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Research paper
Lifetime risk of common neurological diseases in the elderly population
  1. Silvan Licher1,
  2. Sirwan K L Darweesh1,
  3. Frank J Wolters1,2,
  4. Lana Fani1,2,
  5. Alis Heshmatollah1,2,
  6. Unal Mutlu1,3,
  7. Peter J Koudstaal2,
  8. Jan Heeringa1,
  9. Maarten J G Leening1,4,5,
  10. M Kamran Ikram1,2,
  11. M Arfan Ikram1
  1. 1 Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
  2. 2 Department of Neurology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
  3. 3 Department of Radiology and Nuclear Medicine, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
  4. 4 Department of Cardiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
  5. 5 Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
  1. Correspondence to Dr M Arfan Ikram, Department of Epidemiology, Erasmus MC University Medical Center Rotterdam, Rotterdam 3015 GD, The Netherlands; m.a.ikram{at}


Objective To quantify the burden of common neurological disease in older adults in terms of lifetime risks, including their co-occurrence and preventive potential, within a competing risk framework.

Methods Within the prospective population-based Rotterdam Study, we studied lifetime risk of dementia, stroke and parkinsonism between 1990 and 2016. Among 12 102 individuals (57.7% women) aged ≥45 years free from these diseases at baseline, we studied co-occurrence, and quantified the combined, and disease-specific remaining lifetime risk of these diseases at various ages for men and women separately. We also projected effects on lifetime risk of hypothetical preventive strategies that delay disease onset by 1, 2 and 3 years, respectively.

Results During follow-up of up to 26 years (156 088 person-years of follow-up), 1489 individuals were diagnosed with dementia, 1285 with stroke and 263 with parkinsonism. Of these individuals, 438 (14.6%) were diagnosed with multiple diseases. Women were almost twice as likely as men to be diagnosed with both stroke and dementia during their lifetime. The lifetime risk for any of these diseases at age 45 was 48.2% (95% CI 47.1% to 51.5%) in women and 36.2% (35.1% to 39.3%) in men. This difference was driven by a higher risk of dementia as the first manifesting disease in women than in men (25.9% vs 13.7%; p<0.001), while this was similar for stroke (19.0%vs18.9% in men) and parkinsonism (3.3% vs 3.6% in men). Preventive strategies that delay disease onset with 1 to 3 years could theoretically reduce lifetime risk for developing any of these diseases by 20%–50%.

Conclusion One in two women and one in three men will develop dementia, stroke or parkinsonism during their life. These findings strengthen the call for prioritising the focus on preventive interventions at population level which could substantially reduce the burden of common neurological diseases in the ageing population.

  • dementia
  • stroke

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  • MKI and MAI are joint last authors.

  • SL, SKLD and FJW contributed equally.

  • Contributors All authors have made a substantial intellectual contribution to design of the study (MKI, MAI), acquisition of data (PJK, MKI, JH, SKLD, FJW, UM, SL, LF, AH), analysis and interpretation of data (SKLD, FJW, SL, MKI, MAI), drafting the manuscript (SL, SKLD, FJW) or revising it critically for important intellectual content (PJK, LF, AH, UM, JH, MJGL, MKI, MAI). All authors approved the final version of the manuscript for publication. MAI had full access to the data in the study and takes responsibility for data integrity and accuracy of data analysis.

  • Funding The Rotterdam Study is sponsored by the Erasmus MC and Erasmus University Rotterdam, The Netherlands Organisation for Scientific Research (NWO), The Netherlands Organisation for Health Research and Development (ZonMw), the Research Institute for Diseases in the Elderly (RIDE), The Netherlands Genomics Initiative, the Ministry of Education, Culture and Science, the Ministry of Health, Welfare and Sports, the European Commission (DG XII) and the Municipality of Rotterdam. Further support was obtained from the Netherlands Consortium for Healthy Ageing and the Dutch Heart Foundation (2012T008). None of the funding organisations or sponsors were involved in study design, in collection, analysis and interpretation of data, in writing of the report or in the decision to submit the article for publication.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Because of ethical restrictions, data are available on request. Interested researchers may contact our data management team ( or the corresponding author of this study.