(12)测量您的阿尔茨海默症的风险水平-Measuring Your Risk of Alzheimer’s Disease-公开课-关爱惟士
(12)测量您的阿尔茨海默症的风险水平-Measuring Your Risk of Alzheimer’s Disease

http://player.youku.com/embed/XMzYwNjc1Nzg2OA



Professor Kaarin Anstey

卡兰·安斯蒂教授


If we’re talking about Alzheimer’s disease, there is a known genetic risk factor that has a known increased risk associated with it. So if you were tested for that, you could say that you have an increased risk. But, at the same time, we know many people live a full life with this genetic risk factor and don’t ever develop Alzheimer’s disease. So it’s not a sentence to find out that you have that risk. And, at the same time, there are people who don’t have that genotype, who do develop Alzheimer’s disease. So, even when we’re looking at genetics, it’s not possible to say to an individual, you will definitely develop Alzheimer’s disease. All we can do is talk about whether you have characteristics that increase your risk relative to the population, but we could never say for the individual, your personal risk is this, because there are so many other complicating factors.

如果我们谈论阿尔茨海默病话题,发现有一个已知的遗传风险因素会增加患病的风险。如果你测试了之后,发现有这个遗传风险因素,可以说你有了一个增加患病风险的因素。但是,同时我们知道,这种遗传风险因素会伴随很多人一生,但并没有发展成为阿尔茨海默病。所以,这不是说你被发现你有这种风险因素,你就一定会患阿尔茨海默病。同时,也有不具有那种基因型的人会发展为阿尔茨海默病。即使我们在做遗传学分析,我们也不可能对某个人说,你一定会患阿尔茨海默病。我们可以做的是讨论你是否具有相对于人群增加患病风险的特征,但我们不能对某个人说你的个人患病风险就是这样的,因为还有很多其他非常复杂的因素。


So the example I like to use is smoking and lung cancer. We know that if you smoke you’ve got a greatly increased risk of lung cancer, and of dying of lung cancer. But there are people who develop lung cancer who never smoke, and there are smokers who never develop lung cancer. There are also people who have a genetic risk factor for lung cancer and that can increase their risk, or if they have that genetic risk factor and they smoke, they’ve got a greatly increased risk of developing lung cancer. And it’s pretty much the same with Alzheimer’s disease. The things that we know increase the risk of Alzheimer's disease, apart from your genetics, the biggest risk factor is age. There’s nothing we can do about age.

因此我喜欢使用的例子是吸烟和肺癌。据我们所知,如果你吸烟,你患肺癌的风险会大大增加,并有可能死于肺癌。但是有些肺癌患者从来不抽烟,有些吸烟者从来没有发展成肺癌。还有一些人有肺癌的遗传风险因素,并且这可能会增加他们的患肺癌的风险,或者如果他们有这种遗传风险因素并且吸烟的话,他们患肺癌的风险会大大增加。它与阿尔茨海默病的情况几乎完全相同。我们知道增加患阿尔茨海默病的风险的因素,除了遗传因素之外,最大的风险因素是衰老。对于衰老我们什么也做不了。


So, if you wanted to assess your risk, there are a few tools that are available to assess risk. You can do some self-report risk assessment. We've developed an online self-report risk assessment tool at the ANU, that can give you feedback on your risk profile for Alzheimer's disease, and tell you if you’ve got things you can modify to reduce your risk. And there are some clinical assessments that have been used in clinics, particularly in the United States where people have developed a clinical risk assessment for midlife adults, or that have developed in Finland where they can check things like high cholesterol, high blood pressure and so forth, and they give you a score. It’s not as advanced as the field of heart disease, so in heart disease you can go and you can get a Framingham Risk Score done which will tell you your risk of developing heart disease in the next 10 years. We’re not at that point in dementia research; we haven’t been able to pin it down to a time period. We do have risk assessment, but we need the research to develop to get us to that level, the specificity of diabetes and heart disease.

