INCIDENCE AND RISK-FACTORS OF VASCULAR DEMENTIA AND ALZHEIMERS-DISEASE IN A DEFINED ELDERLY JAPANESE POPULATION - THE HISAYAMA STUDY
INCIDENCE AND RISK-FACTORS OF VASCULAR DEMENTIA AND ALZHEIMERS-DISEASE IN A DEFINED ELDERLY JAPANESE POPULATION - THE HISAYAMA STUDY
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DOI：
10.1212/wnl.45.6.1161
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发表时间：
1995-06-01
期刊：
影响因子：
9.9
通讯作者：
FUJISHIMA, M
中科院分区：
文献类型：
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作者：
YOSHITAKE, T;KIYOHARA, Y;FUJISHIMA, M
我们从1985年开始对日本九州久山镇828名65岁或以上的非痴呆居民(占老年人口的88.3%)进行了长达7年的跟踪调查，以确定日本普通人群中痴呆的特定类型发病率及其危险因素。只有两名受试者失去了随访，在此期间，103名受试者患上了痴呆症。89例(86.4%)通过尸检或CT进行了脑组织形态检查。我们根据DSM-III-R标准对痴呆进行了初步诊断，其中血管性痴呆(VD)的诊断基于NINDS-Airen标准，阿尔茨海默病(AD)的诊断基于NINCDS-ADRDA标准。无论男女，VD和AD的发病率均随年龄增长而增加。年龄调整后的痴呆症总发病率(每1000人年)男性为19.3，女性为20.9。VD的相应发病率男性为12.2，女性为9.0；AD的相应发病率为男性5.1，女性10.9。在我们检查其脑形态的VD受试者中，最常见的中风类型是多发性腔隙性脑梗塞(42%)，但这些受试者中有一半在他们的病史中没有中风发作。多因素分析显示，年龄、既往中风病史、收缩压和饮酒是VD发生的显著独立危险因素。相比之下，年龄和长谷川痴呆量表得分低是AD的显著危险因素，而体力活动是AD的重要预防因素。我们的研究结果表明，无症状性卒中是VD发生的重要因素，年龄、既往卒中发作、收缩压和饮酒是其发生的独立危险因素。年龄和长谷川痴呆量表的低分是AD的重要风险因素，适度的体力活动具有统计上显著的预防效果。
We followed 828 nondemented residents of Hisayama Town, Kyushu,Japan, aged 65 years or older (88.3% of the elderly population) for 7 years starting in 1985 in order to determine the type-specific incidence of dementia and its risk factors in the general Japanese population. Only two subjects were lost to the follow-up, during which period 103 subjects developed dementia. Morphologic examination of the brains of 89 subjects (86.4%) was made by autopsy or CT. We made the initial diagnosis of dementia based on the DSM-III-R criteria, with the diagnoses of vascular dementia (VD) being based on the NINDS-AIREN criteria and Alzheimer's disease (AD) on the NINCDS-ADRDA criteria. The incidence of VD and AD increased with age for both sexes. The age-adjusted total incidence (per 1,000 person-years) of dementia was 19.3 for men and 20.9 for women. The corresponding rates for VD were 12.2 for men and 9.0 for women, and for AD, 5.1 for men and 10.9 for women. Among the VD subjects whose brain morphology we examined, the most frequent type of stroke was multiple lacunar infarcts (42%), but half these subjects lacked a stroke episode in their histories. Multivariate analysis showed that age, prior stroke episodes, systolic blood pressure, and alcohol consumption were significant independent risk factors for the occurrence of VD. In contrast, age and a low score on Hasegawa's dementia scale were significant risk factors for AD, and physical activity was a significant preventive factor for AD. Our findings suggest that asymptomatic stroke is an important factor in the development of VD, with age, prior stroke episodes, systolic blood pressure, and alcohol consumption being independent risk factors for its occurrence. Age and a low score on Hasegawa's dementia scale are significant risk factors for AD, with moderate physical activity having a statistically significant preventive effect.