公开课-关爱惟士
公开课
(2)慕课操作导航-Navigating the MOOC

课程视频http://player.youku.com/embed/XMzYwNDQ0NDA4OA



Hello, my name is Shannon, and I’m a part of the academic team behind the Preventing Dementia MOOC.

大家好,我是Shannon,我是预防认知症慕课的学术团队的一员。


I’d like to present an overview of how to navigate the MOOC. This presentation is intended for people who are unfamiliar with how the course works, or just need a refresher. You’re welcome to use this guide before you begin the course, or you can delve straight in and return to this video later if required.

我想介绍一下如何使用慕课。 此演示主要面向不熟悉课程操作流程或仅需要复习的参与者。 欢迎您在开始课程之前使用本指南,或者您可以先进入课程,需要时再返回到此视频。


Changing your Profile Picture

更换头像

Firstly, I'll show you how to change your profile photo. At the top right of the screen you'll see your name. Click on this and then Profile from the menu - you'll get some options. You can change your Nickname, add a little Tagline, or click this button to change your Picture. Click Upload and then Browse to where your photo is stored, and then click Choose. Once you've selected it click Add, and then Save and Close. Note that your image must be less than 1000 pixels wide and 1000 pixels high. It must be either a JPG or a GIF file and can't be any larger than 1 MB. In other words, just make sure your image isn't too large. And please, only upload an image of yourself.

首先,我会向您展示如何更换头像。 你会在屏幕右上方看到你的名字。 点击你的名字,然后从菜单中选择“我的账户”-你会看到一些选项。 你可以更改昵称,添加个性签名,或者点击按钮更改头像。 点击“上传”,浏览你所存储的照片,然后选择所要上传的照片。 选好之后点击“添加”,然后“保存”并“关闭”。 注意照片应小于1000像素×1000像素。 照片格式必须是JPG或者GIF,且不得大于1MB。 也就是说,要确保你的照片不能过大。 并且,请上传你本人的照片。


Navigation

操作导航

Now I'll give you a demonstration of this top navigation bar. This will be on all the pages within the MOOC. Clicking the left-hand button - the Home button - will always bring you back to this front page.

现在我给大家演示一下这个顶部导航栏。 它会出现在慕课所有的页面中。 点击左边的主页按钮会返回到首页。


Next is the Content button. This is probably the most important one, because it is through this that you're going to access all the content that's inside the MOOC. I'll explain more about this a little later.

接着是内容按钮。 这个可能最为重要,因为通过它你将可以访问慕课里面的所有内容。 稍后我会对此做进一步讲解。


The Discussions tool is where a list of discussion topics is located. This is where you may go to participate in text conversations with your fellow participants and Wicking experts or engage in different activities that we provide within the MOOC.

讨论工具位于讨论主题列表中。 在这里你可以与课程参与者及专家进行文本对话,或参与我们在慕课中提供的不同任务。


Next, the Grades tool is where you can see which quizzes you have successfully submitted, and the highest score you have achieved on each quiz.

接下来,在成绩工具中,你可以看到你已经成功提交的测验以及你每次测验所得的最高分数。


And finally, the Glossary tool is where we’ll list dictionary definitions of the various terms you’ll come across in the MOOC.

最后,在词汇表工具中,我们会列出你在慕课中可能遇到的词条的字典定义。


I’d now like to present an overview of the Content in the MOOC, because it’s within the content that you’ll probably spend most of your time as you learn about dementia.

现在,我想对慕课的内容部分做一个概述,因为当你在了解认知症时,你可能会花费大部分时间在这一部分。


We’ve tried to present the content in an accessible, engaging, and flexible way. We’ve simplified the navigation so that you can step through each page like a book. Whenever we present an activity to you, we’ll link to it directly so that you never have to navigate to it yourself.

我们尽量以容易理解的、有趣的以及灵活的方式来表述这一部分。 我们已经对使用导引进行了简化,这样你就可以像看书一样,浏览每一页。 当我们向你展示一个任务时,我们会直接给出任务的链接,这样你就不用再通过使用导引自己寻找了。


Once you’ve logged in and entered the course, you’ll find the Content link in the navigation bar at the top here. Click the link and you’ll land on the course overview page.

