Estimating the Prevalence of Dementia and Mild Cognitive Impairment in the US The 2016 Health and Retirement Study Harmonized Cognitive Assessment Protocol Project
Estimating the Prevalence of Dementia and Mild Cognitive Impairment in the US The 2016 Health and Retirement Study Harmonized Cognitive Assessment Protocol Project
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DOI：
10.1001/jamaneurol.2022.3543
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发表时间：
2022-10-24
期刊：
影响因子：
29
通讯作者：
Weir, David
中科院分区：
文献类型：
--
作者：
Manly, Jennifer J.;Jones, Richard N.;Weir, David
具有全国代表性的数据对于了解美国痴呆症和轻度认知障碍（MCI）相关的原因、成本和结果至关重要，并可以为旨在减少这些疾病对患者、家庭和公共项目影响的政策提供信息。具有全国代表性的健康与退休研究（HRS）是此类数据的重要来源，但提供痴呆症诊断信息的HRS子研究是20多年前开始的，需要更新的数据。目的：制定统一认知评估方案（HCAP），以更新美国MCI和痴呆患病率的国家估计值，并检查年龄、种族、民族和性别的差异。HRS是一项正在进行的纵向全国代表性研究，研究对象为51岁及以上的人群，交错入组日期为1992年至2022年，随访时间为4年至30年。HCAP是2016年HRS中65岁或以上个体的横断面随机样本。在9972名符合年龄条件的HRS参与者中，4425名被随机选择进行HCAP，3496名完成了全面的神经心理测试和线人访谈，没有一人被排除在外。痴呆症和MCI使用基于标准诊断标准的算法进行分类，并将测试性能与稳健的规范样本进行比较。暴露组按年龄、性别、教育、人种和种族分层。主要结果和测量：使用人口权重进行的国家患病率估计。结果：研究人群样本（N = 3496）的平均（SD）年龄为76.4（7.6）岁，2095名参与者（60%）为女性。有551名参与者自认为是黑人而不是西班牙裔（16%），382名参与者自认为是西班牙裔（无论种族如何）（16%），2483名参与者自认为是白色而不是西班牙裔（71%），还有80人自认为是另一个种族（2%），包括美洲印第安人或阿拉斯加原住民、亚洲人、夏威夷原住民或太平洋岛民，或另一个自称的种族。共有393人（10%; 95%CI，9-11）被归类为患有痴呆症，804人（22%; 95%CI，20-24）被归类为患有MCI。年龄每增加5岁，痴呆（加权比值比[OR]，每5岁年龄差1.95; 95%，CI，1.77-2.14）和MCI（OR，每5岁年龄差1.17，95% CI，1.09-1.26）的风险增加。每增加一年的教育与痴呆（OR，0.93/学年，95%CI，0.89-0.97）和MCI（OR，0.94，95%CI，0.91-0.97）的风险降低相关。与非西班牙裔白色个体相比，非西班牙裔黑人个体中痴呆更常见（OR，1.81; 95%CI，1.20-2.75），西班牙裔个体中MCI更常见（OR，1.42; 95%CI，1.03-1.96）。由于人数较少，无法按种族和民族进行其他群体比较。女性个体和男性个体之间的患病率无差异。结论和相关性使用全面的神经心理学测试组合和大样本，这项横断面研究中发现的2016年痴呆症和MCI的全国患病率与其他美国研究相似，表明老年黑人和西班牙裔成年人以及受教育程度较低的人中痴呆症和MCI的负担不成比例。
IMPORTANCE Nationally representative data are critical for understanding the causes, costs, and outcomes associated with dementia and mild cognitive impairment (MCI) in the US and can inform policies aimed at reducing the impact of these conditions on patients, families, and public programs. The nationally representative Health and Retirement Study (HRS) is an essential resource for such data, but the HRS substudy providing dementia diagnostic information was fielded more than 20 years ago and more recent data are needed. OBJECTIVE The Harmonized Cognitive Assessment Protocol (HCAP) was developed to update national estimates of the prevalence of MCI and dementia in the US and examine differences by age, race, ethnicity, and sex. DESIGN, SETTING, AND PARTICIPANTS HRS is an ongoing longitudinal nationally representative study of people 51 years and older with staggered entry dates from 1992 to 2022 and follow-up ranging from 4 to 30 years. HCAP is a cross-sectional random sample of individuals in HRS who were 65 years or older in 2016. Of 9972 age-eligible HRS participants, 4425 were randomly selected for HCAP, and 3496 completed a comprehensive neuropsychological test battery and informant interview, none of whom were excluded. Dementia and MCI were classified using an algorithm based on standard diagnostic criteria and comparing test performance to a robust normative sample. EXPOSURES Groups were stratified by age, sex, education, race, and ethnicity. MAIN OUTCOMES AND MEASURES National prevalence estimates using populationweights. RESULTS The mean (SD) age of the study population sample (N = 3496) was 76.4 (7.6) years, and 2095 participants (60%) were female. Therewere 551 participants who self-identified as Black and not Hispanic (16%), 382 who self-identified as Hispanic regardless of race (16%), 2483 who self-identified as White and not Hispanic (71%), and 80 who self-identified as another race (2%), including American Indian or Alaska Native, Asian, NativeHawaiian or Pacific Islander, or another self-described race. A total of 393 individuals (10%; 95% CI, 9-11) were classified as having dementia and 804 (22%; 95% CI, 20-24) as having MCI. Every 5-year increase in agewas associated with higher risk of dementia (weighted odds ratio [OR], 1.95 per 5-year age difference; 95%, CI, 1.77-2.14) and MCI (OR, 1.17 per 5-year age difference, 95% CI, 1.09-1.26). Each additional year of educationwas associated with a decrease in risk of dementia (OR, 0.93 per year of school, 95% CI, 0.89-0.97) and MCI (OR, 0.94, 95% CI, 0.91-0.97). Dementiawas more common among non-Hispanic Black individuals (OR, 1.81; 95% CI, 1.20-2.75) and MCI in Hispanic individuals (OR, 1.42; 95% CI, 1.03-1.96) compared with non-Hispanic White individuals. Other group comparisons by race and ethnicitywere not possible owing to small numbers. No differences in prevalencewere found between female individuals and male individuals. CONCLUSIONS AND RELEVANCE Using a comprehensive neuropsychological test battery and large sample, the national prevalence of dementia and MCI in 2016 found in this cross-sectional study was similar to that of other US-based studies, indicating a disproportionate burden of dementia and MCI among older Black and Hispanic adults and those with lower education.