Time Trends in Incidence of Reported Memory Concerns and Cognitive Decline: A Cohort Study in UK Primary Care.

Purpose: To investigate time trends in incidence of recorded memory concerns (MC) and cognitive decline (CD) in a UK older population presenting to primary care with no prior diagnosis of dementia. To determine the risk of developing dementia in people with recorded memory concern and cognitive decline. Patients and methods: We included individuals aged 65-99 years who contributed to data within the IQVIA medical research database from 1st January 2009 to 31st December 2018. We reported crude incidence rates for MC (study population n=1,310,838) and CD (n=1,348,796). We conducted survival analysis to estimate the risk of developing dementia using fine-grey sub-distribution hazard model with competing risk of death. Results: We identified 55,941 individuals (4.3%) with a record of incident MC; rates were fairly stable over the decade of study. We identified 14,869 people (1.1%) with a record of incident CD, and these rates increased from 1.29/1000 PYAR (95% CI 1.21 to 1.38) in 2009 to 3.49/1000 PYAR (95% CI 3.30 to 3.68) in 2018. Within 3 years of follow up from the first record of MC, 45.5% of individuals received a diagnosis of dementia, while of those with a record of CD, 51.7% received a dementia diagnosis. Women, people in older age groups and those living in more deprived areas were more likely to have a record of MC or CD, and their symptoms were more likely to progress to a dementia diagnosis. Conclusion: Incidence rates of MC and CD estimated from routinely collected primary care data are lower than those reported in community surveys, suggesting that a minority of people who experience memory loss consult their GP and have it recorded. Our findings indicate that those who do report concerns to primary care, especially women, those in older age groups and those in more deprived areas, are at a higher risk for developing dementia.