Dementia in the oldest old: a multi-factorial and growing public health issue.
Dementia in the oldest old: a multi-factorial and growing public health issue.
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DOI：
10.1186/alzrt181
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发表时间：
2013
期刊：
影响因子：
--
通讯作者：
Yaffe K
中科院分区：
文献类型：
--
作者：
Gardner RC;Valcour V;Yaffe K
最老的老年人，即85岁及以上的人，正在迅速增长。因此，更好地了解这一人群中的痴呆症具有越来越重要的国家和全球意义。在这篇综述中，我们描述了主要的流行病学研究，患病率，临床表现，神经病理学和影像学特征，危险因素和治疗的老年期痴呆。85岁以上人群中痴呆症的患病率估计为18%至38%。最常见的临床综合征是阿尔茨海默氏痴呆、血管性痴呆和多种病因的混合性痴呆。进展速度似乎比年轻老年人慢。单一的神经病理实体，如阿尔茨海默氏痴呆症和路易体病理似乎与认知能力下降的相关性下降，而与阿尔茨海默氏病，血管疾病（特别是皮质微梗死），海马硬化症的混合病理似乎有越来越多的相关性。神经影像学资料很少。老年痴呆症的危险因素包括教育水平低，中年健康状况差，体力活动水平低，抑郁和谵妄，而载脂蛋白E基因型，晚年高血压，高脂血症和外周炎症标志物升高似乎相关性较小。治疗方法需要进一步研究，但与年轻患者相比，年龄最大的老年人可能更容易出现负面副作用，并且由于单一病理不太常见，靶向治疗可能不太有效。我们还强调了这一领域研究的局限性和挑战，包括定义功能衰退的困难，痴呆诊断的必要组成部分，缺乏规范的神经心理学数据，以及现有诊断标准固有的其他缺点。总之，近年来，我们对老年痴呆症的理解有了很大的进步，但还需要更多的研究，特别是在不同的种族、民族和社会经济群体中，以及在神经影像学、可改变的风险因素和治疗等生物标志物方面。
The population of oldest old, or people aged 85 and older, is growing rapidly. A better understanding of dementia in this population is thus of increasing national and global importance. In this review, we describe the major epidemiological studies, prevalence, clinical presentation, neuropathological and imaging features, risk factors, and treatment of dementia in the oldest old. Prevalence estimates for dementia among those aged 85+ ranges from 18 to 38%. The most common clinical syndromes are Alzheimer's dementia, vascular dementia, and mixed dementia from multiple etiologies. The rate of progression appears to be slower than in the younger old. Single neuropathological entities such as Alzheimer's dementia and Lewy body pathology appear to have declining relevance to cognitive decline, while mixed pathology with Alzheimer's disease, vascular disease (especially cortical microinfarcts), and hippocampal sclerosis appear to have increasing relevance. Neuroimaging data are sparse. Risk factors for dementia in the oldest old include a low level of education, poor mid-life general health, low level of physical activity, depression, and delirium, whereas apolipoprotein E genotype, late-life hypertension, hyperlipidemia, and elevated peripheral inflammatory markers appear to have less relevance. Treatment approaches require further study, but the oldest old may be more prone to negative side effects compared with younger patients and targeted therapies may be less efficacious since single pathologies are less frequent. We also highlight the limitations and challenges of research in this area, including the difficulty of defining functional decline, a necessary component for a dementia diagnosis, the lack of normative neuropsychological data, and other shortcomings inherent in existing diagnostic criteria. In summary, our understanding of dementia in the oldest old has advanced dramatically in recent years, but more research is needed, particularly among varied racial, ethnic, and socioeconomic groups, and with respect to biomarkers such as neuroimaging, modifiable risk factors, and therapy.
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影响因子：
4.4
作者：
DeCarli, C
通讯作者：
DeCarli, C
影响因子：
9.9
作者：
Börjesson-Hanson, A;Edin, E;Skoog, I
通讯作者：
Skoog, I
影响因子：
9.9
作者：
Fratiglioni, L;Viitanen, M;Winblad, B
通讯作者：
Winblad, B
影响因子：
9.9
作者：
EBLY, EM;PARHAD, IM;FUNG, TS
通讯作者：
FUNG, TS
DOI：
10.1016/j.jalz.2011.09.232
发表时间：
2012-11
期刊：
Alzheimer's & dementia : the journal of the Alzheimer's Association
影响因子：
--
作者：
Erten-Lyons D;Sherbakov LO;Piccinin AM;Hofer SM;Dodge HH;Quinn JF;Woltjer RL;Kramer PL;Kaye JA
通讯作者：
Kaye JA