Department of Public Health and Primary Care, Cambridge Institute of Public Health, School of Clinical Medicine, University of Cambridge, Cambridge, UK.
Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet-Stockholm University, Stockholm, Sweden.
Lancet Neurol. 2016 Jan;15(1):116-24. doi: 10.1016/S1474-4422(15)00092-7. Epub 2015 Aug 21.
Dementia is receiving increasing attention from governments and politicians. Epidemiological research based on western European populations done 20 years ago provided key initial evidence for dementia policy making, but these estimates are now out of date because of changes in life expectancy, living conditions, and health profiles. To assess whether dementia occurrence has changed during the past 20-30 years, investigators of five different studies done in western Europe (Sweden [Stockholm and Gothenburg], the Netherlands [Rotterdam], the UK [England], and Spain [Zaragoza]) have compared dementia occurrence using consistent research methods between two timepoints in well-defined geographical areas. Findings from four of the five studies showed non-significant changes in overall dementia occurrence. The only significant reduction in overall prevalence was found in the study done in the UK, powered and designed explicitly from its outset to detect change across generations (decrease in prevalence of 22%; p=0.003). Findings from the study done in Zaragoza (Spain) showed a significant reduction in dementia prevalence in men (43%; p=0.0002). The studies estimating incidence done in Stockholm and Rotterdam reported non-significant reductions. Such reductions could be the outcomes from earlier population-level investments such as improved education and living conditions, and better prevention and treatment of vascular and chronic conditions. This evidence suggests that attention to optimum health early in life might benefit cognitive health late in life. Policy planning and future research should be balanced across primary (policies reducing risk and increasing cognitive reserve), secondary (early detection and screening), and tertiary (once dementia is present) prevention. Each has their place, but upstream primary prevention has the largest effect on reduction of later dementia occurrence and disability.
痴呆症越来越受到政府和政治家的关注。20 年前基于西欧人口的流行病学研究为痴呆症政策制定提供了关键的初步证据，但由于预期寿命、生活条件和健康状况的变化，这些估计现在已经过时。为了评估过去 20-30 年来痴呆症的发生是否发生了变化，来自西欧五个不同研究的研究人员（瑞典[斯德哥尔摩和哥德堡]、荷兰[鹿特丹]、英国[英格兰]和西班牙[萨拉戈萨]）使用一致的研究方法在明确定义的地理区域内比较了两个时间点的痴呆症发生情况。五项研究中的四项发现，总体痴呆症的发生没有显著变化。唯一一项在英国进行的研究发现，总体患病率显著下降（下降 22%；p=0.003）。在西班牙萨拉戈萨进行的研究发现，男性痴呆症的患病率显著下降（43%；p=0.0002）。在斯德哥尔摩和鹿特丹进行的发病率估计研究报告称，发病率没有显著下降。这种下降可能是由于早期在人口层面上进行的投资的结果，如改善教育和生活条件，以及更好地预防和治疗血管和慢性疾病。这一证据表明，关注生命早期的最佳健康状况可能有益于生命后期的认知健康。政策规划和未来研究应在初级（降低风险和增加认知储备的政策）、二级（早期发现和筛查）和三级（痴呆症出现后）预防之间保持平衡。每个都有其作用，但上游的初级预防对减少后期痴呆症的发生和残疾有最大的影响。