一旦登录并进入了该课程,您会在顶部的导航栏中找到内容链接 点击链接,登陆课程概述页面。


You’ll notice on the left-hand side there is a Table of Contents. We’ve split the course into weeks, so that you can roughly gauge how far you’ve progressed. Content is released weekly, and can then be accessed once you have completed certain activities.

你会注意到左手边有一个目录列表。 我们把课程分成了几周,这样你就可以大致估计自己的学习进度。 内容会按周发布,只有完成特定任务才能看到新发布的内容。


If you click the Table of Contents you'll see a list of topic pages. Within a module, you can visit any page in any order, but we highly recommend that you start from the beginning and work your way through page by page.

点击目录列表,会出现主题页面列表。 在一个模块中,您可以按任何顺序访问任何页面,但是我们强烈建议您从头开始,按顺序逐页学习。


Any pages with the word Quiz in the title will contain a link to a Quiz for you to complete.

任何带有单词“测验”的页面都会包含一个测验的链接,让你完成。


Click a link to see that page. Each page contains information that will advance your understanding of dementia. In the Introduction, we will ask you to spend some time familiarising yourself with the MOOC.

单击链接以查看该页。 每一页都包含可以促进你对认知症的理解的信息。 在引言中,我们将要求你花一些时间熟悉慕课。


Here, for example, is a map of the course modules and content. It is possible to step through the pages of the course using the buttons at either the top or the bottom of the page. This is like turning the pages of a book.

例如,这是课程模块和内容的映射。 可以使用页面顶部或底部的按钮来浏览课程页面。 就像翻书一样。


We often feature short videos of discussions within the content. You can play these videos directly on the page. If you cannot watch the video, or would prefer to read text, we have also provided transcripts for each video.

内容中会经常出现简短的讨论视频。 你可以直接在页面上播放这些视频。 如果你不能观看视频,或者更喜欢阅读文本,我们也提供了每个视频的文本资料。


If you find that the summary within the videos is too quick to read, you can pause the videos at any time. Simply click on the screen while it's playing, and click it again to continue playing. Alternatively, you can click Play or Pause at the bottom-left of the video. If you want to re-watch part of the video, you can simply drag the playerhead at the bottom of the clip to the desired location.

如果觉得视频中的摘要播放得太快,可随时暂停视频。 播放状态点击屏幕就可暂停播放,再次点击即可继续播放。 也可点击视频左下方的“播放”或“暂停”按钮来进行操作。 如果想重看视频的某部分,只需将视频下方的进度条拖到想要观看的视频位置即可。


I’m on a different page now. You will notice the activity box. Once you are ready, you can participate in discussion forums about the topic. Occasionally, we may ask you to complete a quiz.

我不在当前页面。 你会注意到任务框。 一旦准备好了,您就可以去讨论区参加这个话题的讨论。 有时,我们可能要求您完成一个小测验。


You'll notice at the top of each page a series of links that we call breadcrumbs. You can use these to locate where you are within the content.

你会注意到在每页的顶部有一系列链接,我们称它们为痕迹导航。 你能够运用它们来定位你在内容中的位置。


After the introduction, the course is divided into four modules, which will open on successive Thursdays.

在引言之后,课程被分成了四个模块,它们会在每周四相继开放。


When you have visited a topic page within a section of the course, a tick will appear next to that topic in the Table of Contents.  After all topics are viewed, you will see above the topic list a message that the section is “100% complete.” Please note that this feature is intended to allow you to keep track of where you are up to in the course. A tick on a page only shows that you have visited it, but not necessarily that you have completed all activities on that page, such as watching a video or submitting a quiz.  To confirm whether you have successfully submitted a quiz, please check under “Grades.”

当你在课程的某一节查看了一个主题页后,该主题对应的目录旁边就会出现一个标记。 当你查看了所有主题之后,主题列表上方会出现一条消息,显示此节“100%完成”。请注意这个功能是为了方便你跟踪自己在课程中的完成情况。 页面上的标记只能说明你查看过该页,并不代表你已经完成了该页的所有任务,比如观看一段视频或者提交了小测验。 可通过在“成绩”下查询分数,来确认自己是否已经成功提交了测验。


So that’s a quick overview of Content within the Preventing Dementia MOOC.

