(7)认知症对全球的巨大影响-The Global impact of dementia-公开课-关爱惟士
(7)认知症对全球的巨大影响-The Global impact of dementia

课程视频:http://player.youku.com/embed/XMzYwNzE3NTcyMA



Professor 

Perminder Sachdev

Perminder Sachdev教授


We can look at figures from perhaps two sources here. One is of course the global observatory in London, which was set up by the ADI some years ago. That observatory, run by Professor Martin Prince, has been collecting data, and these data were actually published by the Alzheimer's Disease International in 2015. The estimate was that there were roughly about 45 to 50 million people, I think the figure they came to was 47.8 or something like that, around the world. More recently there was another publication that’s from the Global Burden of Disease group, which is run from Washington DC. They came to very similar figure, about 45 million, so that’s really the number of people overall in the world, with a diagnosis of dementia.

我们也许可以从两个地方查找全球认知症患者的数据。其中一个当然是伦敦的全球天文台,它是由ADI在多年前建立的。Martin Prince教授一直在用这个天文台收集数据,而这些数据于2015年刊登在了国际阿尔兹海默病期刊上。该数据估计全球有4.5-5千万人被诊断为认知,我认为他们得到的数据应该大约在4.78千万左右。最近,另一份来自华盛顿的全球疾病负担小组的出版物也指出全球有4.5千万人被诊断为认知症。这个数据和之前Martin Price教授他们采集的数据(4.5-5千万)非常接近。所以,全球真的有这么多认知症患者。


But I must emphasise that this is not a precise figure, and for various reasons. One is that the data we have from many countries, is secondary data, we do not have good surveys. Even from high income countries or developed countries, the figures on dementia vary depending upon what criteria have been used, what the sampling strategy has been. This is a very rough guide.

但是,因为种种原因,我必须要强调的是这并不是一个准确的数据。第一,我们从很多国家获取的数据都是二手数据,我们并没有做好的调查。即便从高收入或者发达国家获得的有关认知症患者的数据也取决于我们用了什么样的标准以及采样方法。这是一个非常粗略的数据。


I think there are two points I want to make here. First point is that there is an increase in the number of people, and that is quite a rapid increase projected over the next 30 to 40 years. Primarily that increase is driven by the increase in the total number of people, who are over the age of 60 or 65. We know that dementia increases exponentially with age, and especially after the age of 65, there is a doubling of the number of people with dementia. Every 6 years or 6.3 years to be precise, I think is probably the estimate. The more older people there are, the more people with dementia there will be. We know there are going to be more and more older people around the world.

我认为这里有两点我要指出。第一点就是认知症患者人数在增长,而且在未来的30-40年,预计还会有相当快速的增长。这种增长主要是由于年龄超过60或65岁的人口总数量的增长导致的。我们都知道认知症的发病率随着年龄的增长呈指数型增长,特别是在65岁以后,认知症患者的数量增加了一倍。准确地讲,是每6年或每6.3年增加一倍,我认为这也许是预估。老年人越多,认知症患者越多。我们知道全球将会有越来越多的老年人。


In particular in the developing countries or low income countries and low and middle income countries, there is going to be a rapid increase, because those populations are ageing now. Whereas in the high income countries, the population has already aged to a significant degree. But ageing is happening very quickly in those countries. In fact they're going to contribute more and more towards people with dementia in the future. That’s really one reason that there is going to be more and more people with dementia around the world. It's projected that by the middle of the century, the number is going to be more than twice as many. One projection is maybe about 150 million people by the middle of the century around the world.

特别是在发展中国家或低收入以及中低收入国家,认知症患者将会有一个快速的增长,因为这些国家的人口正在老龄化。而在高收入国家,人口老龄化已经到一个相当大的程度了。但在这些国家,人口老龄化正在加速。实际上,他们将对未来认知症患者的增加做出越来越大的贡献。这确实也是全球越来越多认知症患者的原因之一。据估计,在本世纪中叶,认知症患者数将是这个数据的两倍不止。另一个预测是,到2050年,全球也许会有1.5亿认知症患者。


The second point I want to make is that there are some other trends we are seeing. Especially this trend has come from developed countries, high income countries, that in fact the incidence of dementia may actually not be rising, may in fact be falling. I think here we need to distinguish between the overall numbers, the prevalence of dementia, and incidence. By incidence we mean people with a new diagnosis of dementia, so how many new people are coming in to this fold of getting a diagnosis of dementia. There have been some studies from Europe and from North America, which have suggested that in fact the incidence of dementia in the developed countries may be falling, or may have been falling for the last two decades or so, and may continue to fall for some more time. Although we think that that will plateau, sometime in the future.

