Dementia before death in ageing societies - The promise of prevention and the reality
Dementia before death in ageing societies - The promise of prevention and the reality
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DOI：
10.1371/journal.pmed.0030397
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发表时间：
2006-10-01
期刊：
影响因子：
15.8
通讯作者：
Matthews, Fiona E.
中科院分区：
文献类型：
--
作者：
Brayne, Carol;Gao, Lu;Matthews, Fiona E.
背景痴呆和严重认知障碍与衰老密切相关。我们活得越久，就越有可能遭受这些疾病的折磨。考虑到人口寿命的增加，重要的是不仅要了解特定年龄的痴呆症和严重认知障碍的风险和保护因素，而且还要了解保护是否会影响累积风险。这可以探讨通过检查的累积风险的影响，死亡的因素，发现一贯降低风险，在特定的年龄，如教育和社会地位。方法和结果在这项分析中，我们报告的患病率痴呆症和严重的认知功能障碍的前一年死亡的大规模人口样本。在医学研究理事会认知功能和老龄化研究（英格兰和威尔士65岁及以上人群的10年队列研究）中，根据年龄、性别、社会阶层和教育程度估计了这些患病率。使用logistic回归分析了差异。死亡时痴呆的总患病率为30%。随着年龄的增长，痴呆症的发病率呈明显上升趋势，从65-69岁死亡时的6%上升到95岁及以上死亡时的58%。严重认知障碍的患病率较高，模式相似。人与高等教育和社会阶层有显着减少痴呆症和严重的认知功能障碍死亡前，但绝对差异很小（10%以下）。结论降低风险，痴呆症在给定的年龄将导致进一步延长寿命，因此累积风险（即使在人群中，在较低的风险为给定的年龄）仍然很高。即使有预防方案，人口老龄化也可能导致死于痴呆症和严重认知障碍的人数增加。痴呆症的政策制定和研究必须满足那些在死亡前将继续经历这些疾病的人的需求。
Background Dementia and severe cognitive impairment are very closely linked to ageing. The longer we live the more likely we are to suffer from these conditions. Given population increases in longevity it is important to understand not only risk and protective factors for dementia and severe cognitive impairment at given ages but also whether protection affects cumulative risk. This can be explored by examining the effect on cumulative risk by time of death of factors found consistently to reduce risk at particular ages, such as education and social status.Methods and Findings In this analysis we report the prevalence of dementia and severe cognitive impairment in the year before death in a large population sample. In the Medical Research Council Cognitive Function and Ageing Study (a 10-y population-based cohort study of individuals 65 and over in England and Wales), these prevalences have been estimated by age, sex, social class, and education. Differences have been explored using logistic regression. The overall prevalence of dementia at death was 30%. There was a strong increasing trend for dementia with age from 6% for those aged 65-69 y at time of death to 58% for those aged 95 y and above at time of death. Higher prevalences were seen for severe cognitive impairment, with similar patterns. People with higher education and social class had significantly reduced dementia and severe cognitive impairment before death, but the absolute difference was small (under 10%).Conclusions Reducing risk for dementia at a given age will lead to further extension of life, thus cumulative risk (even in populations at lower risk for given ages) remains high. Ageing of populations is likely to result in an increase in the number of people dying with dementia and severe cognitive impairment even in the presence of preventative programmes. Policy development and research for dementia must address the needs of individuals who will continue to experience these conditions before death.