Incidence of Dementia over Three Decades in the Framingham Heart Study.
Incidence of Dementia over Three Decades in the Framingham Heart Study.
复制标题
DOI：
10.1056/nejmoa1504327
复制
发表时间：
2016-02-11
期刊：
影响因子：
--
通讯作者：
Seshadri S
中科院分区：
文献类型：
--
作者：
Satizabal CL;Beiser AS;Chouraki V;Chêne G;Dufouil C;Seshadri S
随着平均预期寿命的增加，痴呆症的患病率预计会飙升，但最近的估计表明，高收入国家中特定年龄的痴呆症发病率正在下降。时间趋势最好通过使用一致的诊断标准对人口进行长期持续监测而得出。我们描述了弗雷明汉心脏研究参与者中痴呆发病率的时间趋势。弗雷明汉心脏研究的参与者从1975年起就一直处于痴呆的监控之下。在这项分析中，包括5205名年龄在60岁或以上的人，我们使用Cox比例风险模型调整了年龄和性别，以确定痴呆在四个时期的5年发病率。我们还探讨了时代与年龄、性别、载脂蛋白E ε4状态和教育水平之间的相互作用，并研究了这些相互作用以及血管危险因素和心血管疾病对时间趋势的影响。第一个时期（20世纪70年代末和80年代初），5年年龄和性别调整后的痴呆累积风险率为3.6 / 100人，第二个时期（20世纪80年代末和90年代初）为2.8 / 100人，第三个时期（20世纪90年代末和21世纪初）为2.2 / 100人，第四个时期（21世纪末和2010年代初）为2.0 / 100人。与第1世相比，第2、3、4世的发病率分别下降了22%、38%和44%。这种风险降低仅在至少有高中文凭的人群中观察到（风险比，0.77；95%置信区间，0.67至0.88）。随着时间的推移，大多数血管危险因素（除了肥胖和糖尿病）的患病率以及与中风、心房颤动或心力衰竭相关的痴呆风险都有所下降，但这些趋势都不能完全解释痴呆发病率的下降。在弗雷明汉心脏研究的参与者中，痴呆症的发病率在过去三十年中有所下降。导致这种下降的因素尚未完全确定。（由美国国立卫生研究院资助。）
The prevalence of dementia is expected to soar as the average life expectancy increases, but recent estimates suggest that the age-specific incidence of dementia is declining in high-income countries. Temporal trends are best derived through continuous monitoring of a population over a long period with the use of consistent diagnostic criteria. We describe temporal trends in the incidence of dementia over three decades among participants in the Framingham Heart Study. Participants in the Framingham Heart Study have been under surveillance for incident dementia since 1975. In this analysis, which included 5205 persons 60 years of age or older, we used Cox proportional-hazards models adjusted for age and sex to determine the 5-year incidence of dementia during each of four epochs. We also explored the interactions between epoch and age, sex, apolipoprotein E ε4 status, and educational level, and we examined the effects of these interactions, as well as the effects of vascular risk factors and cardiovascular disease, on temporal trends. The 5-year age- and sex-adjusted cumulative hazard rates for dementia were 3.6 per 100 persons during the first epoch (late 1970s and early 1980s), 2.8 per 100 persons during the second epoch (late 1980s and early 1990s), 2.2 per 100 persons during the third epoch (late 1990s and early 2000s), and 2.0 per 100 persons during the fourth epoch (late 2000s and early 2010s). Relative to the incidence during the first epoch, the incidence declined by 22%, 38%, and 44% during the second, third, and fourth epochs, respectively. This risk reduction was observed only among persons who had at least a high school diploma (hazard ratio, 0.77; 95% confidence interval, 0.67 to 0.88). The prevalence of most vascular risk factors (except obesity and diabetes) and the risk of dementia associated with stroke, atrial fibrillation, or heart failure have decreased over time, but none of these trends completely explain the decrease in the incidence of dementia. Among participants in the Framingham Heart Study, the incidence of dementia has declined over the course of three decades. The factors contributing to this decline have not been completely identified. (Funded by the National Institutes of Health.)