痴呆症患病率和发病率以及痴呆症风险因素的变化:队列研究分析。

IF 25.4 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Lancet Public Health Pub Date : 2024-07-01 DOI:10.1016/S2468-2667(24)00120-8
Naaheed Mukadam, Frank J Wolters, Sebastian Walsh, Lindsay Wallace, Carol Brayne, Fiona E Matthews, Simona Sacuiu, Ingmar Skoog, Sudha Seshadri, Alexa Beiser, Saptaparni Ghosh, Gill Livingston
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引用次数: 0

摘要

背景:一些队列研究报告称,随着时间的推移,痴呆症患病率和发病率有所下降,但这些研究结果并不一致。我们利用已发表的基于人群的队列研究,回顾了痴呆症患病率和发病率随时间推移而变化的证据,这些研究在每一波次中都采用了一致的方法,并旨在利用人群可归因分数(PAFs)量化风险因素随时间推移而发生的相关变化:我们搜索了有关研究痴呆症患病率或发病率随时间变化的队列研究的系统综述。我们使用检索词 "系统综述 "和 "痴呆症 "和("患病率 "或 "发病率")检索了 PubMed 上从数据库开始到 2023 年 1 月 12 日的出版物,没有语言限制。我们在 2024 年 3 月 28 日重复了这一搜索。在符合条件的系统综述中,我们检索了参考文献并选择了同行评议出版物中的队列研究,这些研究在同一地理位置、至少两个时间点测量了痴呆症的流行率或发病率,并报告了年龄标准化的痴呆症流行率或发病率。此外,数据必须来自以人口为基础的样本,对参与者的认知状况进行评估,并使用有效的标准来诊断痴呆症。我们从每篇论文中提取了有关痴呆症风险因素的摘要级数据,如果发表的论文中没有此类数据,我们会联系作者,并计算出每个风险因素在所有可用时间点上的 PAFs。在可能的情况下,我们将痴呆症患病率或发病率的变化与风险因素患病率的变化联系起来:我们在初步搜索中发现了 1925 条记录,其中有五篇符合条件的系统综述。在这些系统综述中,我们发现了 71 篇可能符合条件的主要论文,其中 27 篇被纳入我们的分析。27 篇主要论文中有 13 篇(48%)报告了痴呆症患病率的变化,10 篇(37%)报告了痴呆症发病率的变化,4 篇(15%)报告了痴呆症发病率和患病率的变化。欧洲(5 项)和美国(5 项)报告痴呆症发病率随时间变化的研究一致报告痴呆症发病率在下降。日本的一项研究报告痴呆症患病率和发病率均有所上升,尼日利亚的一项研究报告发病率保持稳定。总体而言,在各项研究中,受教育程度较低或吸烟或两者的 PAFs 随时间推移普遍下降,而肥胖、高血压和糖尿病的 PAFs 则普遍上升。在弗雷明汉研究(美国马萨诸塞州弗雷明汉,1997-2013 年)中,教育程度较低和吸烟的 PAFs 下降与痴呆症发病率下降有关,这是唯一一项有足够数据进行分析的研究:我们的研究结果表明,义务教育和通过国家层面的政策变化降低吸烟率等生活方式干预措施可能与观察到的痴呆症发病率下降有关,因此也可能与未来痴呆症发病率下降有关。还需要在中低收入国家开展更多研究,因为这些国家的痴呆症发病率最高,而且还在继续增加:国家健康与护理研究所三校痴呆症研究计划。
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Changes in prevalence and incidence of dementia and risk factors for dementia: an analysis from cohort studies.

Background: Some cohort studies have reported a decline in dementia prevalence and incidence over time, although these findings have not been consistent across studies. We reviewed evidence on changes in dementia prevalence and incidence over time using published population-based cohort studies that had used consistent methods with each wave and aimed to quantify associated changes in risk factors over time using population attributable fractions (PAFs).

Methods: We searched for systematic reviews of cohort studies examining changes in dementia prevalence or incidence over time. We searched PubMed for publications from database inception up to Jan 12, 2023, using the search terms "systematic review" AND "dementia" AND ("prevalence" OR "incidence"), with no language restrictions. We repeated this search on March 28, 2024. From eligible systematic reviews, we searched the references and selected peer-reviewed publications about cohort studies where dementia prevalence or incidence was measured in the same geographical location, at a minimum of two timepoints, and that reported age-standardised prevalence or incidence of dementia. Additionally, data had to be from population-based samples, in which participants' cognitive status was assessed and where validated criteria were used to diagnose dementia. We extracted summary-level data from each paper about dementia risk factors, contacting authors when such data were not available in the published paper, and calculated PAFs for each risk factor at all available timepoints. Where possible, we linked changes in dementia prevalence or incidence with changes in the prevalence of risk factors.

Findings: We identified 1925 records in our initial search, of which five eligible systematic reviews were identified. Within these systematic reviews, we identified 71 potentially eligible primary papers, of which 27 were included in our analysis. 13 (48%) of 27 primary papers reported change in prevalence of dementia, ten (37%) reported change in incidence of dementia, and four (15%) reported change in both incidence and prevalence of dementia. Studies reporting change in dementia incidence over time in Europe (n=5) and the USA (n=5) consistently reported a declining incidence in dementia. One study from Japan reported an increase in dementia prevalence and incidence and a stable incidence was reported in one study from Nigeria. Overall, across studies, the PAFs for less education or smoking, or both, generally declined over time, whereas PAFs for obesity, hypertension, and diabetes generally increased. The decrease in PAFs for less education and smoking was associated with a decline in the incidence of dementia in the Framingham study (Framingham, MA, USA, 1997-2013), the only study with sufficient data to allow analysis.

Interpretation: Our findings suggest that lifestyle interventions such as compulsory education and reducing rates of smoking through country-level policy changes could be associated with an observed reduction, and therefore future reduction, in the incidence of dementia. More studies are needed in low-income and middle-income countries, where the burden of dementia is highest, and continues to increase.

Funding: National Institute for Health and Care Research Three Schools' Dementia Research Programme.

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来源期刊
Lancet Public Health
Lancet Public Health Medicine-Public Health, Environmental and Occupational Health
CiteScore
55.60
自引率
0.80%
发文量
305
审稿时长
8 weeks
期刊介绍: The Lancet Public Health is committed to tackling the most pressing issues across all aspects of public health. We have a strong commitment to using science to improve health equity and social justice. In line with the values and vision of The Lancet, we take a broad and inclusive approach to public health and are interested in interdisciplinary research. We publish a range of content types that can advance public health policies and outcomes. These include Articles, Review, Comment, and Correspondence. Learn more about the types of papers we publish.
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