Zhang M Y, Katzman R, Salmon D, Jin H, Cai G J, Wang Z Y, Qu G Y, Grant I, Yu E, Levy P
Shanghai Institute of Mental Health, China.
Ann Neurol. 1990 Apr;27(4):428-37. doi: 10.1002/ana.410270412.
We report the prevalence rates for dementia and Alzheimer's disease (AD) obtained from a probability sample survey of 5,055 noninstitutionalized older persons in Shanghai, China. A two-stage procedure was used for case finding and case identification. A Chinese version of the Mini-Mental State Examination was used to determine cases of possible dementia. Three different cutoff points on this mental status test were used depending on the respondent's level of education. Clinical evaluations, based on functional assessments and psychiatric interview, medical and neurological examinations, three standardized mental status tests, and a selected group of psychometric tests, were made in the second stage of the study to ascertain the clinical diagnosis of dementia and AD utilizing the Diagnostic and Statistical Manual for Mental Disorders, edition 3 and National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association criteria, respectively. The prevalence rate of dementia in persons 65 years and older was 4.6%. Clinically diagnosed AD accounted for 65% of the subjects with dementia. These findings indicate that the prevalence of dementia in Shanghai is very much higher than figures published earlier for China and Japan, and at the lower part of the range of values reported for community residents in the United States and other Western countries, but less than half of that reported in the recently published survey of the elderly in East Boston. Increasing age, gender (female), and low education are each highly significant and independent risk factors for dementia. One hypothesis to explain the increased prevalence in elderly women who had received no formal education invokes the possibility of an effect of early deprivation, perhaps lowering brain "reserve," allowing the symptoms of dementia to appear at an earlier date during disease progression.
我们报告了从中国上海5055名非机构化老年人的概率抽样调查中获得的痴呆症和阿尔茨海默病（AD）患病率。采用两阶段程序进行病例发现和病例识别。使用中文版简易精神状态检查表来确定可能患有痴呆症的病例。根据受访者的教育程度，在该精神状态测试中使用了三个不同的临界值。在研究的第二阶段，基于功能评估、精神科访谈、医学和神经学检查、三项标准化精神状态测试以及一组选定的心理测量测试进行临床评估，分别利用《精神疾病诊断与统计手册》第三版和美国国立神经疾病与中风研究所 - 阿尔茨海默病及相关疾病协会标准确定痴呆症和AD的临床诊断。65岁及以上人群的痴呆症患病率为4.6%。临床诊断为AD的患者占痴呆症患者的65%。这些发现表明，上海痴呆症的患病率远高于中国和日本早期公布的数据，处于美国和其他西方国家社区居民报告值范围的下限，但低于最近公布的东波士顿老年人调查中报告值的一半。年龄增长、性别（女性）和低教育程度都是痴呆症非常显著且独立的危险因素。一种解释未接受过正规教育的老年女性患病率增加的假设认为，早期剥夺可能产生影响，也许会降低大脑“储备”，从而使痴呆症状在疾病进展过程中更早出现。
