Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland.
J Alzheimers Dis. 2013;35(3):565-73. doi: 10.3233/JAD-121819.
Epidemiologic studies on age-specific incidence rates (IRs) separating Alzheimer's disease (AD) and vascular dementia (VaD) in the UK are scarce. We sought to assess IRs of AD and VaD in the UK and to compare co-morbidities and medication use between patients with AD, VaD, or without dementia. We identified cases aged ≥65 years with an incident diagnosis of AD or VaD between 1998 and 2008 using the General Practice Research Database (GPRD). We assessed IRs, stratified by age and gender, matched one dementia-free control patient to each demented patient, and analyzed co-morbidities and medication use. We identified 7,086 AD and 4,438 VaD cases. Overall, the IR of AD was 1.59/1,000 person-years (py) (95% CI 1.55-1.62) and the IR of VaD 0.99/1,000 py (95% CI 0.96-1.02). For AD, IRs were higher for women than for men, but not for VaD. Except for orthostatic hypotension, the prevalence of all cardiovascular (CV) co-morbidities and exposure to CV drugs was lower in patients with AD than in corresponding controls, whereas the opposite was true for VaD. The lower prevalence of CV diseases in patients with AD may be a true finding or the result of a channeling effect, i.e., the possibility that demented patients with CV diseases may be more likely diagnosed with VaD than AD.
在英国,针对阿尔茨海默病(AD)和血管性痴呆(VaD)的特定年龄发病率(IRs)进行的流行病学研究很少。我们旨在评估英国 AD 和 VaD 的 IR,并比较 AD、VaD 或无痴呆患者的合并症和药物使用情况。我们使用全科医生研究数据库(GPRD),确定了 1998 年至 2008 年间年龄≥65 岁、新发 AD 或 VaD 诊断的病例。我们评估了发病率,按年龄和性别分层,为每位痴呆患者匹配一位无痴呆对照患者,并分析了合并症和药物使用情况。我们确定了 7086 例 AD 和 4438 例 VaD 病例。总体而言,AD 的发病率为 1.59/1000 人年(95%CI 1.55-1.62),VaD 的发病率为 0.99/1000 人年(95%CI 0.96-1.02)。对于 AD,女性的发病率高于男性,但 VaD 则不然。除直立性低血压外,AD 患者的所有心血管(CV)合并症和 CV 药物暴露的患病率均低于相应的对照患者,而 VaD 则相反。AD 患者中 CV 疾病的低患病率可能是真实的发现,也可能是通道效应的结果,即患有 CV 疾病的痴呆患者更有可能被诊断为 VaD 而不是 AD。