以上是预防认知症慕课内容的快速概述。


Discussion Boards

讨论板

Next I’d like to present an overview of the Discussions tool in the MOOC, because it is a vital part of the way that we communicate during the course.

接下来,我想对慕课中的讨论工具进行概述,因为这些工具是我们在课程中交流的重要组成部分。


Discussion topics allow you to interact with your peers and get guidance from academic staff in a way that is similar to what would happen in a university class tutorial. You can get feedback on your ideas, be exposed to new ideas and perspectives, and discuss important aspects of the material you are learning and its implications.

讨论主题促使您与同伴进行互动,并能够获得同大学课堂一样的学术人员的指导。 您的想法能够得到反馈,您能够接触新的想法和观点,并讨论您正在学习的材料的重要内容及其含义。


So how do you get to the Discussions? Well, once you’ve logged in to the course you’ll find in the top, navigation bar a link called Discussions. Just click on this link and you’ll be taken to the list of discussion topics.

那么如何进行讨论呢? 当登录进课程,在顶部导航栏有个名为“讨论”的链接。 点击这个链接,就会进入讨论主题列表。


You’ll notice a number of topics. The first ones are general topics.

你将会看到很多话题。 首先出现的是一般性话题。


Use the ‘Your Course Feedback’ discussion to highlight any feedback that you consider important regarding any aspect of the course. All participants will be able to see your comments.

对课程任何方面你认为很重要的反馈,可以通过“你的课程反馈”进行讨论。 所有参与者都能看到你的意见。


The Social Space discussion is a place to chat, or to have off-topic conversations with your peers.

社交空间讨论是一个聊天或与同伴进行非话题讨论的场所。


There is also a Technical Issues topic where you might want to report computer problems related to the MOOC. It’s certainly worth having a look in here to see whether somebody else has answered your problem. If you have figured out how to solve a problem yourself then you are more than welcome to report your solution here.

还有一个是有关技术问题的,您可能需要报告与慕课有关的计算机问题。 可以在这里查看是否已经有人回答了你的问题。 如果你的问题得到了解决,那么非常欢迎你在这里报告自己的解决方案。


So what does a discussion topic look like?

那么讨论话题是什么样子的呢?


I’ll enter the ‘Social Space’ topic as an example. So I just click on the link and you’ll notice that we have a thread in here already.

作为一个例子,我将进入“社会空间”话题。 点击链接,你就会发现我们已经有了一个帖子。


To start a thread, click the Start a New Thread button. Now, just like writing an email, you need to enter a subject and then the message. Then, when you’ve finished, press the Post button.

点击“创建新帖”按钮,开始创建帖子。 现在,就像写电子邮件一样,你需要输入一个主题,然后输入信息。 完成后,按下“发布”按钮。


Only create threads when you’re certain that no other thread covers that same topic; that is, only create a new thread when you’re starting a new conversation. Often you’ll be responding to threads that are already there.

确保您所创建帖子的同一主题未被其它帖子涵盖;也就是说,只有在您开始新会话时才创建新帖子。 通常你会对已有帖子进行回复。


If you want to make a reply to somebody else's thread, click on the message subject line. You are taken to a new page, where you can click Reply to Thread. You can fill in the message just as you would when you're posting the first message of a new thread.

如果您想要回复其他人的帖子,则点击信息主题栏。 然后打开新页面,点击“回帖”按钮。 就如发表一个新帖子的首条信息时,输入所需的信息。


To return to the list of messages within a discussion topic, you can click on the View Topic breadcrumb up here, or you can jump back even further and list all of the discussions using the Discussions List breadcrumb.

您可以通过点击此处的“查看话题”导航按钮返回到某个讨论话题的信息列表,或者您可以后退更多并且通过讨论列表导航功能来列出所有讨论话题。


Now, eventually there will be perhaps hundreds of threads with thousands of messages, and you’ll need ways of managing those. The fastest way to look for a particular thread or message is to search for it. In the top-right corner of the topic list and thread list is the search box. You can enter the name of a person or a snippet from the message, and the messages or threads which match will be returned.

最终可能有数百个帖子附带数千条信息,你可能需要一些方法来管理这些帖子和信息。 查找某个特定帖子或信息,最快的方法就是搜索。 搜索框位于主题列表和帖子列表的右上角。 输入人名或信息的字段,匹配的信息或帖子将会出现。


A handy tip is to search for your own name. That will bring up all your messages within a particular discussion board. This may include replies to someone else’s thread. If you then click on “clear search” you will be able to see other replies within each thread.

