背景:一些队列研究报告了痴呆患病率和发病率随着时间的推移而下降,尽管这些发现在所有研究中并不一致.我们使用已发表的基于人群的队列研究回顾了痴呆患病率和发病率随时间变化的证据,这些研究使用了与每个波一致的方法,旨在使用人群归因分数(PAF)量化风险因素随时间的相关变化。
方法:我们搜索了关于痴呆患病率或发病率随时间变化的队列研究的系统评价。我们搜索了PubMed从数据库开始到2023年1月12日的出版物,使用搜索词“系统评价”和“痴呆症”和(“患病率”或“发病率”),没有语言限制。我们在2024年3月28日重复了这一搜索。从合格的系统审查中,我们检索了有关在同一地理位置测量痴呆患病率或发病率的队列研究的参考文献和经过同行评审的出版物,至少在两个时间点,并报告了痴呆的年龄标准化患病率或发病率。此外,数据必须来自基于人群的样本,评估参与者的认知状态,并使用经过验证的标准诊断痴呆.我们从每篇论文中提取了关于痴呆症危险因素的汇总数据,当发表的论文中没有这些数据时,联系作者,并在所有可用时间点计算每个风险因素的PAF。在可能的情况下,我们将痴呆患病率或发病率的变化与危险因素患病率的变化联系起来.
结果:我们在最初的搜索中确定了1925条记录,其中确定了五项合格的系统评价。在这些系统审查中,我们确定了71篇潜在合格的初级论文,其中27个被包括在我们的分析中。27篇主要论文中有13篇(48%)报告了痴呆症患病率的变化,十个(37%)报告了痴呆症发病率的变化,4例(15%)报告了痴呆的发病率和患病率的变化.欧洲(n=5)和美国(n=5)的痴呆症发病率随时间变化的研究报告一致地报告了痴呆症的发病率下降。来自日本的一项研究报告了痴呆患病率和发病率的增加,尼日利亚的一项研究报告了稳定的发病率。总的来说,在整个研究中,受教育程度较低或吸烟的PAF,或者两者兼而有之,随着时间的推移,通常会下降,而肥胖的PAF,高血压,糖尿病普遍增加。在Framingham研究中,受教育和吸烟较少的PAF减少与痴呆症发病率下降有关(Framingham,MA,美国,1997-2013),唯一有足够数据允许分析的研究。
结论:我们的研究结果表明,通过国家层面的政策改变,义务教育和降低吸烟率等生活方式干预措施可能与观察到的减少有关。因此未来的减少,在痴呆症的发病率中。低收入和中等收入国家需要更多的研究,痴呆症负担最高的地方,并继续增加。
背景:国家健康与护理研究所三所学校痴呆症研究计划。
BACKGROUND: Some cohort studies have reported a decline in dementia prevalence and incidence over time, although these findings have not been consistent across studies. We reviewed evidence on changes in dementia prevalence and incidence over time using published population-based cohort studies that had used consistent methods with each wave and aimed to quantify associated changes in risk factors over time using population attributable fractions (PAFs).
METHODS: We searched for systematic reviews of cohort studies examining changes in dementia prevalence or incidence over time. We searched PubMed for publications from database inception up to Jan 12, 2023, using the search terms \"systematic review\" AND \"dementia\" AND (\"prevalence\" OR \"incidence\"), with no language restrictions. We repeated this search on March 28, 2024. From eligible systematic reviews, we searched the references and selected peer-reviewed publications about cohort studies where dementia prevalence or incidence was measured in the same geographical location, at a minimum of two timepoints, and that reported age-standardised prevalence or incidence of dementia. Additionally, data had to be from population-based samples, in which participants\' cognitive status was assessed and where validated criteria were used to diagnose dementia. We extracted summary-level data from each paper about dementia risk factors, contacting authors when such data were not available in the published paper, and calculated PAFs for each risk factor at all available timepoints. Where possible, we linked changes in dementia prevalence or incidence with changes in the prevalence of risk factors.
RESULTS: We identified 1925 records in our initial search, of which five eligible systematic reviews were identified. Within these systematic reviews, we identified 71 potentially eligible primary papers, of which 27 were included in our analysis. 13 (48%) of 27 primary papers reported change in prevalence of dementia, ten (37%) reported change in incidence of dementia, and four (15%) reported change in both incidence and prevalence of dementia. Studies reporting change in dementia incidence over time in Europe (n=5) and the USA (n=5) consistently reported a declining incidence in dementia. One study from Japan reported an increase in dementia prevalence and incidence and a stable incidence was reported in one study from Nigeria. Overall, across studies, the PAFs for less education or smoking, or both, generally declined over time, whereas PAFs for obesity, hypertension, and diabetes generally increased. The decrease in PAFs for less education and smoking was associated with a decline in the incidence of dementia in the Framingham study (Framingham, MA, USA, 1997-2013), the only study with sufficient data to allow analysis.
CONCLUSIONS: Our findings suggest that lifestyle interventions such as compulsory education and reducing rates of smoking through country-level policy changes could be associated with an observed reduction, and therefore future reduction, in the incidence of dementia. More studies are needed in low-income and middle-income countries, where the burden of dementia is highest, and continues to increase.
BACKGROUND: National Institute for Health and Care Research Three Schools\' Dementia Research Programme.