Background Gender‐specific risks for dementia and Alzheimer's disease (AD) starting in midlife remain largely unknown. Methods Prospectively ascertained dementia/AD and cause‐specific mortality in Framingham Heart Study (FHS) participants was used to generate 10‐ to 50‐year risk estimates of dementia/AD on the basis of the Kaplan–Meier method (cumulative incidence) or accounting for competing risk of death (lifetime risk [LTR]). Results Overall, 777 cases of incident dementia (601 AD) occurred in 7901 participants (4333 women) over 136,266 person‐years. Whereas cumulative incidences were similar in women and men, LTRs were higher in women older than 85 years of age. LTR of dementia/AD at age 45 was 1 in 5 in women and 1 in 10 in men. Cardiovascular mortality was higher in men with rate ratios decreasing from approximately 6 at 45 to 54 years of age to less than 2 after age 65. Conclusion Selective survival of men with a healthier cardiovascular risk profile and hence lower propensity to dementia might partly explain the higher LTR of dementia/AD in women.

Gender and incidence of dementia in the Framingham Heart Study from mid‐adult life