Alzheimer''s & Dementia：系统评价荟萃分析全球痴呆患病率

痴呆的流行病学证据资料正迅速地扩展起来，特别是在低收入或中等收入水平的国家。因其对社会政策和发展计划的影响十分重要，需要对全球的发病率和患者数进行再评估。近日，发表在2013年1月《阿尔茨海默病与痴呆症：阿尔茨海默病学会杂志》上的一篇研究对全球痴呆患病率进行了荟萃分析。
　　研究对全球范围内关于痴呆患病率的文献（1980-2009）进行了系统性的回顾及荟萃分析，评估患病率和发病人数、≥60岁的病人数以及21个疾病负担区域的病人数。
　　结果显示，60岁及以上的人群中，年龄标准化的患病率在全球范围内为5%-7%，拉丁美洲的患病率较高（8.5%），在撒哈拉以南非洲区域的患病率很低（2%-4%）。据估计，2010年全世界共有3560万痴呆患者，每20年发病人数可能会翻一番。在2030年痴呆患者可能达到6570万，2050年将达11540万。2010年，58%的痴呆患者生活在低收入或中等收入国家，到2030年这一比例将达到63%，2050年将达到71%。
　　本研究详细的评估为政策制定和痴呆治疗及护理等福利保障提供了证据。痴呆的年龄特异性发病率在世界各地差异不大，并可能进一步缩小。今后对痴呆患者的护理应着眼于预防性干预（降低发病率）、提高治疗和护理水平（延长生存期）以及根据疾病调整干预措施（避免或延缓进展）。所有国家都应进行全国范围的调查并定期监测趋势。

与痴呆相关的拓展阅读：

• 系统评价荟萃分析全球痴呆患病率
• NEJM：痴呆花费已超过癌症和心脏病
• Ann Intern Med：房颤增痴呆风险再添新证
• “双高”中年人患老年痴呆症风险同样升高（Whitehall II研究）
• JAMA：痴呆症非药物治疗六步走
• 韩国老年痴呆患者11年增至8倍
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The global prevalence of dementia: A systematic review and metaanalysis
Background
The evidence base on the prevalence of dementia is expanding rapidly, particularly in countries with low and middle incomes. A reappraisal of global prevalence and numbers is due, given the significant implications for social and public policy and planning.
Methods
In this study we provide a systematic review of the global literature on the prevalence of dementia (1980–2009) and metaanalysis to estimate the prevalence and numbers of those affected, aged ≥60 years in 21 Global Burden of Disease regions.
Results
Age-standardized prevalence for those aged ≥60 years varied in a narrow band, 5%–7% in most world regions, with a higher prevalence in Latin America (8.5%), and a distinctively lower prevalence in the four sub-Saharan African regions (2%–4%). It was estimated that 35.6 million people lived with dementia worldwide in 2010, with numbers expected to almost double every 20 years, to 65.7 million in 2030 and 115.4 million in 2050. In 2010, 58% of all people with dementia lived in countries with low or middle incomes, with this proportion anticipated to rise to 63% in 2030 and 71% in 2050.
Conclusion
The detailed estimates in this study constitute the best current basis for policymaking, planning, and allocation of health and welfare resources in dementia care. The age-specific prevalence of dementia varies little between world regions, and may converge further. Future projections of numbers of people with dementia may be modified substantially by preventive interventions (lowering incidence), improvements in treatment and care (prolonging survival), and disease-modifying interventions (preventing or slowing progression). All countries need to commission nationally representative surveys that are repeated regularly to monitor trends.