一个小窍门就是搜索你自己的名字。 将会出现你在某特定讨论板中的所有信息。 其中可能包含了对其他人的帖子的回复。 点击“清除搜索”,将会出现每个帖子中的其他回复。


You can subscribe to any post or thread. For any post or thread that you have created, the platform will automatically subscribe you to this thread. That means, you will be notified if anyone writes back to you. Click on the Subscribe to this thread and make sure the box is ticked if you want to follow any of the conversations. You will see a notification alert under the Bell symbol if someone replies to you.

您可以订阅任何帖子或线程。 对于您创建的任何帖子或线程,平台将自动订阅您的线程。 也就是说,如果有人写信给你,你会得到通知。 单击此线程的“订阅”,并确保如果您想执行任何会话,则该框被勾选。 如果有人回复你,你会在铃铛符号下看到通知提醒。


There are ways that you can sort your messages or threads. You can flag the ones that are important to you by selecting the drop-down arrow beside the name and selecting Flag Thread or Flag Post. This is useful later when you want to filter messages to just those that you’ve flagged, by clicking Flagged like so. Likewise, you can filter to just those messages that haven’t been read.

你可以通过下列方法对信息或线程进行排序。 选择名称旁边的下拉箭头,选择重要的线程或帖子,对其做出重要标记。 通过单击这样的标记,可以很容易筛选出标记过的重要信息。 同样,您也可以筛选出那些未被读取的信息。


So, there are a few tips in how to manage your discussions, but you also need to know about netiquette, which is a term that means how to behave online. Even when you’re anonymous, you need to be respectful of others. We’re sure you will be, but nonetheless we will be monitoring activity to ensure that everybody remains polite and respectful during the discussions.

以上是关于如何管理自己在讨论中的行为的一些建议,同时你还需要了解网络礼仪,即,在网上如何表现。 即使你是匿名的,你也需要尊重他人。 我们相信你会这样做,但我们还是会对其进行监控,以确保大家在讨论中都能保持礼貌和尊重。


You need to remember that the messages you post are open to anyone in the world, so only say what you would ever be willing to share publicly. You need to consider whether the information you are discussing is confidential or private.

你需要记住,你发布的信息对世界上任何人都是开放的,所以只谈论你愿意公开分享的信息。 你需要考虑你正在讨论的信息是很机密的还是隐私的。


Below this video you’ll find a link to a page which contains further information on netiquette and the expectations we have of how the discussion boards should be used. Please take the time to read through it, as it will help ensure that everyone has an enjoyable time using the discussion boards.

本视频下面有一个网页链接,该网页包含关于网络礼仪的更多信息和我们对于如何使用该讨论板的期望。 请花时间仔细阅读,这将有助于确保大家能愉快地使用该讨论板。


So, there you have it. That’s an overview of the Discussions system.

好了,就讲这么多。 这就是该讨论系统的总体情况。


翻译:关爱惟士-未经允许不得转载,违者必追究法律责任

塔斯马尼亚大学预防认知症MOOC
2018-05-21
(3)测验-Quizzes

课程视频:http://player.youku.com/embed/XMzYwNDQ3NjAxMg


I’d now like to present an overview of the quizzes in the MOOC, because it’s these quizzes which we'll use to assess your knowledge of dementia.

现在我想介绍一下慕课中的小测验,因为这是我们用来评估认知症知识的测验。


The important quizzes come at the end of modules 1, 2, 3 and 4. In those you have unlimited attempts, but you must score 70% or more in your highest attempt to progress on to the next module. We don’t enforce a time limit on these quizzes.

重要的测验在模块1, 2, 3和4的末尾出现。 这些测验没有测试次数限制,但是你必须取得70%或更高的分数,才能进入下一个模块。 这些测验也没有时间限制。


So, when will you need to do a quiz? Once you’ve logged in to the course and you've navigated through the content you’ll come across a task box similar to this one, and that indicates it is time to take a quiz.

那么,什么时候需要做个测验呢? 当登录课程浏览了内容后,会出现一个类似于这个的任务框,这表明是时候进行一次测验了。


Whenever you come across this, click the button, and your page will reload with the quiz.

