Epidemiology of Mild Cognitive Impairment and Dementia in China

申请人预测，到2050年，美国将有900万人被诊断出患有阿尔茨海默病，这是惊人的；更令人望而生畏的是，据估计，到2025年，中国将有3,400万AD病例。美国和中国之间千丝万缕的联系，决定了中国会对美国产生什么样的影响。由于中国在很大程度上仍然不知道AD或其他类型的痴呆症是神经疾病，这种知识的缺乏将阻碍潜在的预防/治疗策略，这些策略可以减少肯定会上升的成本。弗雷明翰心脏研究估计，将发病延迟5年将使一个人的患病风险降低50%，但中国缺乏足够的知识来采取措施降低患病风险。几十年来，FHS一直在进行轻度认知障碍(MCI，AD的前驱阶段)以及AD和痴呆的流行病学研究。这项名为“中国轻度认知障碍和痴呆症的流行病学”的试点拨款的目的，是在中国建立类似的队列研究中，模仿英国家庭保健系统研究流行和偶发痴呆症的方法。我们建议在广州和广西的农村和城市实施测试协议，在中国。方法包括进行健康检查，以测量已知和新的风险因素，这些因素以前被认为与MCI和AD的风险增加有关，以及神经心理测试组合，以确定基线认知状态。还将建立用于识别普遍存在的痴呆症和纵向跟踪事件病例的监测技术。中国目前的痴呆症患病率和发病率研究表明，中国的AD/痴呆率低于美国，但方法上的差异限制了这些结果的可推广性。此外，随着中国老年人口的快速增长，与前十年相比，近年来痴呆症的发病率有所上升。了解中国人的痴呆症模式及其相关因素将有助于设计有效的干预方案。此外，比较研究的长期影响将是深入了解环境x基因相互作用的机会，这些相互作用是阿尔茨海默病等复杂疾病的基础。这项拟议的研究将为中国的全面实施研究奠定基础，并可能有助于促进中国在AD和痴呆症方面的进一步研究。 公共卫生相关性：拟议的先导性研究《中国轻度认知障碍与痴呆流行病学》旨在建立一项队列研究，以确定中国南部农村和城市地区轻度认知障碍、阿尔茨海默病和其他类型痴呆症的流行和事件病例。根据弗雷明翰心脏研究对临床前和临床痴呆症的研究，长期目标是确定与中国人群中MCI、AD和其他痴呆症亚型风险增加有关的风险因素和生物标志物。这项队列研究的建立将极大地提高对中国对AD/痴呆的认识，并为确定环境和基因在痴呆疾病发展中所起的作用提供重要的比较数据。。

DESCRIPTION (provided by applicant Projections that 9 million people in the US will be diagnosed with AD by the year 2050 is staggering; even more daunting are estimates that China will have 34 million AD cases by the year 2025. The inextricable links between the U.S. and China ensure that what effects China will affect the US. With China still largely unaware of AD or other types of dementia as neurologic disorders, this lack of knowledge will prevent potential prevention/treatment strategies that can abate the costs that are certain to rise. The Framingham Heart Study (FHS) estimates that delaying the onset of disease by 5 years will reduce a person's risk of disease by 50%, but China is not sufficiently knowledgeable to take steps to reduce risk of disease. FHS has been conducting epidemiological study of mild cognitive impairment (MCI, a prodromal stage of AD) and AD and dementia for decades. The goal of this pilot grant entitled "Epidemiology of Mild Cognitive Impairment and Dementia in China", is to model FHS' methods for studying prevalent and incident dementia in establishing a similar cohort study in China. We propose to implement the test protocol in both rural and urban areas of Guangzhou and Guangxi provinces in China. Methods include administering a health examination that will measure known and novel risk factors that have been previously linked to increase risk of MCI and AD, as well as a neuropsychological test battery to determine baseline cognitive status. Surveillance techniques for identifying prevalent dementia and tracking incident cases longitudinally will also be established. Current prevalence and incidence studies of dementia in China suggest that rates of AD/dementia are lower in China than in the US, but methodological variations limit generability of these findings. Further, with a rapidly growing elderly population in China, incidence rates of dementia have increased in recent years compared to the previous decade. Understanding the pattern of dementia among the Chinese and associated factors would help design effective intervention programs. Further, the long term implications of comparative studies will be opportunities to gain insight into the environmental x gene interactions that underlie a complex disease such as AD. The proposed study will lay the groundwork for a full-implementation study in China and may also help stimulate further Chinese research in AD and dementia. PUBLIC HEALTH RELEVANCE: The proposed pilot study, Epidemiology of Mild Cognitive Impairment and Dementia in China, seeks to establish a cohort study to identify prevalent and incident cases of mild cognitive impairment (MCI) and Alzheimer's disease (AD) and other types of dementia in rural an urban regions of southern China. Modeled after the Framingham Heart Study's studies of preclinical and clinical dementia, the long-term aims are to determine risk factors and biomarkers linked to increased risk of MCI, AD and other dementia subtypes within the Chinese population. The establishment of this cohort study will greatly enhance the understanding of AD/dementia in China, as well as provide important comparative data for identifying the role that environment and genes play in development of dementing illnesses. .