北京市社区居民老年期痴呆发病率及其危险因素研究

摘要

目的 了解北京市城乡居民老年期痴呆发病率,探讨其发病的流行病学危险因素.方法 1997年采用按类分层、分阶段随机抽取区(县)街道(乡)居委会(自然村),按照整群抽样原则获得研究样本.分两阶段进行基线痴呆患病率调查,第1阶段完成问卷调查及筛查量表(MMSE)等测试,第2阶段由神经内科医师对MMSE得分低于界值和部分正常的老年人进行病史搜集、临床查体和神经心理测验等,最后根据DSM-Ⅲ-R和NINCDS-ADRDA诊断标准完成痴呆临床诊断.按照同样的方法在2000年和2004年对研究样本进行随访,总计追踪7.25年.结果 基线调查有效样本2788例,筛查出痴呆171例.截至随访期末,累积诊断新发痴呆180例,经年龄标化的年发病率(以下均为标化率)为0.84/100人年,其中男性为0.64/100人年,女性为1.01/100人年.老年性痴呆(AD)的年发病率为0.41/100人年,其中男性为0.23/100人年,女性为0.59/100人年;血管性痴呆(VaD)年发病率为0.35/100人年,其中男性为0.39/100人年,女性为0.32/100人年.痴呆的年发病率随年龄的增加而提高,随受教育年限的增加而下降.经多分类logistic回归分析,高龄、文肓是AD发病的危险因素;而男性、文盲、卒中和血压(收缩压)高是VaD发病的危险因素.结论 北京市社区居民老年期痴呆年发病率略高于国内其他研究.高龄、文盲是AD发病的危险因素;男性、文肓、卒中和血压(收缩压)高是VaD发病的危险因素.%Objective To study the incidence of dementia and its risk factors among the elderly living in the community of Beijing. Methods A sample of 2788 elderly residents from Beijing were investigated regarding the incidence of dementia which was diagnosed using two-stage method in 1997. In the first stage, questionnaire was filled, including MMSE checked up. In the second stage, all the elderly who had lower MMSE score and some with normal MMSE score were examined by neurologists. The clinical diagnosis of dementia was set up by two neurologists according to the criteria of DSM- Ⅲ -R and NINCDS-ADRDA. The same sample was followed up on 2000 and 2004 by the same way, with the overall time for following-up as 7.25 years. Results 171dementias cases were diagnosed among the 2788 elderly in 1997. At the end of the survey, another 180 new cases developed. The average weighted incidence was 0.84/100 person year, adjusted by age (it's same followed), with 0.64/100 person year in males and 1.01/100 person years in females. The incidence of vascular dementia was 0.35/100 person years, with male as 0.39/100 person year and female as 0.32/100 person years. The incidence of dementia was increasing with age, but decreasing with time of education by Multinomial Logistic Regression Analysis. Old age and illiterate appeared to be the risk factors for dementia. People with stroke history and elevated systolic blood pressure were risk factors for vascular dementia. Conclusion The incidence of dementia in the elderly in Beijing was higher than in other areas of China. Old age and illiterate were risk factors for dementia. Being male, illiterate, with stroke history and elevated systolic blood pressure were risk factors for vascular dementia.