每当遇到这个,单击按钮,页面即可重新加载试题。


You’ll land on the description page, which details how the quiz works before you actually attempt it. You’ll see under Time Allowed that you have unlimited attempts; along with this it will give an estimated time for completion - again, that is not enforced.

你将打开说明页,该页面详细说明了在你真正尝试答题之前如何操作。 你会发现在允许时间内你可不限次数地进行练习;同时,还会给出预计完成的时间-这也不是强制性的。


Under attempts you’ll see how many times you’ve already attempted this quiz.

在练习过程中,你会看到你已练习的次数。


So, read through these instructions carefully, and when you’re ready, you'll click the Start Quiz button, and then OK, to begin.

因此,请仔细阅读本说明。阅读完毕后,可单击“开始测试”按钮,然后点击“确定”,开始测试。


To look more closely at the quiz function, let’s consider the simple, one question quiz in the Introduction. This quiz actually serves two purposes, it is a Practice quiz to ensure you know how to use the quiz function. It also gives you the opportunity to decide whether or not you give consent for us to use the information, or data, that you provide during your participation in the MOOC in our research. Research participation is entirely voluntary and your decision will not affect your participation in the MOOC in any way.

为了更深入了解测试的功能,我们来看一下引言中里的一个试题测验。 该测试实际上有两个目的,这是一个实践测试,确保你了解如何使用测试功能。 另一个目的是让你有这一个机会,决定你是否同意我们使用你在参加我们慕课调研时提供的信息或数据。 调研是完全自愿的,你的决定不会对你参与慕课有任何影响。


To start with, click on ‘Go to quiz’ and this will take you to the quiz page.

首先,点击“去测验”按钮,进入测验页面。


For this particular quiz, there is only one question, with a possible answer either ‘yes’ or ‘no.’ Please select the one that indicates your preference. Regardless of whether you want to give us your consent or not, you will need to complete this quiz. There are no incorrect answers as we are simply asking you for a ‘Yes’ or ‘No’ on whether you want to give your consent.

这个特定的测验只有一个问题,回答“是”或“否”。请任选其一表明你的意愿。 不论你是否同意,你都得完成这个测验。 答案没有对错,因为我们就是想知道你是否同意。


In later quizzes, there will be around ten questions.   As well as yes/no questions, there may be multiple choice, true or false, or a single word answer (it will be necessary to spell this correctly, but you will be able to check spelling if required).

在稍后的测验中,大概会有十个问题。 除了是/否问题外,还可能有多选、判断或用一个单词回答问题(单词需拼写正确,但是如果需要,你可以检查拼写)。


As you progress through the quiz, we would recommend that you save your answers as you go. There is a 'save' button associated with every question, and you can either click that after putting in your answer, or you can scroll right down to the bottom and save all of your answers in one go.

测验中,建议你把答案保存下来。 每一个问题都有一个“保存”按钮,你可以在输入答案后点击它,或者你可以向下滚动到底部并保存所有答案。


You’ll notice that there's a floppy disk icon beside each question, and in the left-hand column, which shows you which ones you've saved.

你会注意到每个问题旁边都有一个软盘图标,在左边的列中显示你保存了哪些图标。


You can change your mind about any questions, whether you’ve saved them or not. When you’ve finished the quiz, you’ll need to submit your answers to us. You may have saved as you went along, but you still won’t have submitted them.

你可以对答案进行修改,不管是否已经保存。 当你完成测验时,你需要把答案提交给我们。 你可能已经保存了,但并不代表你已经提交了。


Click 'Go to Submit Quiz.'

点击“提交测验”。


If you have neglected to answer some questions, and then you hit 'submit', you’ll be met with a prompt and a list of those questions you haven’t answered. You can click ‘Submit Quiz,’ in which case you’ll get 0 for those unanswered questions, or you can click on the link for each question to return to it and fill it in.

如果你遗漏了某些问题就点击“提交”,你将看到一个提示和一个列表列明你未回答的问题。 你可以点击“提交测验”,这样你未回答的问题将得0分,或者你可以点击每个问题的链接,返回到该问题并填写答案。


So, once they’re all answered, click on ‘Go To Submit Quiz,’ but beware, once you have submitted your answers, you can’t change any of them. You can, of course, attempt the whole quiz again. If you’re unsure, though, click on any of the question numbers in the left-hand column to return to any questions you’d like to retry.

