Department of Internal Medicine and Medical Specialties, DIMI, Section of Cardiovascular Diseases, University of Genoa, Genoa, Italy.
IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
J Alzheimers Dis. 2020;75(4):1083-1103. doi: 10.3233/JAD-191075.
Dementia is an age-related clinical condition, with higher incidence rates in older ages. However, there is some evidence that a reverse epidemiology is also observed. Namely, the cohort analysis of dementia incidence rates by birth in selected populations demonstrated a decreased incidence of dementia in late life across the last twenty years, possibly due to decreased incidence of cardiovascular disorders and increased education and cognitive reserve. In line with that, age is probably a proxy for other pathophysiological processes rather than a strictly causative factor for the onset of dementia, especially in oldest old persons. The present narrative review provides an update on the clinical interplay between the spectrum of brain aging, cardiovascular morbidity, dementia pathologies, and their clinical expression in the oldest old patients. Available evidence suggests that vascular prevention in the perspective of dementia largely involve middle ages, with an apparent reverse epidemiology in oldest old. Similarly, the present findings underline how cognitive resilience and frailty may be key relevant mediators in the modulation of the clinical expression of brain mixed neuropathologies in persons over 85 years old, providing a new integrated conceptual framework.
痴呆是一种与年龄相关的临床病症，在老年人中的发病率更高。然而，有一些证据表明，反向流行病学也存在。即，对特定人群中按出生时间划分的痴呆发病率的队列分析表明，在过去二十年中，由于心血管疾病发病率降低以及教育和认知储备增加，晚年痴呆的发病率有所降低。与之相符的是，年龄可能是其他病理生理过程的替代指标，而不是痴呆发病的严格因果因素，尤其是在最年长的人群中。本综述叙述提供了关于脑老化、心血管发病率、痴呆病理以及它们在最年长患者中的临床表现之间的临床相互作用的最新信息。现有证据表明，从痴呆的角度来看，血管预防主要涉及中年，而在最年长的老年人中则存在明显的反向流行病学。同样，目前的研究结果强调了认知弹性和脆弱性如何可能是调节 85 岁以上人群大脑混合神经病理学临床表达的关键相关中介因素，提供了一个新的综合概念框架。
