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， 增加的幅度将取决于具体年龄的比率。大多数对老年痴呆症的预测 疾病和痴呆症假设特定年龄的患病率不会改变，仅人口老龄化 将推动痴呆症的流行趋势。然而，最近有一些证据表明， 可能在欧洲和美国都在下降。 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70岁以上的有8000人。收集的数据包括对认知、健康、社会经济地位、 家庭背景，现在是遗传信息和生物标志物。21世纪初的一项子研究 对856名HRS受访者进行了一项深入的认知评估，包括痴呆症，现在又进行了一项新的子研究， 开始在2016年将评估痴呆症状态的子样本约3000。 这项研究有五个具体目标。首先，它将估计从1998年到2000年痴呆症的年龄调整患病率。 2016年在70岁以上的人口中，基于痴呆概率的改进模型，包括使用 它还将估计痴呆症发病率（发病）和痴呆症的年龄调整趋势 mortality. 其次，它将分析亚群，如按性别或种族/民族，以记录差异， 老年痴呆症的风险。它将测试是否可以通过暴露于以下因素的差异来解释这些差异： 风险因素，如糖尿病或教育，以及风险因素的群体特异性趋势是否影响群体特异性 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，使用痴呆发生概率模型、因果关系证据和风险预测 该研究将预测到2040年人口和重要亚群的痴呆症患病率。 第五，这项研究将预测非正式护理的使用和提供情况，例如，家庭成员的照顾，以及它将如何 影响疗养院的使用和成本。

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.