因此,回答完所有问题后再点击“提交测验”,但注意,一旦你提交了答案,你就无法再进行任何更改。 当然,你可以重新参加全部测验。 如果你没把握,点击左栏中的任一问题编号,返回到你想重新回答的问题。


Once you’re absolutely ready, click 'Submit Quiz', and then confirm that you do indeed want to submit your quiz.

一旦你准备好了,点击“提交测验”,然后确认你确实想提交你的测验。


Once you’ve submitted a quiz, you’ll be presented with a page that summarises how you went.  If you got a question correct, you will see a score of 1/1 next to the question number, if incorrect you will see 0/1.  The total score will appear at the bottom of the summary report. I can navigate back to the content, and if the quiz has been successfully submitted and the required score achieved, the next unit would become available to me when released. You can also click on View Feedback to view some feedback on the questions of the quiz, particularly on those questions that you did not answer correctly.

一旦你提交了测验,你会得到一个总结你的进展的页面。 如果你有一个问题回答正确,你会看到问题编号旁边出现分数1/1,如果不正确,你会看到0/1。 总成绩将出现在总结报告的底部。 返回到内容,如果测验已经成功提交并获得所需的分数,将获准进入已经发布的下一单元。 你也可以点击查看反馈来查看问题的反馈,尤其是那些你回答错了的问题。


That completes my overview of quizzes.

以上就是关于测验的概述。


Thank you, and I hope that you enjoy participating in the Preventing Dementia MOOC.

谢谢大家,我希望你们喜欢参与预防认知症慕课。


翻译:关爱惟士-未经允许不得转载,违者必追究法律责任

塔斯马尼亚大学预防认知症MOOC
2018-05-21
(4)模块1---认知症可以预防吗?Can Dementia be Prevented?

课程视频http://player.youku.com/embed/XMzYwNDQ3Nzk5Mg



Prof. Carol Brayne

Carol Brayne 教授


We all hope to have prevention. Medical practitioners treat people, and we deal with diseases and disorders when they're present, but most people understand that it's better to think about prevention.

我们都希望能预防所有疾病。生病了我们找医生,需要他们来处理我们的各种疾病和状况,但很多人心知肚明,最好的方法是预防。


Well, what do we mean by prevention? We mean trying to stop something, a disease, happening at all, and in ageing we know that dementia becomes very much more common and there's a sense that it might be inevitable, but there's also evidence that it might not be as inevitable as we had thought. So although the increase in dementia is very related to age in our populations, there is some evidence that we can reduce our risks of developing dementia, so in some terms that could be viewed as prevention.

那么,预防的意思是什么呢?它指的是尝试去阻止疾病的发生发展,认知症随着社会老龄化已经变得越来越常见,普遍认为它是不可逆的,不过同时也有证据显示它在某些方面并不像我们想象中那样不可逆转。尽管认知症和衰老存在相关性,但是有证据显示,认知症的风险是可以被降低的,所以从这个角度说,认知症可以被预防。


So we understand that dementia, particularly in the oldest old where it's most common, is a mixture of classical Alzheimer's type, which most people have heard of, but also of vascular changes. And that's related to earlier life, what we call non-communicable diseases, which includes things like heart disease and diabetes. Now we've got very good understanding of how to prevent those disorders in the population and those relate to both individually-based prevention but also predominantly to societally-based activities or interventions, such as the smoking bans and trying to reduce excessive alcohol and so on. So these are all factors which can improve health earlier in life and reduce the risk of the risk factors for dementia, and so we have pretty good evidence on those.

我们知道认知症,最常见于一些高龄老年群体,它是以最为熟知的阿尔茨海默病为典型代表加上血管病变的一类综合征。认知症在早期与一些像心脏病和糖尿病这样的非传染病相关。现在我们早已知道如何预防这些疾病,包括个体水平为基础的预防以及像禁烟令、建议减少过量饮酒等等这样基于社会水平的活动或者干预手段。这些是可以在早期提高健康水平减少认知症患病风险的因素,当然我们有很多有力的证据来支持以上观点。


I've been working in the field of dementia research for 30 years and for decades I thought that we could not reduce our risk of dementia because it was so closely associated with age. But, when we did the research that suggested that - well, which showed that dementia prevalence, that is the proportion of people who had dementia at any given age, has gone down, I realised that we do have the potential to reduce our risk. It does not mean that we will eradicate dementia because what it means is that we still have a lot of dementia in the oldest old because age is such a powerful risk factor. Because we're living longer, we have more people in the oldest age groups. So we can't prevent all dementia but we might reduce our risk at particular ages.

