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Lifetime risk and projected burden of dementia

Nature Medicine volume 31, pages 772–776 (2025)Cite this article

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Abstract

Understanding the lifetime risk of dementia can inform public health planning and improve patient engagement in prevention. Using data from a community-based, prospective cohort study (n = 15,043; 26.9% Black race, 55.1% women and 30.8% with at least one apolipoprotein E4 (APOE ε4) allele), we estimated the lifetime risk of dementia (from age 55 years to 95 years), with mortality treated as a competing event. We applied lifetime risk estimates to US Census projections to evaluate the annual number of incident dementia cases from 2020 to 2060. The lifetime risk of dementia after age 55 years was 42% (95% confidence interval: 41–43). Rates were substantially higher in women, Black adults and APOE ε4 carriers, with lifetime risks ranging from approximately 45% to 60% in these populations. The number of US adults who will develop dementia each year was projected to increase from approximately 514,000 in 2020 to approximately 1 million in 2060. The relative growth in new dementia cases was especially pronounced for Black adults. These results highlight the urgent need for policies that enhance healthy aging, with a focus on health equity.

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Fig. 1: Lifetime risk of dementia (from age 55 years to 95 years), the ARIC study, overall and by sex, race and APOE ε4 status (n = 15,043).
Fig. 2: Projected number of incident dementia cases in US adults, 2020–2060, overall and by age, sex and race.

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Data availability

ARIC data access procedures are in accordance with participant informed consent and NIH data-sharing policy. Anonymized data from the ARIC study are available at the NHLBI Biologic Specimen and Data Repository Information Coordinating Center and can be accessed through the website (https://biolincc.nhlbi.nih.gov/studies/aric/). Requests for access of ARIC data may also be submitted to the ARIC Publications Committee according to established study procedures, which include submission of a completed ARIC Manuscript Proposal Form (available at https://aric.cscc.unc.edu/aric9/publications/policies_forms_and_guidelines) to the ARIC Publications Committee at aricpub@unc.edu. Review and approval of data access requests typically takes approximately 1 month.

Code availability

The analytic code used for analyses in this study is available from the corresponding author upon reasonable request.

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Acknowledgements

This study was supported by National Institutes of Health (NIH)/National Heart, Lung, and Blood Institute (NHLBI) grant K24 HL152440 (to E.S.); NIH/National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) grant K01 DK138273 (to M.F.); NIH/National Institute on Aging (NIA) grant R01AG054787 (to B.G.W.); the National Institute of Neurological Disorders and Stroke (NINDS) Intramural Research Program (to R.F.G.); and the NIA Intramural Research Program (to K.A.W.). The ARIC study is carried out as a collaborative study supported by NHLBI contracts 75N92022D00001, 75N92022D00002, 75N92022D00003, 75N92022D00004 and 75N92022D00005. The ARIC Neurocognitive Study is supported by U01HL096812, U01HL096814, U01HL096899, U01HL096902 and U01HL096917 from the NIH. The funders had no role in the design and conduct of the study; in collection, management, analysis and interpretation of the data; in preparation, review or approval of the manuscript; and in the decision to submit the manuscript for publication. We thank the staff and participants of the ARIC study for their important contributions. We also thank K. Da Silva and J. Pike for their valuable suggestions and help during revisions.

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Authors and Affiliations

  1. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Michael Fang, Jiaqi Hu, A. Richey Sharrett & Elizabeth Selvin

  2. Institute for Hospital Management, Tsinghua University, Beijing, China

    Jiaqi Hu

  3. Optimal Aging Institute and Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA

    Jordan Weiss & Josef Coresh

  4. Department of Neurology, Mayo Clinic, Rochester, MN, USA

    David S. Knopman

  5. Department of Neurology, Johns Hopkins Medicine, Baltimore, MD, USA

    Marilyn Albert

  6. Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA

    B. Gwen Windham & Thomas Mosley

  7. Intramural Research Program, National Institute on Aging, Bethesda, MD, USA

    Keenan A. Walker

  8. Intramural Research Program, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA

    Rebecca F. Gottesman

  9. Division of Epidemiology & Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA

    Pamela L. Lutsey

  10. Division of Epidemiology, Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA

    Josef Coresh

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Contributions

M.F. had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Concept and design: M.F. and J.C. Acquisition, analysis or interpretation of data: M.F., J.C., E.S. and J.H. Drafting of the manuscript: M.F. Critical revision of the manuscript for important intellectual content: all authors. Statistical analysis: J.H. and J.W. Administrative, technical or material support: J.C. and E.S. Supervision: J.C.

Corresponding author

Correspondence to Josef Coresh.

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Competing interests

D.S.K. has no disclosures relevant to the current work. D.S.K. serves on a Data Safety Monitoring Board for the Dominantly Inherited Alzheimer Network Treatment Unit study. He was an investigator in Alzheimer clinical trials sponsored by Biogen, Eli Lilly Pharmaceuticals and the University of Southern California and is currently an investigator in a trial in frontotemporal degeneration with Alector. He has served as a consultant for Roche, AriBio, Linus Health, Biovie and Alzeca Biosciences but receives no personal compensation. He receives funding from the NIH. The other authors declare no competing interests.

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Nature Medicine thanks Robert Clarke, Bryan James and the other, anonymous, reviewer(s) for their contribution to the peer review of this work. Primary handling editor: Jerome Staal, in collaboration with the Nature Medicine team.

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Extended data

Extended Data Table 1 Participant characteristics at age 55 years, the ARIC study
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Extended Data Table 2 Number of participants with dementia by different diagnostic criteria, the ARIC study (n = 3,252)
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Extended Data Table 3 Crude incidence for dementia and death free of dementia from age 55 years to age 95 years, the ARIC study, overall and by sex, race and APOE ε4 status (n = 15,043)
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Extended Data Table 4 Lifetime risk of dementia (from age 55 years to age 95 years), by APOE ε4 status, sex and race
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Extended Data Table 5 Lifetime risk of dementia after select index ages (ages 55, 65, 75 and 85) to 95 years, the ARIC study, overall and by sex, race and APOE ε4 status
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Extended Data Table 6 Median age at dementia diagnosis and distribution of diagnosis age, the ARIC study, overall and by sex, race and APOE ε4 status (n = 3,252)
Full size table

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Fang, M., Hu, J., Weiss, J. et al. Lifetime risk and projected burden of dementia. Nat Med 31, 772–776 (2025). https://doi.org/10.1038/s41591-024-03340-9

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