老年期痴呆流行病学研究概况

随着人口出生率的下降及人类平均寿命的延长,世界人口趋于老龄化,老年期痴呆患者也随之增多,已成为危害老年人健康的主要疾病之一。我国卫生部将老年期痴呆列入“九五”老年医学研究的重点项目之一。本文就老年期痴呆流行病学研究进展作一简要综述。 1 患病率 老年期痴呆患病率各地报道差异较大。我国上海在同一地区做过两次大规模的流行病学调查,得     

老年期痴呆的发病率与预后

老年期痴呆是指发生于老年期或由成年延续下来的痴呆,主要类型为阿尔茨海默病痴呆与脑血管性痴呆,ICD-10将阿尔茨海默病痴呆依发病年龄于65岁前或后分为早发性或晚发性［1］。在21世纪,人口老龄化将达到历史上前所未有的规模和程度。我国以60岁为老年期的年龄界限,预计2000年我国60岁以上的老年人将达到1.3亿,本世纪中叶可能达到4亿左右［2］。现就有关老年期痴呆的发病率及其预后的研究作一简单的回顾。     

农村老年期痴呆发病率和病死率调查

目的：探讨农村老年期痴呆发病率、病死率及相关因素。方法：以1998年在上海郊区青浦农村进行老年期痴呆患病率调查时的非痴呆老年人2015名为样本，进行痴呆发病率的调查，并随访观察3年。结果：在老年人群中，痴呆发病率为0．4％～0．5％，发病率与年龄、性别、文化程度关系密切。痴呆患者的年均病死率为18．5％，明显高于同一地区同一时期同龄老年人的年均病死率3．0％。结论：痴呆在农村老年人群中发病率较高，病死率明显高于同龄老年人，值得引起重视。     

上海市卢湾区一个社区老年期痴呆患病率分析

目的 分析本地老年期痴呆患病情况。方法 采用简易智力状态检查量表（MMSE）作为调查筛选工具,对本社区55岁以上人群进行老年痴呆患病率的调查。结果 AD和VD的患病率分别为2．31％和4．87％,痴呆总 患病率为3．67％。痴呆总患病率与国内报道相近,但VD患病率高于AD。本组男女二性患病率无显著性差异。结论 高龄、文化程度低可能是AD和VD的共同易患因素和重要危险因素。     

南京地区老年期痴呆流行病学调查

目的：了解南京地区老年期痴呆的流行病学情况。方法：采用三阶段调查方法,对南京地区４个居委会和１个乡,共计３２６８名６０岁以上老年人进行老年期痴呆的流行病学调查。结果：老年期痴呆的患病率为１．４７％,Ａｌｚｈｅｉｍｅｒ病（ＡＤ）为０．９５％。脑血管性痴呆（ＶＤ）为０．４９％,其他痴呆为０．０３％。结论：老年期痴呆已成为危害老年人健康的重要疾病之一,而且对社会和家庭的影响非常大,应引起高度重视。     

老年期痴呆和帕金森病患病率调查

目的：了解社区老年期痴呆和帕金森病患病率及相关因素。方法：采用整群随机抽样法,对社区55岁及以上老年人进行调查。采用二阶段调查法,以简易智能状态检查量表（MMSE）、日常生活能力量表（ADL）、帕金森病筛查问卷为筛查工具：以Pfewffer功能活动调查表（POD）、Fud物体记忆测数（FOM）、快速词汇测验（RVR）、Hachinski缺血指数量表（HIS）为细查工具。按ICD－10老年期痴呆诊断标准确诊病例。结果：在1186人55岁及以上老年人中,痴呆患病率2．61％,其中阿尔茨海默病（AD）0．76％,血管性痴呆（VD）0．42％,混合型痴呆1．43％。帕金森病患病率为0．17％。结论 老年期痴呆和帕金森病是危害老年人健康和消耗卫生资源较高的慢性疾病。     

老年期痴呆患者生活质量及影响因素分析

目的 探讨老年期痴呆患者生活质量的影响因素.为老年期痴呆患者生活质量的改善和治疗效果的评估提供参考依据,方法通过横断面凋查,采用老年期痴呆患者生活质量量表(QOL-AD)以患者自评和照料者代评相结合的方式开展119例老年期痴呆患者生活质量调查.结果 老年期痴呆患者自评的QOL-AD评分为(28.49±5.63),高于照料者代评(27.26±4.67),差异有统计学意义(t=2.28,P<0.05).多元线性回归显示,患者自评生活质量主要影响因素为患者抑郁(P<0.01),照料者代评生活质量主要影响因素为患者抑郁(P<0.01)、日常生活能力(P<0.01)、精神行为症状发作(P<0.05)和亲属应激(P<0.05).结论 为改善老年期痴呆患者的生活质量,应使患者能够得到有效治疗和科学护理,延缓病情进展并控制并发症.     

