Dementia Prevalence over Time: Proximate Causes and Consequences

摘要 随着老年人在人口中所占的比例越来越大，痴呆症的患病率可能会增加，但 增加的幅度将取决于特定年龄段的比率。阿尔茨海默氏症的大多数预测 疾病和痴呆症假定特定年龄段的患病率不会改变，而人口老龄化本身 将推动痴呆症的流行趋势。然而，最近有一些证据表明，特定年龄段的流行率 欧洲可能正在衰落，美国可能也是如此。 这项研究将使用健康和退休研究的数据来估计痴呆症患病率的轨迹 并检查风险因素。自1992年以来，HRS每两年对50岁以上的美国人进行一次调查， 其中约有8000人在70岁以上。收集的数据包括认知、健康、社会经济地位、 家庭背景，现在是遗传信息和生物标记物。在21世纪初进行的一项子研究 对856名HRS受访者的痴呆症进行了深入的认知评估，现在又进行了一项新的子研究 Begin in 2016将在约3000人的子样本中评估痴呆症状况。 这项研究有五个具体目标。首先，它将估计从1998年到2005年经年龄调整的痴呆症患病率。 根据改进的痴呆症概率模型，包括使用 遗传信息；它还将估计痴呆症发病率(发病)和痴呆症的年龄调整趋势 死亡率。 其次，它将分析亚群体，如按性别或按种族/民族来记录差异 按组划分的痴呆症风险。它将测试是否有任何这样的差异可以用接触不同的 风险因素，如糖尿病或教育，以及风险因素中的特定群体趋势是否影响特定群体 痴呆症的趋势。第三，在发现风险因素与痴呆症患病率相关的情况下，该研究将 寻求确定这些关联是否反映了因果关系。 第四，使用痴呆症概率模型、因果关系证据和风险预测模型 因素，这项研究将预测人群和重要亚群的痴呆症患病率到2040年。 第五，该研究将预测非正式护理的使用和可获得性，例如家庭成员的护理，以及它将如何 影响养老院的使用和成本。

Abstract As older adults make up a growing share of the population, the prevalence of dementia will likely increase, but the magnitude of the increase will depend on the course of age-specific rates. Most projections of Alzheimer's disease and dementia assume that age-specific prevalence rates do not change and that population aging alone will drive dementia prevalence trends. There is some recent evidence, however, that age-specific prevalence may be declining Europe and possibly in the United States. This study will use data from the Health and Retirement Study to estimate the trajectory of dementia prevalence and to examine risk factors. Since 1992, the HRS has surveyed biennially a panel of Americans over age 50, including about 8000 over 70. Data collected include assessments of cognition, health, socioeconomic status, family background, and now genetic information and biomarkers. A sub-study in the early 2000s administered an in-depth cognitive assessment covering dementia to 856 HRS respondents, and now a new sub-study to begin in 2016 will assess dementia status in a subsample of about 3000. This study has five specific aims. First, it will estimate the age-adjusted prevalence of dementia from 1998 to 2016 in the population over age 70 based on an improved model of dementia probability, including the use of genetic information; it will also estimate age-adjusted trends in dementia incidence (onset) and dementia mortality. Second, it will analyze subpopulations such as by gender or by race/ethnicity to document differences in dementia risk by groups. It will test whether any such differences can be explained by differences in exposure to risk factors such as diabetes or education and whether group-specific trends in risk factors affect group-specific trends in dementia. Third, where risk factors are found to be associated with dementia prevalence, the study will seek to determine whether these associations reflect causality. Fourth, using the models of the probability of dementia, the evidence about causality, and forecasts of risk factors, the study will predict dementia prevalence for the population and for important subpopulations to 2040. Fifth, the study will forecast the use and availability of informal care, e.g., care by family members, and how it will affect nursing home use and costs.