Prevalence, risk factors, and management of dementia and mild cognitive impairment in adults aged 60 years or older in China: a cross-sectional study
Prevalence, risk factors, and management of dementia and mild cognitive impairment in adults aged 60 years or older in China: a cross-sectional study
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中国 60 岁及以上成年人痴呆和轻度认知障碍的患病率、危险因素及治疗：一项横断面研究
DOI：
10.1016/s2468-2667(20)30185-7
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发表时间：
2020-12-01
影响因子：
50
通讯作者：
Jia, Jianping
中科院分区：
文献类型：
--
作者：
Jia, Longfei;Du, Yifeng;Jia, Jianping
背景中国老年人口众多，但尚未对痴呆和轻度认知障碍（MCI）的患病率、危险因素和管理进行全面研究。方法在这项全国性横断面研究中，在2015年3月10日至2018年12月26日期间招募了46 011名60岁或60岁以上的成年人，使用多阶段分层，整群抽样方法，考虑了地理区域、城市化程度、经济发展状况、性别和年龄分布。在代表中国所有社会经济和地理区域的12个省和直辖市随机选择了96个站点。参与者接受采访，以获得有关社会人口特征，生活方式，病史，目前的药物治疗和家族史的数据，然后完成由心理评估员管理的神经心理测试电池。痴呆的患病率（阿尔茨海默病，血管性痴呆和其他痴呆）和MCI进行了计算，并使用多变量调整分析检查了不同群体的危险因素。（95% CI 58-63），阿尔茨海默病为39%（38-41），血管性痴呆为16%（15-17），其他痴呆为05%（05-06）。我们估计，中国60岁及以上人群中有15.07亿（95%CI 1453-1562）人患有痴呆症：9.83亿（939-1029）人患有阿尔茨海默病，3.92亿（364-422）人患有血管性痴呆，1.32亿（116-150）人患有其他痴呆症。总体MCI患病率估计为155%（152-159），代表中国38.77亿（3795-3962）人。痴呆症和MCI有相似的危险因素，包括老年（痴呆：比值比范围为269 [95% CI 243-298]至660 [524-832]; MCI：范围为189 [177-200]至470 [377-587]）;女性（痴呆：143例[131-156]; MCI：151例[143-159]）;父母有痴呆病史（痴呆：720例[568-912]; MCI：191例[148-246]）;农村居住（痴呆：116 [106-127]; MCI：145 [138-154]）;受教育年限较少（痴呆：从117 [106-129]到155 [138-173]; MCI：从148 [139-158]到348 [325-373]）;丧偶，离婚或独居（痴呆：从259 [230-290]到266 [229-310]; MCI：从158 [144-173]到174 [156-195]）;吸烟（痴呆：185 [167-204]; MCI：127 [119-136]），高血压（痴呆：186例[170-203]; MCI：162例[154-171]，MCI），痴呆症（痴呆：187 [171-205]; MCI：129 [121-137]）、糖尿病（痴呆：214 [196-234]; MCI：144 [135-153]）、心脏病（痴呆：198 [173-226]; MCI：117 [106-130]）和脑血管疾病（痴呆：544 [495-597]; MCI：149 [136-162]）。这些危险因素中有九个是可以改变的。解释痴呆症和MCI在中国非常流行，并且有相似的危险因素。应制定针对MCI人群中已确定的危险因素的预防策略，以阻止或减缓疾病进展。作为中国公共卫生体系的重要组成部分，优化痴呆症和MCI的管理也至关重要。
Background China has a large population of older people, but has not yet undertaken a comprehensive study on the prevalence, risk factors, and management of both dementia and mild cognitive impairment (MCI).Methods For this national cross-sectional study, 46 011 adults aged 60 years or older were recruited between March 10, 2015, and Dec 26, 2018, using a multistage, stratified, cluster-sampling method, which considered geographical region, degree of urbanisation, economic development status, and sex and age distribution. 96 sites were randomly selected in 12 provinces and municipalities representative of all socioeconomic and geographical regions in China. Participants were interviewed to obtain data on sociodemographic characteristics, lifestyle, medical history, current medications, and family history, and then completed a neuropsychological testing battery administered by a psychological evaluator. The prevalence of dementia (Alzheimer's disease, vascular dementia, and other dementias) and MCI were calculated and the risk factors for different groups were examined using multivariable-adjusted analyses.Findings Overall age-adjusted and sex-adjusted prevalence was estimated to be 60% (95% CI 58-63) for dementia, 39% (38-41) for Alzheimer's disease, 16% (15-17) for vascular dementia, and 05% (05-06) for other dementias. We estimated that 1507 million (95% CI 1453-1562) people aged 60 years or older in China have dementia: 983 million (939-1029) with Alzheimer's disease, 392 million (364-422) with vascular dementia, and 132 million (116-150) with other dementias. Overall MCI prevalence was estimated to be 155% (152-159), representing 3877 million (3795-3962) people in China. Dementia and MCI shared similar risk factors including old age (dementia: odds ratios ranging from 269 [95% CI 243-298] to 660 [524-832]; MCI: from 189 [177-200] to 470 [377-587]); female sex (dementia: 143 [131-156]; MCI: 151 [143-159]); parental history of dementia (dementia: 720 [568-912]; MCI:191 [148-246]); rural residence (dementia:116 [106-127]; MCI:145 [138-154]); fewer years of education (dementia: from 117 [106-129] to 155 [138-173]; MCI: from 148 [139-158] to 348 [325-373]); being widowed, divorced, or living alone (dementia: from 259 [230-290] to 266 [229-310]; MCI: from 158 [144-173] to 174 [156-195]); smoking (dementia: 185 [167-204]; MCI: 127 [119-136]), hypertension (dementia: 186 [170-203]; MCI: 162 [154-171] for MCI), hyperlipidaemia (dementia: 187 [171-205]; MCI: 129 [121-137]), diabetes (dementia: 214 [196-234]; MCI: 144 [135-153]), heart disease (dementia: 198 [173-226]; MCI: 117 [106-130]), and cerebrovascular disease (dementia: 544 [495-597]; MCI: 149 [136-162]). Nine of these risk factors are modifiable.Interpretation Dementia and MCI are highly prevalent in China and share similar risk factors. A prevention strategy should be developed to target the identified risk factors in the MCI population to thwart or slow down disease progression. It is also crucial to optimise the management of dementia and MCI as an important part of China's public health system.