农村老年期痴呆临床症状调查

目的：探讨农村的老年期痴呆的临床表现。方法：采用美国加里福尼亚州的痴呆行为问答卷（ＣＤＢＱ），对符合ＤＳＭ－Ⅲ－Ｒ阿尔茨海默病（ＡＤ）和脑血管性痴呆（ＶＤ）诊断标准患者共８０例进行测试。结果：老年期痴呆临床症状可有行为、思维、情绪、睡眠和定向等障碍。以妄想、抑郁、违拗、易分心、幻觉、攻击、无目的走动、重复行为较为多见，因性别、年龄、病程、痴呆类型和严重程度不同而有差异。结论：老年期痴呆常表现出多种     

老年期痴呆及Alzheimer病心理社会危险因素初探

目的 对老年期痴呆及Ａｌｚｈｅｉｍｅｒ病（ＡＤ）的心理社会危险因素进行初步探索。方法 在城市社区中分层整群抽样，５年间进行两次二阶段法调查。分析５年前心理社会因素对痴呆及ＡＤ发生的影响作用。结果 ５年中新发痴呆病人１４１名，其中ＡＤ９２名，经相对危险度ＲＲ分析，发现与痴呆及ＡＤ有关的心理社会危险因素有健康感不良，情绪不良，睡眠过多，不照顾家人，不访亲问友，不工作，不参加闲暇活动和缺乏教育项（ＲＲ〉     

社区痴呆患者的家庭照料者心理状况研究

目的：为了社区痴呆患者的家庭照料者心理状况及相关因素，方法：采用MMSE，ADL，GDS，Be-AD和GHQ对103例社区痴呆患者的家庭照料者心理状况进行调查并分析。结果：家庭照料者的焦虑失眠症状明显，主要是痴呆患者的精神／行为问题相关，与照料者本身的年龄，文化和对痴呆知识的了解程度有关。结论：对老年痴呆的照料以及照料者的心理健康状况值得重视。     

Neuroanatomical correlates of clinical misidentification and misperception in senile dementia of the Alzheimer type

BACKGROUND: Impaired frontal lobe and/or nondominant hemisphere lesions have been described in patients with typical misidentification syndromes (e.g., Capgras' syndrome or reduplicative paramnesia) who had various underlying psychiatric or neurologic disorders. In a prospective long-term study, the authors examined computed tomography measurements of patients with senile dementia of the Alzheimer type (DAT) to determine whether the forms of misidentification they suffered might correlate with organic factors. METHOD: One hundred twenty-eight consecutive DAT patients were examined by means of standardized clinical instruments (Mini-Mental State score, CAMCOG, the Benton facial recognition test, the Kendrick object learning test, CAMDEX, and the Geriatric Mental State Schedule) and computed tomography. RESULTS: Of the 128 patients, 40 showed symptoms of misidentification; 25 of them misidentified other people in their homes, 7 misidentified their own mirror images, and 7 misidentified television images as being real. Computer-assisted planimetric computed tomography measurements showed that patients with misidentification syndromes had significantly larger right anterior horn areas of the lateral ventricle and significantly larger left anterior brain areas than did patients without such symptoms. CONCLUSIONS: The authors conclude that an accentuated degeneration of the right frontal lobe (and a relative preservation of the left frontal lobe) may be associated with delusional misidentification symptoms in DAT.     

Coexisting depression and dementia in a community survey of the elderly

We report here on the coexistence of dementia and depression in a community population aged 75 years and older. Complete information about mood and cognition was available for 286 cognitively intact subjects selected for assessment because of their low scores on the Mini-Mental State, and for 158 mildly and moderately demented subjects. Severely demented subjects, who were incapable of providing information, were excluded. Five percent (8/158) of demented subjects also fulfilled criteria for major depressive disorder Diagnostic and Statistical Manual of Mental Disorders, third edition (DSM-III) compared with 9% (27/286) of cognitively intact subjects. No substantial differences existed in the symptoms reported by demented depressives and nondemented depressives, but subjects who suffered from both disorders were so markedly apathetic that their depression might easily have been overlooked had specific enquiries not been made. Depression was particularly associated with dementia secondary to multi-infarct and Parkinson's disease. When reviewed one year later, 2 of the 18 surviving depressed, nondemented subjects showed evidence of dementia. Both presented unusual diagnostic difficulties, however, and no evidence emerged that large numbers of elderly people will be misclassified in community surveys that include a mental state examination, cognitive testing, and an informant interview.     

