Dementia Prevalence over Time: Proximate Causes and Consequences

摘要 随着老年人在人口中所占比例不断增加，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比率的进程。大多数关于阿尔茨海默病的预测 疾病和痴呆症假设特定年龄的患病率不会改变，并且仅考虑人口老龄化 将推动痴呆症患病率趋势。然而，最近有一些证据表明，特定年龄的患病率 欧洲可能正在衰落，美国也可能正在衰落。 这项研究将使用健康与退休研究的数据来估计痴呆症患病率的轨迹 并检查危险因素。自 1992 年以来，HRS 每两年对 50 岁以上的美国人进行一次调查， 包括 70 岁以上的约 8000 人。收集的数据包括对认知、健康、社会经济状况、 家庭背景，现在是遗传信息和生物标志物。 2000年代初进行的一项子研究 对 856 名 HRS 受访者进行了一项涵盖痴呆症的深入认知评估，现在一项新的子研究 2016 年开始，将对约 3000 名子样本的痴呆状况进行评估。 这项研究有五个具体目标。首先，它将估计 1998 年至 2017 年按年龄调整的痴呆症患病率 2016年在70岁以上人口中基于改进的痴呆概率模型，包括使用 遗传信息；它还将估计痴呆症发病率（发作）和痴呆症的年龄调整趋势 死亡率。 其次，它将分析亚人群，例如按性别或种族/民族来记录差异 各群体的痴呆风险。它将测试任何此类差异是否可以通过接触的差异来解释 糖尿病或教育等风险因素，以及风险因素的特定群体趋势是否会影响特定群体 痴呆症的趋势。第三，如果发现风险因素与痴呆症患病率相关，该研究将 试图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 该研究将预测到 2040 年人口和重要亚人群的痴呆症患病率。 第五，该研究将预测非正式护理的使用和可用性，例如家庭成员的护理，以及它将如何 影响疗养院的使用和费用。

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.