Wu Yu-Tzu, Matthews Fiona E, Brayne Carol
Department of Public Health and Primary Care, Cambridge Institute of Public Health, Forvie Site, University of Cambridge, School of Clinical Medicine, Box 113, Cambridge Biomedical Campus, Cambridge CB2 0SR, United Kingdom.
MRC Biostatistics Unit, Institute of Public Health, Forvie Site, University of Cambridge, School of Clinical Medicine, Box 113, Cambridge Biomedical Campus, Cambridge CB2 0SR, United Kingdom.
Maturitas. 2014 Oct;79(2):191-5. doi: 10.1016/j.maturitas.2014.06.020. Epub 2014 Jul 8.
In recent years, dementia has been considered a public health priority and become a topic of major political interest. Recent reviews and studies have reported with varying degrees of alarm an impending and existing "dementia epidemic" with increasing predicted trends in prevalence and enormous numbers of people with dementia particularly in low- and middle-income countries (LMICs). However, robust evidence from dementia research in high-income countries suggests stable or decreased prevalence over the last decades. Current evidence is not sufficient to suggest increasing trends of prevalence in LMICs once variation in methodological factors and study populations are taken into account. Changes in diagnostic methods over the last decades substantially influence the identification of dementia cases with systematic difference between the resulting individual prevalence studies. Potential geographical variations at the country level might indicate potential risk factors at population levels or systematic difference in clinical application of dementia diagnosis. Although it is important and necessary to use information from dementia research for evidence-based policymaking, over-interpretation of results without carefully considering underlying factors could exaggerate the findings and influence policy planning in ways which do not serve current and future population best. Planning of dementia policy needs to take full cognisance of the provenance of the data being used and be integrated with policies which optimise health across the lifecourse.
近年来，痴呆症已被视为公共卫生重点问题，并成为主要政治关注的话题。近期的综述和研究已不同程度地发出警示，称即将出现且现有的“痴呆症流行”态势，预计患病率呈上升趋势，尤其是在低收入和中等收入国家（LMICs），患有痴呆症的人数众多。然而，来自高收入国家痴呆症研究的有力证据表明，在过去几十年中患病率稳定或有所下降。一旦考虑到方法学因素和研究人群的差异，目前的证据不足以表明低收入和中等收入国家的患病率呈上升趋势。过去几十年诊断方法的变化极大地影响了痴呆症病例的识别，各独立患病率研究结果之间存在系统性差异。国家层面潜在的地理差异可能表明人群层面的潜在风险因素或痴呆症诊断临床应用中的系统性差异。尽管利用痴呆症研究信息进行循证决策很重要且必要，但在未仔细考虑潜在因素的情况下过度解读结果，可能会夸大研究发现，并以不利于当前和未来人群的方式影响政策规划。痴呆症政策规划需要充分认识所使用数据的来源，并与优化全生命周期健康的政策相结合。
