Recent global trends in the prevalence and incidence of dementia, and survival with dementia.
Recent global trends in the prevalence and incidence of dementia, and survival with dementia.
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DOI：
10.1186/s13195-016-0188-8
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发表时间：
2016-07-30
期刊：
影响因子：
--
通讯作者：
Wu YT
中科院分区：
文献类型：
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作者：
Prince M;Ali GC;Guerchet M;Prina AM;Albanese E;Wu YT
目前对即将到来的痴呆症流行病规模的预测假设，痴呆症的年龄和性别特异性流行率不会随着时间的推移而变化，仅人口老龄化（增加有风险的老年人人数）就推动了预计的增加。这一假设的依据令人怀疑，长期趋势（即在长期内流行率逐渐下降或上升）是完全合理的。我们对自1980年以来进行的痴呆症患者患病率、发病率和死亡率趋势的研究进行了系统回顾。我们确定了9项跟踪痴呆症患病率的研究，8项跟踪痴呆症发病率的研究，4项跟踪痴呆症患者死亡率的研究。有一些适度一致的证据表明，痴呆症的发病率在高收入国家可能正在下降。关于痴呆症患病率趋势的证据在各研究中不一致，也没有表明任何明确的总体影响。发病率的下降可能与痴呆症的长期生存相平衡，尽管死亡率趋势很少被研究。有一些证据表明东亚的患病率增加，与心血管风险因素特征恶化一致，尽管诊断标准的长期变化也可能有贡献。我们没有发现任何证据表明，目前的假设，随着时间的推移，痴呆症的年龄特异性患病率恒定是没有根据的。然而，关于痴呆症流行病的未来规模仍然存在一些不确定性。人口老龄化似乎注定要发挥最大的作用，谨慎的决策者应根据目前的流行预测来规划未来的服务提供。其他优先事项应包括投资于大脑健康促进和痴呆症预防计划，并监测疫情的未来发展趋势，以确定这些措施的有效性。
Current projections of the scale of the coming dementia epidemic assume that the age- and sex-specific prevalence of dementia will not vary over time, and that population ageing alone (increasing the number of older people at risk) drives the projected increases. The basis for this assumption is doubtful, and secular trends (that is, gradual decreases or increases in prevalence over long-term periods) are perfectly plausible. We carried out a systematic review of studies of trends in prevalence, incidence and mortality for people with dementia, conducted since 1980. We identified nine studies that had tracked dementia prevalence, eight that had tracked dementia incidence, and four that had tracked mortality among people with dementia. There was some moderately consistent evidence to suggest that the incidence of dementia may be declining in high-income countries. Evidence on trends in the prevalence of dementia were inconsistent across studies and did not suggest any clear overall effect. Declining incidence may be balanced by longer survival with dementia, although mortality trends have been little studied. There is some evidence to suggest increasing prevalence in East Asia, consistent with worsening cardiovascular risk factor profiles, although secular changes in diagnostic criteria may also have contributed. We found no evidence to suggest that the current assumption of constant age-specific prevalence of dementia over time is ill-founded. However, there remains some uncertainty as to the future scale of the dementia epidemic. Population ageing seems destined to play the greatest role, and prudent policymakers should plan future service provision based upon current prevalence projections. Additional priorities should include investing in brain health promotion and dementia prevention programs, and monitoring the future course of the epidemic to chart the effectiveness of these measures.