我想说的第二点是,我们看到了一些其他的趋势。特别来自发达国家或高收入国家的趋势——事实上,认知症的发病率并没有增加,也许实际上正在下降。我认为在这里我们需要区别认知症总人口、患病率和发病率。发病率指的是新诊断出为认知症的患者,也就是说有多少人刚加入被诊断为认知症的行列。欧洲和北美已经有一些研究表明实际上在发达国家认知症的发病率也许在降低或可能在过去的20年中一直在下降,并且有可能会持续下降一段时间。尽管我们认为这可能在未来的某段时间趋于平稳。


In particular I want to highlight three studies here. The first study perhaps, is from the UK, which is called the MRC CFAS study. Essentially it was a large study from six centres in the United Kingdom, which was done twice. Once this study was done to look at the overall prevalence of dementia in the UK in the early ‘90s. Then the study was repeated 20 years later, so to see after a generation what has happened. The short message from that study is that what they had projected was that the rate would be about 8.1% 20 years later. But actually the rate that they found on this survey, on this, was much lower, about 6.7%. There were fewer people with dementia than they had projected from the earlier estimates. In fact the total number had not gone up very much, even though the number of people who were at risk, of that old age population, had gone up significantly, suggesting that fewer people were developing dementia than 20 years earlier.

我在这里要特别强调三项研究。第一项来自英国的MRC CFAS研究,它是由6个中心做的大型研究,这项研究已经被做了2次。最初这项研究是为了调查英国90年代早期认知症的患病率。然后,这项研究在20年后重新做了一次,以此来看过了一代人后发生了什么。这项研究预测的是在20年后认知症的患病率大约是8.1%,然而,实际上通过他们的调查,他们发现这个数据更低,大约是6.7%。认知症患者比他们之前估计的要少。实际上,尽管认知症高危老年人口数量显著增加了,认知症总人数并没有增加很多。这说明与20年前相比,认知症的患者更少了。


Then there’s another study from The Netherlands, that's the Rotterdam study, and the Rotterdam study is interesting because they've been following people in Rotterdam as they grow older over several years now. They looked at their rates of dementia and here they're looking at new cases, which is the incidence of dementia, 10 years apart. They found that 10 years later, the incidence was lower. Although not significantly lower, but slightly lower, not statistically significant. But a very interesting study that’s been published from the United States and that’s from a place called Framingham in Massachusetts. The audience will be familiar with the Framingham study, which actually is a study of cardiovascular health, which has been going on now for 40 to 50 years.

然后还有一项来自荷兰的鹿特丹研究,这项研究很有趣,因为他们跟踪了鹿特丹市民很多年,陪着他们慢慢变老。他们调查鹿特丹市民的认知症患病率和10年后新增加的认知症患者数量,也就是认知症的发病率。他们发现10年后,认知症的发病率更低。尽管并没有显著地降低,只轻微降低了一点点,不具有统计学意义。但是,还有一项已经在美国马萨诸塞州的弗雷明汉发表的研究。大家以后将会熟悉弗雷明汉研究,这实际上是一项关于心血管健康的研究,它已经持续了40-50年。


They started with heart health and now they've gone on to brain health. They've been looking at dementia cases now for about 40 years. They looked at rates in the late ‘70s, and then the ‘80s, ‘90s and the 2000s and see what has happened. They found that each decade, the incidence of dementia has actually gone down, to the extent that over this period of 30 years, there was about a 44% reduction in the incidence or new cases of dementia. So in fact there's both a bad news story and a good news story in this. The bad news story is that overall the number of people with dementia around the world is increasing and is likely to increase. The greatest increase is going to be in low and middle income countries. But high income countries, still there's going to be maybe an increase, but not as much as we had feared in the past. Because there is probably a levelling off or even a slight decline in these people. Unfortunately in the low and middle income countries, this decline is not likely to happen very soon, in fact at this point, there is some suggestion that the rates may be increasing to some extent because of certain risk factors.

