Derby Carol A, Katz Mindy J, Lipton Richard B, Hall Charles B
Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, New York.
Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York.
JAMA Neurol. 2017 Nov 1;74(11):1345-1351. doi: 10.1001/jamaneurol.2017.1964.
Trends in dementia incidence rates have important implications for planning and prevention. To better understand incidence trends over time requires separation of age and cohort effects, and few prior studies have used this approach.
To examine trends in dementia incidence and concomitant trends in cardiovascular comorbidities among individuals aged 70 years or older who were enrolled in the Einstein Aging Study between 1993 and 2015.
DESIGN, SETTING, AND PARTICIPANTS: In this birth cohort analysis of all-cause dementia incidence in persons enrolled in the Einstein Aging Study from October 20, 1993, through November 17, 2015, a systematically recruited, population-based sample of 1348 participants from Bronx County, New York, who were 70 years or older without dementia at enrollment and at least one annual follow-up was studied. Poisson regression was used to model dementia incidence as a function of age, sex, educational level, race, and birth cohort, with profile likelihood used to identify the timing of significant increases or decreases in incidence.
Birth year and age.
Incident dementia defined by consensus case conference based on annual, standardized neuropsychological and neurologic examination findings, using criteria from the DSM-IV.
Among 1348 individuals (mean [SD] baseline age, 78.5 [5.4] years; 830 [61.6%] female; 915 [67.9%] non-Hispanic white), 150 incident dementia cases developed during 5932 person-years (mean [SD] follow-up, 4.4 [3.4] years). Dementia incidence decreased in successive birth cohorts. Incidence per 100 person-years was 5.09 in birth cohorts before 1920, 3.11 in the 1920 through 1924 birth cohorts, 1.73 in the 1925 through 1929 birth cohorts, and 0.23 in cohorts born after 1929. Change point analyses identified a significant decrease in dementia incidence among those born after July 1929 (95% CI, June 1929 to January 1930). The relative rate for birth cohorts before July 1929 vs after was 0.13 (95% CI, 0.04-0.41). Prevalence of stroke and myocardial infarction decreased across successive birth cohorts, whereas diabetes prevalence increased. Adjustment for these cardiovascular comorbidities did not explain the decreased dementia incidence rates for more recent birth cohorts.
Analyses confirm decreasing dementia incidence in this population-based sample. Whether decreasing incidence will contribute to reduced burden of dementia given the aging of the population is not known.
痴呆症发病率趋势对规划和预防具有重要意义。要更好地了解发病率随时间的变化趋势，需要区分年龄和队列效应，而此前很少有研究采用这种方法。
研究1993年至2015年参加爱因斯坦衰老研究的70岁及以上人群中痴呆症发病率的趋势以及心血管合并症的伴随趋势。
设计、地点和参与者：在这项对1993年10月20日至2015年11月17日参加爱因斯坦衰老研究的人群全因痴呆症发病率的出生队列分析中，对来自纽约布朗克斯县的1348名系统招募的、基于人群的参与者进行了研究，这些参与者在入组时年龄在70岁及以上且无痴呆症，并至少有一次年度随访。采用泊松回归将痴呆症发病率建模为年龄、性别、教育水平、种族和出生队列的函数，使用轮廓似然法确定发病率显著上升或下降的时间点。
出生年份和年龄。
根据年度标准化神经心理学和神经学检查结果，通过共识病例会议，使用《精神疾病诊断与统计手册》第四版（DSM-IV）的标准定义新发痴呆症。
在1348名个体中（平均[标准差]基线年龄为78.5[5.4]岁；830名[61.6%]为女性；915名[67.9%]为非西班牙裔白人）, 在5932人年期间出现了150例新发痴呆症病例（平均[标准差]随访时间为4.4[3.4]年）。痴呆症发病率在连续出生队列中呈下降趋势。1920年以前出生队列中每100人年的发病率为5.09，1920年至1924年出生队列中为3.11，1925年至1929年出生队列中为1.73，1929年以后出生队列中为0.23。变化点分析确定1929年7月以后出生者的痴呆症发病率显著下降（95%置信区间，1929年6月至1930年1月）。1929年7月以前出生队列与之后出生队列的相对发病率为0.13（95%置信区间，0.04 - 0.41）。中风和心肌梗死的患病率在连续出生队列中呈下降趋势，而糖尿病患病率呈上升趋势。对这些心血管合并症进行调整并不能解释较近出生队列中痴呆症发病率下降的情况。
分析证实了该基于人群样本中痴呆症发病率的下降。鉴于人口老龄化，发病率下降是否会有助于减轻痴呆症负担尚不清楚。
