Hu S M, Li F, Guan S C, Wang C X, Song X W, Liu H J, Ma J H, Zhao Y, Liu C X, Li H H, Zhang Y L, Wu J, Fang X H
Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing100053, China.
Department of Neurology, Fuxing Hospital, Capital Medical University, Beijing100038, China.
Zhonghua Liu Xing Bing Xue Za Zhi. 2024 Nov 10;45(11):1573-1581. doi: 10.3760/cma.j.cn112338-20240514-00273.
To investigate the prevalence and mortality of dementia and assess the impact of geriatric syndromes (GS) on the risk for dementia and death in elderly population in Beijing. A cross-sectional survey was conducted in the elderly population aged ≥65 years and selected by a multi-stage sampling in Beijing during 2013-2015. Cognitive function was screened using the Chinese Revised Version of the Mini-Mental State Examination (MMSE). Then, neurological examination and psychiatric assessment were performed for those with the MMSE score lower than the cut-off value. The information about GS prevalence was also collected. The study also collected death records for all individuals from baseline until December 31, 2019. Based on the age and gender distribution from Beijing data of the 2010 Six National Population Census, the dementia prevalence in the study population was directly standardized. Logistic regression analysis was used to evaluate the association of different forms of dementia with GS, and Cox proportional hazards regression model was used to estimate the hazard ratio () and 95% of death. During 2013-2015, a total of 2 935 individuals completed dementia assessments, of which 167 were diagnosed with dementia. The standardized prevalence of dementia was 5.9% (95%: 5.0%-17.4%). The individuals with Alzheimer's disease (AD) and vascular dementia (VaD) accounted for 58.7% and 28.1% of total individuals with dementia, respectively. Aging, lower education level, urinary incontinence, and fall were risk factors for AD, while disability of activity of daily life dependence, hypertension, and stroke were found to be risk factors for VaD. After a median follow-up of 5.44 person-years, 399 deaths were recorded. The 5-year mortality risk was 2.87 (95%: 1.92-4.17) times and 4.93 (95%: 3.23-7.53) times higher for the elderly individuals with AD and VaD, respectively, compared to non-demented individuals. After adjusting for demographic, GS, and cardiovascular risk factors, the mortality risk in the elderly individuals with AD showed no significant difference compared with non-demented individuals (=1.32, 95%: 0.89-1.97), while the mortality risk in those with VaD was 2.46 (95%: 1.49-4.05) times higher than that in non-demented individuals. The prevalence of dementia in Beijing increased significantly in the context of population aging, especially the prevalence of AD. The presence of GS increased the risks for AD and VaD, as well as the risk for death. Close attention needs to be paid to GS management in dementia prevention in elderly population.
为调查北京老年人群中痴呆症的患病率和死亡率,并评估老年综合征(GS)对痴呆症风险和死亡风险的影响。于2013 - 2015年在北京对年龄≥65岁的老年人群进行了多阶段抽样的横断面调查。使用中文版简易精神状态检查表(MMSE)筛查认知功能。然后,对MMSE评分低于临界值的人群进行神经学检查和精神评估。还收集了GS患病率的相关信息。该研究还收集了所有个体从基线到2019年12月31日的死亡记录。根据2010年第六次全国人口普查北京数据的年龄和性别分布,对研究人群中的痴呆症患病率进行了直接标准化。采用逻辑回归分析评估不同形式痴呆症与GS的关联,并使用Cox比例风险回归模型估计死亡风险比(HR)和95%置信区间。在2013 - 2015年期间,共有2935人完成了痴呆症评估,其中167人被诊断为痴呆症。痴呆症的标准化患病率为5.9%(95%置信区间:5.0% - 17.4%)。阿尔茨海默病(AD)和血管性痴呆(VaD)患者分别占痴呆症患者总数的58.7%和28.1%。年龄增长、教育水平较低、尿失禁和跌倒为AD的危险因素,而日常生活活动依赖残疾、高血压和中风被发现是VaD的危险因素。在中位随访5.44人年之后,记录了399例死亡。与非痴呆个体相比,患有AD和VaD的老年个体的5年死亡风险分别高出2.87倍(95%置信区间:1.92 - 4.17)和4.93倍(95%置信区间:3.23 - 7.53)。在调整了人口统计学、GS和心血管危险因素后,患有AD的老年个体的死亡风险与非痴呆个体相比无显著差异(HR = 1.32,95%置信区间:0.89 - 1.97),而患有VaD的个体的死亡风险比非痴呆个体高2.46倍(95%置信区间:1.49 - 4.05)。在北京,随着人口老龄化,痴呆症患病率显著上升,尤其是AD的患病率。GS的存在增加了患AD和VaD的风险以及死亡风险。在老年人群痴呆症预防中需要密切关注GS的管理。