Dementia in western Europe: epidemiological evidence and implications for policy making
Dementia in western Europe: epidemiological evidence and implications for policy making
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DOI：
10.1016/s1474-4422(15)00092-7
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发表时间：
2016-01-01
期刊：
影响因子：
48
通讯作者：
Brayne, Carol
中科院分区：
文献类型：
--
作者：
Wu, Yu-Tzu;Fratiglioni, Laura;Brayne, Carol
痴呆症越来越受到各国政府和政界人士的关注。20年前对西欧人群进行的流行病学研究为痴呆政策的制定提供了关键的初步证据，但由于预期寿命、生活条件和健康状况的变化，这些估计现在已经过时。为了评估痴呆症的发生在过去20-30年中是否发生了变化，在西欧(瑞典[斯德哥尔摩和哥德堡]、荷兰[鹿特丹]、英国[英格兰]和西班牙[萨拉戈萨])进行的五项不同研究的调查人员使用定义明确的地理区域内两个时间点之间的一致研究方法比较了痴呆症的发生情况。五项研究中有四项的研究结果显示，痴呆症的总体发生率没有显著变化。总体患病率唯一显著下降的是在英国进行的这项研究，这项研究从一开始就明确设计用来检测代际间的变化(患病率下降22%；p=0.003)。在西班牙萨拉戈萨进行的这项研究结果显示，男性痴呆症患病率显著降低(43%；p=0.0002)。在斯德哥尔摩和鹿特丹进行的估计发病率的研究报告称，发病率没有显著下降。这种减少可能是早期人口层面投资的结果，例如改善教育和生活条件，以及更好地预防和治疗血管和慢性病。这一证据表明，关注生命早期的最佳健康状况可能有利于晚年的认知健康。政策规划和未来研究应在一级(降低风险和增加认知储备的政策)、二级(早期发现和筛查)和三级(一旦出现痴呆症)预防方面取得平衡。每一种预防都有其作用，但上游一级预防在减少以后的痴呆症发生和残疾方面效果最大。
Dementia is receiving increasing attention from governments and politicians. Epidemiological research based on western European populations done 20 years ago provided key initial evidence for dementia policy making, but these estimates are now out of date because of changes in life expectancy, living conditions, and health profiles. To assess whether dementia occurrence has changed during the past 20-30 years, investigators of five different studies done in western Europe (Sweden [Stockholm and Gothenburg], the Netherlands [Rotterdam], the UK [England], and Spain [Zaragoza]) have compared dementia occurrence using consistent research methods between two timepoints in well-defined geographical areas. Findings from four of the five studies showed non-significant changes in overall dementia occurrence. The only significant reduction in overall prevalence was found in the study done in the UK, powered and designed explicitly from its outset to detect change across generations (decrease in prevalence of 22%; p=0.003). Findings from the study done in Zaragoza (Spain) showed a significant reduction in dementia prevalence in men (43%; p=0.0002). The studies estimating incidence done in Stockholm and Rotterdam reported non-significant reductions. Such reductions could be the outcomes from earlier population-level investments such as improved education and living conditions, and better prevention and treatment of vascular and chronic conditions. This evidence suggests that attention to optimum health early in life might benefit cognitive health late in life. Policy planning and future research should be balanced across primary (policies reducing risk and increasing cognitive reserve), secondary (early detection and screening), and tertiary (once dementia is present) prevention. Each has their place, but upstream primary prevention has the largest effect on reduction of later dementia occurrence and disability.