Suemoto Claudia K, Borelli Wyllians V, Calandri Ismael L, Bertola Laiss, Castilhos Raphael M, Caramelli Paulo, Nitrini Ricardo, Brucki Sonia M D, Laks Jerson, Mukadam Naaheed, Livingston Gill, Ferri Cleusa P
Division of Geriatrics, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil.
Department of Morphological Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
Lancet Reg Health Am. 2025 Aug 7;49:101209. doi: 10.1016/j.lana.2025.101209. eCollection 2025 Sep.
The Lancet Commission on dementia prevention, intervention, and care 2024 updated the list of modifiable risk factors to include 14 factors. The potential for dementia prevention seems to be greater in low- and middle-income countries (LMIC) due to the higher prevalence of these factors. This study aims to provide the first LMIC figure for the potential for dementia prevention in Brazil attributed to 14 modifiable risk factors.
Data was retrieved from 9949 participants aged 50 years or older from the nationally representative second wave of the Brazilian Longitudinal Study of Aging (ELSI-Brazil) conducted between 2019 and 2021. The prevalence of modifiable risk factors was estimated, and principal component analysis was used to account for factor communalities. Overall and individual population attributable fractions (PAF) were calculated using relative risks from the 2024 Lancet Commission report. Stratified analyses by sex, race, and Brazilian macro regions were performed to assess disparities in dementia risk.
The overall PAF for the 14 modifiable risk factors was 59.5% (95% CI = 58.5-60.5). The three risk factors with the highest PAFs were less education (9.5%, 95% CI = 8.9-10.1), untreated visual loss (9.2%, 95% CI = 8.6-9.8), and midlife depression (6.3%, 95% CI = 5.8-6.8). The overall PAF was similar across race and region but was higher among women (61.1%, 95% CI = 59.9-62.4) compared to men (58.2%, 95% CI = 56.7-59.8).
Almost 60% of dementia cases in Brazil could potentially be prevented by addressing 14 modifiable risk factors. Public health strategies could further reduce the dementia burden in Brazil.
CKS, PC, and CPF received productivity fellowships from the National Council for Scientific and Technological Development (CNPq). ELSI-Brazil was supported by the Brazilian Ministry of Health: DECIT/SCTIE (Grants: 404965/2012-1 and TED 28/2017); COPID/DECIV/SAPS (Grants: 20836, 22566, 23700, 25560, 25552, and 27510).
《柳叶刀》痴呆症预防、干预与护理委员会2024年更新了可改变风险因素清单，其中包括14个因素。由于这些因素在低收入和中等收入国家（LMIC）的患病率较高，因此在这些国家预防痴呆症的潜力似乎更大。本研究旨在提供巴西归因于14个可改变风险因素的痴呆症预防潜力的首个低收入和中等收入国家数据。
数据取自2019年至2021年进行的具有全国代表性的巴西衰老纵向研究（ELSI - Brazil）第二轮中9949名50岁及以上的参与者。估计了可改变风险因素的患病率，并使用主成分分析来考虑因素共性。使用《柳叶刀》委员会2024年报告中的相对风险计算总体和个体人群归因分数（PAF）。按性别、种族和巴西宏观区域进行分层分析，以评估痴呆症风险的差异。
14个可改变风险因素的总体PAF为59.5%（95%置信区间 = 58.5 - 60.5）。PAF最高的三个风险因素是教育程度低（9.5%，95%置信区间 = 8.9 - 10.1）、未治疗的视力丧失（9.2%，95%置信区间 = 8.6 - 9.8）和中年抑郁症（6.3%，95%置信区间 = 5.8 - 6.8）。总体PAF在种族和地区之间相似，但女性（61.1%，95%置信区间 = 59.9 - 62.4）高于男性（58.2%，95%置信区间 = 56.7 - 59.8）。
通过解决14个可改变风险因素，巴西近60%的痴呆症病例有可能得到预防。公共卫生策略可以进一步减轻巴西的痴呆症负担。
CKS、PC和CPF获得了国家科学技术发展委员会（CNPq）的生产力奖学金。ELSI - Brazil得到了巴西卫生部的支持：DECIT/SCTIE（资助：404965/2012 - 1和TED 28/2017）；COPID/DECIV/SAPS（资助：20836、22566、23700、25560、25552和27510）。
