Seshadri S, Wolf P A, Beiser A, Au R, McNulty K, White R, D'Agostino R B
Department of Neurology, Boston University School of Medicine, MA 02118, USA.
Neurology. 1997 Dec;49(6):1498-504. doi: 10.1212/wnl.49.6.1498.
We estimated the remaining lifetime risks of developing Alzheimer's disease (AD) and dementia from all causes, based on data from longitudinal population studies. The risk of developing AD during one's lifetime depends on both disease incidence and life expectancy. Conventional estimates of cumulative incidence overestimate the risk when there is a substantial probability of mortality due to competing causes. A total of 2,611 cognitively intact subjects (1,061 men, 1,550 women; mean age, 66 +/- 7 years) were prospectively evaluated for the development of AD or other dementia. A modified survival analysis was used to estimate both cumulative incidence and the sex-specific remaining lifetime risk estimates for quinquennial age groups above age 65 years. Over a 20-year follow-up period, 198 subjects developed dementia (120 with AD). The remaining lifetime risk of AD or other dementia depended on sex, being higher in women, but varied little with age between 65 and 80 years. In a 65-year-old man, the remaining lifetime risk of AD was 6.3% (95% CI, 3.9 to 8.7) and the remaining lifetime risk of developing any dementing illness was 10.9% (95% CI, 8.0 to 13.8); corresponding risks for a 65-year-old woman were 12% (95% CI, 9.2 to 14.8) and 19% (95% CI, 17.2 to 22.5). The cumulative incidence between age 65 and 100 years was much higher: for AD, 25.5% in men and 28.1% in women; for dementia, 32.8% in men and 45% in women. The actual remaining lifetime risk of AD or dementia varies with age, sex, and life expectancy and is lower than the hypothetical risk estimated by a cumulative incidence in the same population.
基于纵向人群研究数据，我们估算了患阿尔茨海默病（AD）和各种原因导致的痴呆症的剩余终生风险。一生中患AD的风险取决于疾病发病率和预期寿命。当存在因其他竞争原因导致死亡的较大可能性时，传统的累积发病率估算会高估风险。共有2611名认知功能正常的受试者（1061名男性，1550名女性；平均年龄66±7岁）接受了AD或其他痴呆症发病情况的前瞻性评估。采用改良生存分析来估算65岁以上每五岁年龄组的累积发病率和按性别划分的剩余终生风险估算值。在20年的随访期内，198名受试者患上痴呆症（120名患AD）。AD或其他痴呆症的剩余终生风险取决于性别，女性风险更高，但在65至80岁之间随年龄变化不大。对于一名65岁男性，患AD的剩余终生风险为6.3%（95%置信区间，3.9%至8.7%），患任何痴呆症的剩余终生风险为10.9%（95%置信区间，8.0%至13.8%）；一名65岁女性的相应风险分别为12%（95%置信区间，9.2%至14.8%）和19%（95%置信区间，17.2%至22.5%）。65至100岁之间的累积发病率要高得多：AD在男性中为25.5%，在女性中为28.1%；痴呆症在男性中为32.8%，在女性中为45%。AD或痴呆症的实际剩余终生风险随年龄、性别和预期寿命而变化，且低于同一人群中累积发病率估算的假设风险。
