A two-decade comparison of prevalence of dementia in individuals aged 65 years and older from three geographical areas of England: results of the Cognitive Function and Ageing Study I and II.
A two-decade comparison of prevalence of dementia in individuals aged 65 years and older from three geographical areas of England: results of the Cognitive Function and Ageing Study I and II.
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DOI：
10.1016/s0140-6736(13)61570-6
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发表时间：
2013-10-26
期刊：
影响因子：
168.9
通讯作者：
Brayne, Carol
中科院分区：
文献类型：
--
作者：
Matthews, Fiona E.;Arthur, Antony;Barnes, Linda E.;Bond, John;Jagger, Carol;Robinson, Louise;Brayne, Carol
痴呆症的患病率在世界范围内受到关注。需要当代的估计来规划未来的护理提供，但许多证据是几十年前的。我们的目的是调查痴呆症的患病率是否在过去的二十年中发生了变化，通过重复相同的方法和诊断方法，在医学研究理事会认知功能和老龄化研究（MRC CFAS）在英格兰的三个原始研究领域。1989年和1994年，MRC CFAS调查人员在英格兰和威尔士的六个地理区域对65岁及以上的人群进行了基线访谈。一个两阶段的过程中，筛查，然后诊断评估，用于获得数据的算法诊断（老年精神状态自动老年检查计算机辅助分类），然后用于估计痴呆症的患病率。其中三个地区的数据-剑桥郡、纽卡斯尔和伯明翰-被选入CFAS I。2008年至2011年期间，在第二阶段研究的这三个领域开展了新的实地工作。对于CFAS I和II，每个地区都需要包括2500名65岁及以上的人，以提供地理和代际比较的力量。根据年龄组（65-74岁vs ≥75岁）对样本进行分层。CFAS II采用与CFAS I相同的采样、方法和诊断方法，不同之处在于将筛查和评估合并为一个阶段。使用逆概率加权法计算患病率估计值，以调整抽样设计和无应答。使用全似然贝叶斯模型研究信息性无应答。在剑桥郡、纽卡斯尔和诺丁汉的CFAS I中，对7635名65岁或65岁以上的人进行了访谈（接近9602人，应答率为80%），其中1457人接受了诊断评估。在相同的地理区域，CFAS II调查人员采访了7796人（接近14242人，242人的虚弱信息有限，56%的应答）。 使用CFAS I年龄和性别特异性估计65岁或以上人群的患病率，标准化为2011年人口，预计2011年该人群中有8.3%（88.4万）患有痴呆症。 然而，CFAS II显示患病率较低（6.5%; 670 000），降低了1.8%（CFAS II与CFAS I的比值比为0.7，95% CI为0.6 - 0.9，p= 0.003）。 敏感性分析表明，这些估计数对响应的变化是稳健的。这项研究提供了进一步的证据，队列效应存在于痴呆症的患病率。较晚出生的人群比上个世纪较早出生的人群患痴呆症的风险更低。英国医学研究理事会。
The prevalence of dementia is of interest worldwide. Contemporary estimates are needed to plan for future care provision, but much evidence is decades old. We aimed to investigate whether the prevalence of dementia had changed in the past two decades by repeating the same approach and diagnostic methods as used in the Medical Research Council Cognitive Function and Ageing Study (MRC CFAS) in three of the original study areas in England. 1989 and 1994, MRC CFAS investigators did baseline interviews in populations aged 65 years and older in six geographically defined areas in England and Wales. A two stage process, with screening followed by diagnostic assessment, was used to obtain data for algorithmic diagnoses (geriatric mental state–automated geriatric examination for computer assisted taxonomy), which were then used to estimate dementia prevalence. Data from three of these areas—Cambridgeshire, Newcastle, and Nottingham—were selected for CFAS I. Between 2008 and 2011, new fieldwork was done in the same three areas for the CFAS II study. For both CFAS I and II, each area needed to include 2500 individuals aged 65 years and older to provide power for geographical and generational comparison. Sampling was stratified according to age group (65–74 years vs ≥75 years). CFAS II used identical sampling, approach, and diagnostic methods to CFAS I, except that screening and assessement were combined into one stage. Prevalence estimates were calculated using inverse probability weighting methods to adjust for sampling design and non-response. Full likelihood Bayesian models were used to investigate informative non-response. 7635 people aged 65 years or older were interviewed in CFAS I (9602 approached, 80% response) in Cambridgeshire, Newcastle, and Nottingham, with 1457 being diagnostically assessed. In the same geographical areas, the CFAS II investigators interviewed 7796 individuals (14 242 approached, 242 with limited frailty information, 56% response). Using CFAS I age and sex specific estimates of prevalence in individuals aged 65 years or older, standardised to the 2011 population, 8·3% (884 000) of this population would be expected to have dementia in 2011. However, CFAS II shows that the prevalence is lower (6·5%; 670 000), a decrease of 1·8% (odds ratio for CFAS II vs CFAS I 0·7, 95% CI 0·6–0·9, p=0·003). Sensitivity analyses suggest that these estimates are robust to the change in response. This study provides further evidence that a cohort effect exists in dementia prevalence. Later-born populations have a lower risk of prevalent dementia than those born earlier in the past century. UK Medical Research Council.