我已经在认知症研究领域工作了30年,在几十年里,我一直在思考我们之所以不能降低认知症风险,是因为它跟年龄老化有着极大的关系。但是,当我们在研究那些课题时-它显现出认知症的发展趋势,就是认知症在任何年龄阶段的发病几率,并显示下降趋势,因此我意识到我们有可能降低认知症风险。这不是说可以根除认知症,毕竟相当多的认知症是发生在老年阶段,年龄衰老对认知症是非常强大的风险因素。因为我们的寿命增长,我们有老年群体也随之增大。因此我们不能预防所有的认知症,但是我们或许可以在特殊的年龄阶段降低认知症的发病风险。


Researchers for decades have been looking at the risk factors for dementia in a variety of different ways. A lot of these have been what we call cohort studies, which is following people over time who start out without dementia and then, having examined what their risk factors, or what might be risk factors, are at baseline, we then follow them up over time and identify who gets dementia or who meets diagnostic criteria for dementia over time and who doesn't.

做了多年研究的学者们,应用大量不同的方法去寻找认知症风险因素。大多数应用的是我们称之为“队列研究”的方法,即全称追踪初始并不是认知症的患者,了解他们已有的或者可能的风险因素,这是基线阶段,然后我们从始至终随访这些病人,确定谁患有认知症或者谁满足诊断标准或者谁不符合标准。


Those studies have looked at risk factors close to the expression of dementia and have looked at midlife risk factors as well, and also life course risk factors. Putting all of that together requires systematic reviewing and there have been several exercises in systematic reviewing of the risk factors for dementia in the last decade. One of those identified seven risk factors and it was a very rigorous look at the world literature and it came up with seven, and they included things from across the life course, such as low educational attainment, midlife obesity and hypertension, and then depression and diabetes, and so-called lifestyle behaviours such as smoking.

这些研究所涉及的风险因素都是和认知症的症状相关的,也涉及中年期或者生命全周期风险因素。把它们整理在一起是需要做系统回顾审查,最近十年已经对认知症患病风险因素做了很多系统回顾审查。其中七个已确定风险因素浮出水面,我们仔细地查询了全球范围内的文献,文献也显示为七个风险因素,它所包括的因素贯穿整个生命周期,比如像低受教水平、中年肥胖、高血压、抑郁症以及糖尿病,也包括了我们常提到的不良生活方式-比如吸烟。


That exercise has been done in the US as well, as well as the Lancet Commission, and the exact risk factors have been sort of changed a little bit, so there's the addition recently of midlife hearing loss in particular.

美国以及柳叶刀委员会也做了相关类似的实验,他们对风险因素做了轻微的改动,他们特别增加了一个风险因素:中年期听力丧失。


If you put all of those risk factors together and try to understand how they operate in different populations, looking at the exposure of the population to the particular risk factors, you can calculate what proportion of people might - what proportion of dementia might be attributed to that risk factor or those risk factors. Now the risk factors cluster. Once you take that clustering into account, all of the different exercises come up with roughly a third of dementia that might be prevented if we assume a causal relationship between the risk factors and dementia. So the ultimate message from those analyses is that, if we pay attention to those risk factors across the life course, we might reduce dementia by about a third over time.

如果你把这些所有风险因素进行归纳,尝试去搞清楚它们是如何作用于不同的群体里,找到具备这些风险因素的群体,你可以计算出比例 -一个或多个风险因素在多大比例上导致认知症发生。现在我们把这些风险因素进行归纳,现在我们把所有风险因素考虑进去,假设风险因素同认知症之间存在因果关系,所有不同的实验都显示出大约三分之一的认知症可以被预防。所以最终分析得出的信息就是,如果在全生命周期中能够注意这些风险因素,那么我们或许可以逐渐降低三分之一的认知症。


Speaking from a public health perspective, the idea of removal of one risk factor doesn't work terribly well in populations. What we need to do is look at the clustering of the risk factors and see which sectors of the population are at risk with different profiles of those risks, and what is our knowledge about how to address those risks in those populations and in the population at large. So, for example, smoking has reduced enormously and perhaps that is a single risk factor example where we have had a huge effect, but that has been done through legislation and whole-society action. But something as complicated as midlife obesity, midlife hypertension and consequently stroke and so on are much more complicated. So unless we create environments in which we can be healthy and optimise our ageing and our brain health, we're unlikely to be able to affect those particular risks in a big way for the populations.

