Lifetime risk of dementia and Alzheimer's disease - The impact of mortality on risk estimates in the Framingham Study
Lifetime risk of dementia and Alzheimer's disease - The impact of mortality on risk estimates in the Framingham Study
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DOI：
10.1212/wnl.49.6.1498
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发表时间：
1997-12-01
期刊：
影响因子：
9.9
通讯作者：
D'Agostino, RB
中科院分区：
文献类型：
--
作者：
Seshadri, S;Wolf, PA;D'Agostino, RB
根据纵向人群研究的数据，我们估计了所有原因导致的阿尔茨海默病（AD）和痴呆的剩余终生风险。一个人一生中患阿尔茨海默病的风险取决于疾病发病率和预期寿命。当由于相互竞争的原因有很大的死亡可能性时，传统的累积发病率估计会高估风险。共有2,611名认知完好的受试者（1,061名男性，1,550名女性，平均年龄66±7岁）被前瞻性评估AD或其他痴呆的发展情况。修正生存分析用于估计65岁以上五岁年龄组的累积发病率和性别特异性剩余寿命风险估计。在20年的随访期间，198名受试者发展为痴呆（120名患有AD）。阿尔茨海默病或其他痴呆症的剩余终生风险取决于性别，女性较高，但在65至80岁之间变化不大。在65岁男性中，阿尔茨海默病的剩余终生风险为6.3% (95% CI, 3.9 - 8.7)，发生任何痴呆疾病的剩余终生风险为10.9% (95% CI, 8.0 - 13.8)；65岁女性的相应风险为12% （95% CI, 9.2 - 14.8）和19% （95% CI, 17.2 - 22.5）。65岁至100岁之间的累积发病率要高得多：对于老年痴呆症，男性为25.5%，女性为28.1%；对于痴呆症，男性为32.8%，女性为45%。阿尔茨海默病或痴呆症的实际剩余终生风险因年龄、性别和预期寿命而异，并且低于同一人群中累积发病率估计的假设风险。
We estimated the remaining lifetime risks of developing Alzheimer's disease (AD) and dementia from all causes, based on data from longitudinal population studies. The risk of developing AD during one's lifetime depends on both disease incidence and life expectancy. Conventional estimates of cumulative incidence overestimate the risk when there is a substantial probability of mortality due to competing causes. A total of 2,611 cognitively intact subjects (1,061 men, 1,550 women; mean age, 66 +/- 7 years) were prospectively evaluated for the development of AD or other dementia. A modified survival analysis was used to estimate both cumulative incidence and the sex-specific remaining lifetime risk estimates for quinquennial age groups above age 65 years. Over a 20-year follow-up period, 198 subjects developed dementia (120 with AD). The remaining lifetime risk of AD or other dementia depended on sex, being higher in women, but varied little with age between 65 and 80 years. In a 65-year-old man, the remaining lifetime risk of AD was 6.3% (95% CI, 3.9 to 8.7) and the remaining lifetime risk of developing any dementing illness was 10.9% (95% CI, 8.0 to 13.8); corresponding risks for a 65-year-old woman were 12% (95% CI, 9.2 to 14.8) and 19% (95% CI, 17.2 to 22.5). The cumulative incidence between age 65 and 100 years was much higher: for AD, 25.5% in men and 28.1% in women; for dementia, 32.8% in men and 45% in women. The actual remaining lifetime risk of AD or dementia varies with age, sex, and life expectancy and is lower than the hypothetical risk estimated by a cumulative incidence in the same population.