Universidade Federal de Sao Paulo, Departments of Psychobiology and Department of Psychiatry Sao Paulo, Brazil.
Universidade de Sao Paulo - Hospital das Clinicas da Faculdade de Medicina, Sao Paulo, Brazil.
J Alzheimers Dis. 2019;70(s1):S283-S291. doi: 10.3233/JAD-180636.
Most people with dementia live in low- and middle-income countries and little is known about the potential for reducing these numbers by reducing key risk factors.
To investigate the potential for dementia incidence reduction in Brazil, Mozambique, and Portugal (a culturally related, high-income country).
We replicated previously published methods and based on the relative risks from previous studies, we estimated the population-attributable risk (PAR) of dementia in Mozambique, Brazil, and Portugal for seven modifiable risk factors associated with dementia (low educational attainment, physical inactivity, midlife hypertension, midlife obesity, depression, smoking, and diabetes mellitus). The combined PAR was calculated and adjusted for associations between risk factors. The potential for risk factor reduction was assessed by examining the effect of relative reductions of 10% and 20% per decade for each of the risk factors on projections for dementia cases for each decade until 2050.
After adjusting for non-independence of risk factors, 24.4%, 32.3%, and 40.1% of dementia cases could be related to seven potentially modifiable risk factors in Mozambique, Brazil, and Portugal, respectively. Reducing the prevalence of each risk factor by 20% per decade could, by 2050, potentially reduce the prevalence of dementia in Mozambique, Brazil, and Portugal by 12.9%, 16.2%, and 19.5%, respectively.
There is a substantial difference between the countries in the percentage of dementia cases that could be attributable to the seven potentially modifiable risk factors. The proportion of cases that could be prevented by 2050 if measures were taken to address these main risk factors was higher in Portugal than in Brazil and Mozambique. Each country or region should consider their unique risk factor profile when developing dementia risk reduction programs.
大多数痴呆症患者生活在中低收入国家，对于通过降低关键风险因素来降低这些数字的潜力知之甚少。
调查巴西、莫桑比克和葡萄牙（一个文化相关的高收入国家）减少痴呆症发病率的潜力。
我们复制了以前发表的方法，并根据以前研究的相对风险，我们估计了莫桑比克、巴西和葡萄牙与痴呆症相关的七个可改变风险因素（教育程度低、身体活动不足、中年高血压、中年肥胖、抑郁、吸烟和糖尿病）的人群归因风险（PAR）。计算了综合 PAR，并调整了风险因素之间的关联。通过检查每个风险因素相对减少 10%和 20%每十年对每个十年直至 2050 年的痴呆症病例预测的影响，评估了降低风险因素的潜力。
在调整风险因素的非独立性后，莫桑比克、巴西和葡萄牙分别有 24.4%、32.3%和 40.1%的痴呆症病例可能与七个潜在可改变的风险因素有关。如果每十年将每个风险因素的患病率降低 20%，到 2050 年，莫桑比克、巴西和葡萄牙的痴呆症患病率可能分别降低 12.9%、16.2%和 19.5%。
在可归因于七个潜在可改变风险因素的痴呆症病例百分比方面，各国之间存在很大差异。如果采取措施解决这些主要风险因素，到 2050 年，葡萄牙可预防的病例比例高于巴西和莫桑比克。每个国家或地区在制定痴呆症风险降低计划时都应考虑其独特的风险因素状况。
