Keefover R W, Rankin E D, Keyl P M, Wells J C, Martin J, Shaw J
Health Sciences Center, West Virginia University, Morgantown 26506, USA.
J Rural Health. 1996 Summer;12(3):178-87. doi: 10.1111/j.1748-0361.1996.tb00792.x.
Expansion of the world's elderly populations has increased concerns about aging-related medical disorders like Alzheimer's disease and other dementias. In the United States, one fourth of those older than age 65 and at greatest risk for developing dementia live in rural environments that may influence its manifestation. The objectives of this study were to determine the need for and potential benefits of further epidemiological research concerning dementia and similar disorders in rural U.S. populations and to identify pertinent methodological issues related to rural dementia research. This study employed a National Library of Medicine (MEDLINE) document search based on the key words "cognitive disorders," "dementia," "Alzheimer's disease," and "rural," followed by recovery of literature resources references in the bibliographies of selected articles. Nineteen studies focusing on dementia or related disorders in rural settings have been reported from around the world. While four of these were conducted in the United States, only one rural dementia prevalence study has been undertaken in this country. Because of methodological variability, comparisons of prevalence estimates between these rural studies, as well as with those from urban investigations, is difficult. Nonetheless, there is reason to believe that certain potentially dementing illnesses are more common in rural populations. There is also evidence to suggest that the screening instruments commonly used in such studies tend to misclassify rural elders as "false positive" dementia cases. Information regarding dementing disorders, particularly Alzheimer's disease, in rural populations is scarce. Preliminary observations that dementia may be more common in rural settings and that rural families are more likely to maintain their dementing elders in the community imply that further rural dementia research could yield important insights into the risk factors for these illnesses, the variables influencing their course, and the methods by which they can be more effectively managed. A determination of the reliability and validity of commonly used dementia screening instruments in rural populations would represent an important advancement in this area of research.
全球老年人口的增长引发了人们对与衰老相关的医学疾病（如阿尔茨海默病和其他痴呆症）的更多关注。在美国，65岁及以上且患痴呆症风险最高的人群中有四分之一生活在农村环境中，而这种环境可能会影响痴呆症的表现。本研究的目的是确定针对美国农村人口痴呆症及类似疾病开展进一步流行病学研究的必要性和潜在益处，并识别与农村痴呆症研究相关的关键方法学问题。本研究利用美国国立医学图书馆（MEDLINE）数据库，基于关键词“认知障碍”“痴呆症”“阿尔茨海默病”和“农村”进行文献检索，随后从所选文章的参考文献中获取文献资源。全球已报道了19项聚焦农村地区痴呆症或相关疾病的研究。其中四项研究在美国开展，但该国仅进行过一项农村痴呆症患病率研究。由于方法的多样性，很难对这些农村研究之间以及与城市研究的患病率估计进行比较。尽管如此，有理由相信某些潜在的致痴呆疾病在农村人口中更为常见。也有证据表明，此类研究中常用的筛查工具往往会将农村老年人误分类为“假阳性”痴呆症病例。关于农村人口痴呆症疾病，尤其是阿尔茨海默病的信息匮乏。初步观察表明，痴呆症在农村地区可能更为常见，而且农村家庭更有可能让患有痴呆症的老年人留在社区，这意味着进一步开展农村痴呆症研究可能会对这些疾病的风险因素、影响其病程的变量以及更有效管理这些疾病的方法产生重要见解。确定农村人口中常用痴呆症筛查工具的可靠性和有效性将是该研究领域的一项重要进展。