A community based study of the incidence of dementia in subjects aged 85 years and over.

The aim was to investigate the incidence rate of dementia for community residents aged 85 years and over. It was a two wave community study of 224 subjects (community residents including those residing in a nursing home) older than 85 years, restudied 4.1 years after a community prevalence study. A two stage method was used, comprising the mini mental state examination followed in a stratified sample by the geriatric mental state schedule (A3)/AGECAT. Incidence rates were based on person-years at risk. The overall incidence of dementia was 6.9 (95% confidence interval (95% CI) 4.8-9.1) per 100 person-years at risk. The incidence was significantly higher for women than for men; respectively 8.9 (95% CI 5.9-11.9) v 2.7 (95% CI 0.5-4.9) per 100 person-years at risk. In the fastest growing age group seven out of 100 persons develop dementia each year. Women, who constitute two thirds of the oldest old, seem to have a higher risk. Further research is needed into the risk factors for dementia in this age group.     

老年型阿尔茨海默病的病理与影像学对照研究

目的：我们通过4例老年型阿尔茨海默病（SDAT）的病理与其自身不同时期的影像学进行对照研究,探讨病理改变与影像的相关性。方法：病理用HE、Gallyas银染色及四种免疫组化方法,详细观察大脑皮层各叶、扣带回、杏仁核、海马、海马旁回、Meynert基底核、脑干的黑质、蓝斑、迷走神经背核的神经细胞丢失,老年斑、神经原纤维缠结等的变化。影像用4例剖检例自身生前不同时期的CT与病理的对照研究。结果：SDAT以颞叶及顶叶的变性为主：（1）额叶的皮质,以额叶中回的变性最明显;（2）岛叶的皮质,长回比短回的变性明显;（3）扣带回后性较前部变性明显,结论：SDAT的上述病理所见与影像学的改变基本一致。     

A trial of vitamin supplementation in senile dementia

The effect of supplements of vitamins B-1, B-2, niacin, B-6 and C has been assessed in a randomized double-blind trial in 15 hospitalized elderly patients suffering from senile dementia. Supplementation did not prevent an increase in either cognitive impairment or behavioural disturbance. However, it did result in weight gain over a six-week period. Hospitalized demented patients generally suffer significant weight loss, which increases with the duration of hospitalization. Vitamin supplementation may therefore protect against physical deterioration and the development of cachexia.     

Association between changes in adrenal secretion and cerebral morphometric correlates in normal aging and senile dementia

The circadian organization of adrenal secretion was studied in 23 healthy elderly subjects, 23 elderly demented patients and 10 healthy young subjects, in order to investigate the relationships between the hypothalamic-pituitary-adrenal axis and some cerebral morphometric parameters. The cerebral morphometric analysis was performed in some subjects of the three groups by MRI. A significant increase in cortisol levels during evening and nighttime was found in both groups of the aged subjects. In elderly subjects, particularly if demented, the mean serum dehydroepiandrosterone sulfate (DHEAs) levels throughout the 24-hour cycle were significantly lower than in young controls. A significant reduction of the hippocampal and temporal volume and an enlargement of the lateral ventricles were found in aged subjects, these changes being significantly related to subjects' age. Moreover, the hippocampal volume was positively correlated with the circadian mesor of DHEAs (i.e., the circadian rhythm adjusted mean) and with the cortisol nocturnal increase. Our data may suggest the existence of a link between the selective impairment of cortisol secretion and DHEAs levels, and the progression of hippocampal degeneration.     

Early detection of senile dementia. Apropos of the congress on "Current problems in senile dementia"

While research in neurochemistry, genetics and molecular biology progresses in understanding Alzheimer's disease, no therapeutic strategy has hitherto been demonstrated useful. Early detection and diagnosis of dementias are thus equally important. The major part of this symposium was devoted to advances of research in this field. New techniques of clinical assessment, metabolic imaging and brain mapping are promising tools for early diagnosis.