从公共健康的角度来说,仅仅根除一个风险因素的想法在大众范围很难起到很大成效。我们需要做的是观察哪些群体处于哪种风险因素中及他们不同的风险特征,还有我们的知识体系如何大范围解决这些人的风险因素。比如吸烟行为已经减少了很多,它作为一个独立的风险因素产生了很大的影响,国家通过立法及整个社会协作通过一些行动已经使其得到控制。但相比中年肥胖,中年高血压及由此造成的中风等等这些因素,情况却复杂得多。如果我们不能创造一个健康积极的环境,同时延缓衰老和强健大脑,否则我们不太可能大规模地在大众范围内改变这些风险因素。


Not only are risks very complicated in the way that they interact with each other and the behaviour - so we have behaviours, we have disorders and diseases which all interact and they're all our individual profile of risk, but also, when we look at people who have dementia, and it's most common in people aged 80 and over, so if we look in the brains of people who have died with dementia as well as the people who haven't died with dementia, we see that everybody, by the age of 85, 90, has got a mixture of pathologies and changes in their brain, which include atrophy and vascular changes and changes which could be associated with Parkinson's disease as well as the Alzheimer's disease changes, and it's rare to find somebody with a brain at the age of 100 who doesn't have at least some of these pathologies, and the relationship of those with the expression of dementia, with whether the person had dementia, becomes more complicated in the oldest age group.

这些风险因素不但复杂,而且它们之间以及它们和行为之间互相作用, -这就是为什么我们会产生问题行为,功能紊乱以及疾病,这些都是风险因素在个体水平相互作用的体现,而且当我们观察那些死去的或者健在的80岁或以上的认知症患者的大脑,85至90岁的老人出现混合性的病理病变,及可能与帕金森病以及阿尔茨海默氏病等疾病相关的大脑萎缩和血管变化,我们很少发现100岁左右的大脑中没有这些病变的,至少有一部分。高龄老人中认知症的表现和此人是否患有认知症的相互关系是更复杂的。


There is very good evidence now from a variety of different studies, from animal studies through to human studies through to population studies, that there are factors that protect us from dementia, even when we have, say, the neuropathologies that are thought to be classically associated with dementia. So there is good evidence that we can protect the population and protect individuals to some extent, or reduce their likelihood of experiencing dementia during their lives, and these factors probably need to be addressed at different times in the life course.

从动物实验到人体实验到大规模试验我们得到了一些乐观的证据,就是即使有一些和患有认知症相关的典型神经病理改变,但是也有一些保护性因素使我们可以远离认知症。我们同样有证据表明在一定程度上我们可以保护我们大众群体或者降低他们一生中患认知症的可能性,无论从群体上还是从个体上,这些因素在整个生命周期的不同阶段可能需要被强调。


So we have evidence from early life, from midlife and from later life of the kinds of things that appear to protect us from dementia. We can improve aging, we can improve brain aging and we can probably reduce the amount of dementia at any given age and we can reduce that frailty right at the end of life that is almost inevitable for all of us, but maybe reduce the time that we have to experience that through population health activities and a balance of individual and public health, if you like, actions.

所以无论是早期,还是中年到晚年,我们都有证据显示可以通过一些手段使我们远离认知症。我们通过延缓衰老,强化大脑,就有可能降低不同年龄层认知症患者的数量,使每个人在不可避免的生命尽头时减少无助及痛苦。所以我们需要整个社会开始付诸行动,通过一些公共健康活动来减少经受疾病折磨的时间,如果你愿意,行动起来!


翻译:关爱惟士-未经允许不得转载,违者必追究法律责任

塔斯马尼亚大学预防认知症MOOC
2018-05-21