他们起初是研究心脏健康的,现在,他们研究大脑健康。到现在为止,他们已经研究了认知症病例将近40年。他们调查了70年代末、80年代、90年代和21世纪以来认知症患者的患病率并且研究发生了什么。他们发现每10年,认知症的发病率实际上已经下降了,在这30年期间,认知症的发病率和新发病例已经减少了大概44%。因此,事实上,这里面既有坏消息,也有好消息。坏消息就是全球认知症患者的总数量正在增加而且有可能增加。中低收入国家增长最多。但是,高收入国家仍然可能会有增长,但不会像我们过去所担心的增长那么多。因为有可能这个数据会趋于平稳或者轻微的下降。不幸的是,在中低收入国家,这种下降不太可能很快发生,事实上,在这一点上,有一些迹象表明,因为某些风险因素,认知症发病率可能会在一定程度上增加。


We do not know for sure why the numbers in low and middle income countries are increasing. But definitely the major increase is because there are more older people, the life span is increasing so more people are at risk of developing dementia. So that’s the big bulk. But whether there is another contribution being made by factors such as obesity, diabetes, poor metabolic health, cardiovascular disease, stroke, we’re not sure. Because some of these are increasing, unfortunately in many low and middle income countries, with changes with industrialisation, changes in dietary patterns, changes in physical activity levels. Rates of diabetes are increasing, rates of stroke are increasing. This is happening in India, in China, which are major populations really in terms of total world population. It is possible that this will flow on through in terms of rates of dementia in the future. At this point we do not know, but that’s something that we have to watch out for.

我们不是很清楚为什么在中低收入国家,认知症患者数量在增加。但是,能肯定的是,这些患者主要的增长是因为人口老龄化,人们的寿命越来越长,所以更多的人存在患认知症的风险。因此,这是很大的一个原因。但是,我们也不确定是否有其他导致认知症的风险因素,比如说肥胖、糖尿病、代谢不良、心血管疾病或者中风等。因为,不幸的是,在中低收入国家,随着工业化、膳食结构以及体育锻炼水平的变化,一些上述风险因素在增加。在印度和中国这种全球人口大国,人们糖尿病和中风患病率都在增加。我们不知道这是否有可能在未来增加认知症的患病率,但是这是我们必须注意的事情。


Studies that have looked at the changes in prevalence and incidence of dementia across say a 20 year span or over a generation, have tried to hone in to the possible reasons. If you look at the Framingham study, they found that the major change was in vascular dementia, not in Alzheimer's disease, so it is suspected that it could be vascular risk factors, such as better control of hypertension, better control of diabetes, good management of cardiovascular disease. But that did not explain all of the change really.

那些研究了认知症患病率和发病率20年或者超过一代人的研究试图找到可能的原因。如果你去看弗雷明汉研究,他们发现主要的变化是血管性认知,而不是阿尔兹海默病。因此,它怀疑可能是血管风险因素,比如更好地控制好血压、糖尿病以及心血管疾病。但是这并不能真的解释所有的变化。


There is a suspicion that it may be other factors, and starting off with early life factors, such as good education. We find that getting a good education early in life, sets you up for a good health lifestyle, throughout your life. It also gives you protection in terms of cognitive ageing, of decline in your cognitive function as you age. This is evidence that comes from the European studies as well and in fact even from our own study in Sydney. Early education is a significant protective factor. It may work through various different ways. But certainly better control of vascular risk factors, good diet through life, management of obesity, physical activity through life, are all important and maybe all are playing a role in this, in terms of the improvements we are seeing.

有人怀疑可能是其他风险因素,比如说像良好的教育这样的早年生活因素。我们发现,在人生的早期接受良好的教育会让你在一生中拥有好的健康的生活方式。它也能在对老龄化认知方面给予你保护,大家都知道,你的认知功能会随着年龄的增长而下降。来自欧洲的多项研究,甚至是我们自己在悉尼做的研究都证实这一点。早期教育是一个重要的保护因素。它可以通过各种不同的方式影响你。但是当然在整个生命的过程中更好地控制血管风险因素,良好的饮食习惯,肥胖的管理以及体育锻炼都很重要,也许这些所有的因素都对我们看到的认知症患病率的改善发挥了作用。


I think I should add then, that we suspect that if we are seeing an improvement in the high income countries, in the last two to three decades, we cannot take it for granted. Because it’s very likely that this will level off and then we are also seeing that in our younger populations, in developed countries, rates of obesity are increasing, and poor diet, dietary patterns are increasing as well. It’s possible that we might reverse some of these gains in the future. We cannot actually sit back on our laurels, we have to be vigilant forever.

我想我应该补充一点,我们猜想即使我们在高收入国家看到的认知症患病率在过去的20到30年间有所改善,我们不能想当然地认为这是理所当然的。因为很有可能这种现状会趋于平稳,然后我们也看到在发达国家,我们年轻的一代人中,肥胖率、不良饮食、膳食结构这些风险因素都在增长。未来这些改进有可能被我们扭转。我们不能坐以待毙,我们必须时刻保持警惕。


翻译:关爱惟士-未经允许不得转载,违者必追究法律责任

系列视频列表