所以,如果你想评估你的风险,这里有几个工具可以采用。您可以做一些自我报告的风险评估。我们在澳大利亚国立大学开发了一个在线自我报告的风险评估的工具,可以为您提供您患阿尔茨海默病的风险自我评估和评估反馈,告诉您是否可以纠正那些风险因素以减少您的患病风险。还有一些临床评估已经在临床中被使用,特别是在美国,人们已经开发了对中年阶段的成人的临床风险评估,或在芬兰,他们发展的评估体系是可以通过检查例如高胆固醇,高血压等指标,然后给你打个分数。它不像心脏病领域的评估体系那么先进,你可以去做心脏病患病风险评估,从而得到一个Framingham风险评分,这将告诉你在未来10年发展心脏病的风险。在认知症研究中我们还没达到那个地步;我们还未能把它固定到一个时间段。我们有认知症风险评估,但我们需要其研究水平发展到糖尿病和心脏病风险评估的那个水平。


What we did at the ANU was we did those meta-analyses that I’ve already discussed and also looked at published meta-analyses in the literature, and we created a risk assessment algorithm based on the best available evidence at the time for all of the factors known to increase the risk of Alzheimer's disease. So we developed the algorithm and we have risk and protective factors in our scores, so some things actually reduce your risk, and then we developed a questionnaire that assesses each of those risk factors. And the questionnaire is comprised of subscales which are taken from the epidemiological studies that actually linked that exposure to dementia. So, for example, cognitive engagement has been linked to the risk of dementia in two studies, and we use the actual questionnaire that was used in those two studies in our scale.

我们在ANU所做的是我已经讨论过的那些荟萃分析,并且还研究了文献中发表的荟萃分析,并且我们基于当时最好的可用证据创建了一个所有已知能增加患阿尔茨海默病的风险因素的风险评估算法。因此,我们开发了算法,并且在我们的分数中有风险因素和保护因素,所以某些东西实际降低了您的风险。然后我们开发了一个问卷来评估每个风险因素。问卷包括从流行病学研究中获得的与认知症暴露实际关联的分量表。因此,例如,认知的参与已经与两项研究中的痴呆风险相关联,并且在我们的范畴内使用这两项研究中实际使用的问卷。


And that’s another issue around measurement. So one study might find something, but if you use a different questionnaire you may not find the same result. So all the measures that we’ve used in our questionnaire have been linked to dementia. And then we’ve made that available online; it’s free to the public, anybody can assess their own risk and then we provide feedback on what you could do to modify that risk.

并且那是围绕测量的另一个问题。所以一项研究也许会发现些什么,但如果你使用不同的问卷,你可能不会找到相同的结果。因此,我们在问卷中使用的所有措施都与认知症有关。然后我们使之可以通过互联网获得;它是对公众免费的,任何人都可以评估自己的风险,然后我们提供关于你可以做些什么来纠正该风险的反馈。


So it’s at a fairly general level, because this is a publically available website, it’s not a medical clinic, and it doesn’t involve any medical tests. So, for example, we don’t test your blood pressure, which you’d need to have done by your GP. If you’re really concerned, you can print out a PDF of your assessment that we’ve created, and you could take that to your GP. Otherwise, it gives you fairly general information about risk reduction, but you can get much more detailed information from other websites or from your local doctor.

因为这是一个公开的网站,所以这只是一个相当普通的水平。它不是一个医疗诊所,并不涉及任何医学测试。举个例子,我们不会测量你的血压,这个你需要找你的GP做。如果你真的担心的话,你可以打印一份我们创建的你的评估报告的PDF,你可以把它交给你的GP。否则,它只能提供关于降低风险的相当一般的信息,但您可以从其他网站或您当地的医生处获得更多的详细信息。


So with our risk assessment tool, it focuses on understanding your risk, not telling you you’ve got this percentage or that percentage risk of developing Alzheimer's in so many years, and I think it’s important to know your risk profile so you know what you can modify. And then you can change it in time to prevent that risk factor impacting on your brain. People say to me quite often, oh, I just wish I could find out accurate information about what I can improve in my lifestyle to reduce my risk of dementia.

因此,我们的风险评估工具只专注于了解您的风险,而不是告诉您这么多年来患有阿尔茨海默症的百分比或风险百分比,我认为您能了解您的风险特征很重要,这样您知道您的风险并可以纠正它,以防止这种风险因素影响你的大脑。人们常常对我说,哦,我只是希望能找到可以改善我的生活方式,从而减少我的患认知症的风险的准确信息。


We don’t have a single blood test or medical test that will directly tell you your risk of developing Alzheimer's or another type of dementia. There’s a lot of research ongoing at the moment that’s trying to develop blood tests, and you might see things in the media about research results, but so far there’s nothing that’s been validated and rigorously tested and released onto the market.

我们没有一个单一的血液测试或医疗测试,来直接告诉你发展阿尔茨海默病或另一种类型的认知症的风险。目前有很多研究正在尝试开发血液检测,你可能会在媒体上看到关于研究结果的方面的东西,但到目前为止还没有什么已经过验证和严格的测试,并且投放到市场上。


翻译:关爱惟士-未经允许不得转载,违者必追究法律责任


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