Gardner Raquel C, Valcour Victor, Yaffe Kristine
Department of Neurology, Memory and Aging Center, University of California, San Francisco, 675 Nelson Rising Lane - Box 1207, San Francisco, CA 94158, USA.
Department of Neurology, Memory and Aging Center, University of California, San Francisco, 675 Nelson Rising Lane - Box 1207, San Francisco, CA 94158, USA ; Division of Geriatric Medicine, Department of Medicine, University of California, San Francisco, 675 Nelson Rising Lane - Box 1207, San Francisco, CA 94158, USA.
Alzheimers Res Ther. 2013 Jul 1;5(4):27. doi: 10.1186/alzrt181. eCollection 2013.
The population of oldest old, or people aged 85 and older, is growing rapidly. A better understanding of dementia in this population is thus of increasing national and global importance. In this review, we describe the major epidemiological studies, prevalence, clinical presentation, neuropathological and imaging features, risk factors, and treatment of dementia in the oldest old. Prevalence estimates for dementia among those aged 85+ ranges from 18 to 38%. The most common clinical syndromes are Alzheimer's dementia, vascular dementia, and mixed dementia from multiple etiologies. The rate of progression appears to be slower than in the younger old. Single neuropathological entities such as Alzheimer's dementia and Lewy body pathology appear to have declining relevance to cognitive decline, while mixed pathology with Alzheimer's disease, vascular disease (especially cortical microinfarcts), and hippocampal sclerosis appear to have increasing relevance. Neuroimaging data are sparse. Risk factors for dementia in the oldest old include a low level of education, poor mid-life general health, low level of physical activity, depression, and delirium, whereas apolipoprotein E genotype, late-life hypertension, hyperlipidemia, and elevated peripheral inflammatory markers appear to have less relevance. Treatment approaches require further study, but the oldest old may be more prone to negative side effects compared with younger patients and targeted therapies may be less efficacious since single pathologies are less frequent. We also highlight the limitations and challenges of research in this area, including the difficulty of defining functional decline, a necessary component for a dementia diagnosis, the lack of normative neuropsychological data, and other shortcomings inherent in existing diagnostic criteria. In summary, our understanding of dementia in the oldest old has advanced dramatically in recent years, but more research is needed, particularly among varied racial, ethnic, and socioeconomic groups, and with respect to biomarkers such as neuroimaging, modifiable risk factors, and therapy.
高龄老人，即85岁及以上的人群，数量正在迅速增长。因此，更好地了解这一人群中的痴呆症在国家和全球层面上愈发重要。在本综述中，我们描述了关于高龄老人痴呆症的主要流行病学研究、患病率、临床表现、神经病理学和影像学特征、风险因素以及治疗方法。85岁及以上人群中痴呆症的患病率估计在18%至38%之间。最常见的临床综合征是阿尔茨海默病性痴呆、血管性痴呆以及多种病因导致的混合性痴呆。其进展速度似乎比年轻老人更慢。单一的神经病理学实体，如阿尔茨海默病性痴呆和路易体病理，与认知衰退的相关性似乎在下降，而阿尔茨海默病、血管疾病（尤其是皮质微梗死）和海马硬化的混合病理与认知衰退的相关性似乎在增加。神经影像学数据较为匮乏。高龄老人患痴呆症的风险因素包括低教育水平、中年时总体健康状况差、身体活动水平低、抑郁和谵妄，而载脂蛋白E基因型、老年高血压、高脂血症和外周炎症标志物升高似乎相关性较小。治疗方法需要进一步研究，但与年轻患者相比，高龄老人可能更容易出现负面副作用，而且由于单一病理情况较少见，靶向治疗可能效果较差。我们还强调了该领域研究的局限性和挑战，包括难以定义功能衰退（痴呆症诊断的必要组成部分）、缺乏标准化的神经心理学数据以及现有诊断标准中固有的其他缺陷。总之，近年来我们对高龄老人痴呆症的认识有了显著进展，但仍需要更多研究，特别是在不同种族、民族和社会经济群体中，以及在神经影像学等生物标志物、可改变的风险因素和治疗方面。
