研究發現中國北京的阿茲海默氏症盛行率增加


  March 28, 2008(佛羅里達州奧蘭多訊)-西雅圖華盛頓大學的李吉(譯音)醫師在美國老人精神醫學學會第21屆年會的跨文化地理精神學創新研究座談中報告這兩項研究結果,中國北京的老人阿茲海默氏症盛行率在過去的10年間增加。
  
  李醫師表示,阿茲海默氏症的盛行率隨著年齡增長而戲劇化地上升,在全世界各地越來越常見、且在發展中國家是個大問題;她收集1990年到2000年之間的數據,結果顯示,在過去10年間,65歲以上的老年人口增加了27%。
  
  李醫師報告兩項以同樣方法分別收集10年間(從1986年到1989年、1997年到1999年)居住在北京同一地區居民的數據;第一項研究(研究一)是她的博士論文,在她離開北京到美國之前完成的,而第二項研究(研究二)是其同事在中國完成的。
  
  該研究針對60歲以上居住在社區的老人進行,她指出,在中國,60歲以上就被認為是年長的,研究者到這些老年人的家中、進行迷你神智狀況檢驗(MMSE),如果該個體篩檢結果呈陽性,一名精神科醫師將會到該個體家中進行臨床檢驗,以確認診斷。
  
  研究者對研究一的1331位個體使用精神異常診斷與統計手冊第3版(DSM-III)的老年癡呆研究診斷標準,而對研究二的1703位個體使用DSM-IV與國際疾病與相關健康問題統計分類第10版(ICD-10)的老年癡呆診斷標準。
  
  他們發現,整體正逐漸老年化中,落在"最老"分類(80歲以上)的人數從研究一的6.9%增加到研究二的12.1%。
  
  中重度癡呆的比例從研究一的每100位中有1.74位,增加到研究二的每100位中有2.51位;同樣的,研究一的新癡呆病例發生率從每100位有0.56位,增加到研究二的每100位有0.90位。
  
  李醫師指出,在北京,仍有許多年齡沒那麼大的老年人,其癡呆症發生率與西雅圖或是歐洲等國並沒有戲劇化的差異。
  
  她表示,在北京,過去這段時間阿茲海默氏症變得比血管性癡呆更普遍可能有三個原因;第一,整個群體正在老年化中;第二,因為有效的血壓控制與中風預防,大腦血管疾病在過去這段時間顯著減少;第三,生活型態"戲劇化"地改變。李醫師指出,中國老年個體的生活形態已經趕上西方國家的形式,人們花更多的時間坐在電視前,走路到另一個鄉鎮拜訪朋友的情況變少,他們食用更多的肉類、且吃更多的富含膽固醇的食物,且糖尿病的盛行率增加;糖尿病、高血壓與高膽固醇血症已經被認為是阿茲海默氏症的危險因子,這是為什麼中國阿茲海默氏症越來越多的原因之一。
  
  除了針對這個族群的癡呆症之外,研究者也使用老年憂鬱指數來研究憂鬱症,他們發現1,952位中有25位罹患憂鬱症;她指出,北京社區中的這25位憂鬱症病患皆沒有藥物或接受治療。
  
  李醫師表示,根據她在西雅圖的臨床執業經驗,亞洲病患有更多本體憂鬱症狀,例如頭痛或是頭暈;在她的臨床經驗中,你所需要的僅是多問幾個問題;她附帶表示,你必須挖深一點。

Studies Find Increasing Preval

By Marlene Busko
Medscape Medical News

March 28, 2008 (Orlando, Florida) — The prevalence and incidence of Alzheimer's disease in Beijing, China has increased over a recent 10-year period, according to data from 2 studies. This was a time of large changes in lifestyle, according to Ge (Gail) Li, MD, from the University of Washington, in Seattle, who reported these findings in a talk on Innovative Research in Cross-Cultural Geropsychiatry here at the American Association for Geriatric Psychiatry 21st Annual Meeting.

Alzheimer's disease, which increases dramatically with age, is becoming more common worldwide and has become more of a problem for developing countries, said Dr. Li. Census data from China from 1990 to 2000 revealed an aging population with, during this decade, a 27% increase in the number of people who are age 65 years and older, she noted.

Dr. Li presented data from 2 studies done 10 years apart (1986 to 1989 and 1997 to 1999) using identical methods and looking at the same residential area of Beijing. The first study (study 1) was part of her PhD thesis, before she left China to go to the United States, and the second study (study 2) was carried out by colleagues in China.

The studies looked at individuals who were living in the community who were age 60 years and older. "In China, 60 is [considered to be] old age," she said. The researchers went to people's homes and performed a Mini-Mental State Exam (MMSE). If the person screened positive for dementia, a psychiatrist went to the person's home and performed a clinical examination to confirm the diagnosis.

The researchers used Diagnostic and Statistical Manual of Mental Disorders, 3rd ed (DSM-III) criteria for dementia in study 1 (1331 people) and used DSM-IV and International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) criteria for dementia in study 2 (1703 people).

They found that the population is aging; the number of people who fell into the "oldest-old" category (age 80 years or older) grew from 6.9% of the population in study 1 to 12.1% of the population in study 2.

The prevalence of moderate and severe dementia grew from 1.74 per 100 people screened in study 1 to 2.51 per 100 in study 2.

Similarly, the incidence of new dementia grew from 0.56 per 100 people in study 1 to 0.90 per 100 people in study 2.

"In Beijing, there are still a lot of 'young old,' and the incidence of dementia is not dramatically different from Seattle or across multiple Europe countries," Dr. Li said.

There are 3 likely reasons that Alzheimer's disease has become more common than vascular dementia in Beijing over this time period, she noted. First, the population is aging. Second, cerebrovascular disease has been decreasing over time, probably due to effective hypertension treatment and stroke prevention. Third, there has been a "dramatic" lifestyle change, Dr. Li said, explaining that the lifestyle of the elderly Chinese is catching up with the Western lifestyle. People are spending more time in front of televisions and less time walking to the next town to visit friends. They eat more meat and have a diet that is higher in cholesterol, and there is an increase in diabetes. "Diabetes, hypertension, and hypercholesterolemia have been identified as risk factors for Alzheimer's disease. This is another reason you see more Alzheimer's disease in China," she said.

In addition to looking at dementia in this population, the researchers also administered the Geriatric Depression Scale to investigate depression. They found a prevalence of depression of 25 in 1952 people. None of the 25 subjects in this Beijing community were treated for their depression with either medication or therapy, she noted.

Based on her experience in her clinical practice in Seattle, Asian patients do present with more somatic symptoms of depression such as headaches and dizziness, Dr. Li said. "In my clinical experience, you just need to ask more questions. You have to 'dig deeper,' " she added.

American Association for Geriatric Psychiatry 21st Annual Meeting: Innovative Research in Cross-Cultural Geropsychiatry. Presented March 15, 2008.

    
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