Letenneur L, Gilleron V, Commenges D, Helmer C, Orgogozo J M, Dartigues J F
Unité INSERM 330, Université Victor Segalen, Bordeaux, France.
J Neurol Neurosurg Psychiatry. 1999 Feb;66(2):177-83. doi: 10.1136/jnnp.66.2.177.
To examine the age specific risk of Alzheimer's disease according to sex, and to explore the role of education in a cohort of elderly community residents aged 65 years and older.
A community based cohort of elderly people was studied longitudinally for 5 years for the development of dementia. Dementia diagnoses were made according to the DSM III R criteria and Alzheimer's disease was assessed using the NINCDS-ADRDA criteria. Among the 3675 non-demented subjects initially included in the cohort, 2881 participated in the follow up. Hazard ratios of dementia were estimated using a Cox model with delayed entry in which the time scale is the age of the subjects.
During the 5 year follow up, 190 incident cases of dementia, including 140 cases of Alzheimer's disease were identified. The incidence rates of Alzheimer's disease were 0.8/100 person-years in men and 1.4/100 person-years in women. However, the incidence was higher in men than in women before the age of 80 and higher in women than in men after this age. A significant interaction between sex and age was found. The hazard ratio of Alzheimer's disease in women compared with men was estimated to be 0.8 at 75 years and 1.7 at 85 years. The risks of dementia and Alzheimer's disease were associated with a lower educational attainment (hazard ratio=1.8, p<0.001). The increased risk of Alzheimer's disease in women was not changed after adjustment for education.
Women have a higher risk of developing dementia after the age of 80 than men. Low educational attainment is associated with a higher risk of Alzheimer's disease. However, the increased risk in women is not explained by a lower educational level.
根据性别研究阿尔茨海默病的年龄特异性风险，并探讨教育程度在一组65岁及以上老年社区居民中的作用。
对一组以社区为基础的老年人进行了为期5年的纵向研究，以观察痴呆症的发生情况。根据《精神疾病诊断与统计手册》第三版修订版（DSM III R）标准进行痴呆症诊断，并使用美国国立神经疾病和中风研究所-阿尔茨海默病及相关疾病协会（NINCDS-ADRDA）标准评估阿尔茨海默病。在最初纳入队列的3675名非痴呆受试者中，2881人参与了随访。使用带有延迟入组的Cox模型估计痴呆症的风险比，其中时间尺度为受试者的年龄。
在5年的随访期间，共识别出190例新发痴呆症病例，其中包括140例阿尔茨海默病病例。男性阿尔茨海默病的发病率为0.8/100人年，女性为1.4/100人年。然而，80岁之前男性的发病率高于女性，80岁之后女性的发病率高于男性。发现性别和年龄之间存在显著交互作用。75岁时，女性与男性相比，阿尔茨海默病的风险比估计为0.8；85岁时为1.7。痴呆症和阿尔茨海默病的风险与较低的教育程度相关（风险比=1.8，p<0.001）。调整教育程度后，女性患阿尔茨海默病风险的增加并未改变。
80岁之后，女性患痴呆症的风险高于男性。低教育程度与患阿尔茨海默病的较高风险相关。然而，女性风险的增加并非由较低的教育水平所致。
