Dementia and Alzheimer disease incidence - A prospective cohort study
Dementia and Alzheimer disease incidence - A prospective cohort study
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DOI：
10.1001/archneur.59.11.1737
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发表时间：
2002-11-01
影响因子：
--
通讯作者：
Larson, EB
中科院分区：
文献类型：
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作者：
Kukull, WA;Higdon, R;Larson, EB
背景：痴呆症和阿尔茨海默病（AD）的特定发病率对研究和临床实践很重要。发病率估计为美国是很少和不同的人口抽样和研究设计，我们目前的数据，将有助于这些rate.Objectives共识：提供特定年龄的发病率估计痴呆和AD和估计协会的性别，教育水平，载脂蛋白E基因型与onset.Design：前瞻性队列研究;从1994年开始，每2年进行一次随访。设置：以社区为基础的大型健康维护组织的成员，其人口统计学特征与周围基础人群一致;由大学研究临床医生进行诊断评估。无痴呆症，正常化的家庭居民。在5422名符合条件的患者中，2581名入组，2356名至少进行了1次随访评估（10591人-年观察）。使用人-年法和Poisson分布置信区间计算特定的乳腺癌发病率。结果：共诊断痴呆215例，AD 151例。痴呆和AD的发病率在5岁年龄组中增加; AD发病率从2.8/1000人-年（年龄组，65-69岁）上升到90岁以上年龄组的56.1/1000人-年。75至79岁和80至84岁年龄组的死亡率几乎增加了两倍，但此后的相对增幅要小得多。性别与AD发病无关。教育水平（> 15年与< 12年）与AD的风险降低;然而，该协会也依赖于基线认知筛查测试scores.Conclusions：我们的痴呆症和AD发病率是一致的，与最近的美国和欧洲的队列研究，提供临床医生和研究人员的新信息，关于跨设置的发病率估计的再现性。增加的风险与年龄和载脂蛋白E基因型有关，也与基线认知筛查测试评分低有关。教育水平与痴呆的风险呈负相关，与基线认知测试评分呈正相关;因此，通过筛查测试检测AD也可能受到教育水平的影响。
Context: Age-specific incidence rates for dementia and Alzheimer disease (AD) are important for research and clinical practice. Incidence estimates for the United States are few and vary with the population sampled and study design; We present data that will contribute to a consensus of these rates.Objectives: To provide age-specific incidence estimates for dementia and AD and to estimate the association of sex, educational level, and apolipoprotein E genotype with onset.Design: Prospective cohort study; begun in 1994 with follow-up interviews every 2 years.Setting: Members of community-based, large health maintenance organization with demographics consistent with the surrounding base population; diagnostic evaluation by university-based study clinicians.Subjects: Random sample of subjects aged 65 years or older from the base population; dementia free, normursing home residents. Of 5422 who were eligible, 2581 were enrolled, and 2356 had at least I follow-up evaluation (10591 person-years of observation).Main Outcome Measure: Dementia and Alzheimer disease diagnoses were based on standard criteria. Age-specific incidence rates were calculated using a person-years approach with Poisson distribution confidence intervals. Cox proportional hazards model analysis was used to examine other factors.Results: Two hundred fifteen cases of dementia and 151 cases of AD were diagnosed. Incidence rates for dementia and AD increase across the 5-year age groups; AD rates rise from 2.8 per 1000 person-years (age group, 65-69 years) to 56.1 per 1000 person-years in the older than 90-year age group. The rates nearly triple from the 75-to-79-year and 80-to-84-year age groups, but the relative increase is much less thereafter. Sex was not associated with AD onset. Educational level (> 15 years vs < 12 years) was associated with a decreased risk of AD; however, the association was also dependent on the baseline cognitive screening test score.Conclusions: Our dementia and AD incidence rates are consistent with recent US and European cohort studies, providing clinicians and researchers new information concerning the reproducibility of incidence estimates across settings. Increased risk was associated with age and the apolipoprotein E genotype; also with a low baseline cognitive screening test score. Educational level was inversely associated with the risk of dementia and positively associated with the baseline cognitive test score; thus, detection of AD by the screening test could also be influenced by educational level.