs 10.8% (CI = 10.1-11.5), CCHS-HA]. Men reported higher prevalence of cognitive impairment in CSHA study (16.0%) while women reported higher prevalence of cognitive impairment in CCHS-HA (11.6%). In the multivariable analyses, risk factors such as age, poor self-rated health, stroke, Parkinson's disease, and hearing problems were common to both cohorts. Sex differences in risk factors were also noted. This study provides suggestive evidence of a potential reduction in the occurrence of cognitive impairment among community-dwelling Canadian seniors despite the aging of the Canadian population. The moderating roles of improved prevention and treatment of vascular morbidity and improvements in the levels of education of the Canadian population are possible explanations for this decrease in the cognitive impairment.