(41)认知功能与衰老研究-The Cognitive Function and Ageing Studies-公开课-关爱惟士
(41)认知功能与衰老研究-The Cognitive Function and Ageing Studies

课程视频:http://player.youku.com/embed/XMzY0NDE1ODg0NA




Professor Carol Brayne

Carol Braune 教授


The Cognitive Function and Ageing Studies started in the late '80s as a result of the Department of Health and the Medical Research Council in the UK being concerned about the ageing population. They're population-based and they include people in care settings. They use the population registers of primary care, so they're geographically defined, and they are in different parts of the United Kingdom to represent different aspects of exposures to potential risks for dementia. So, for example, in the north of England, where people live for shorter - they have shorter life expectancy and also higher vascular risk, so there's high stroke and so on. In the rural areas, there may be different exposures, such as to pesticides and so on.

基于卫生部及英国医学研究理事会关注的认知功能及老龄化的研究开始于上世纪80年代后期,研究是基于人群的研究,包括一些有医疗健康背景的人群。通过国民早期健康照护登记记录,在地理位置上我们选择了英国不同地区的群体,这些群体有不同的认知症患病风险。举例来说,生活在北英格兰地区的人普遍寿命较短—平均寿命短并伴有高危血管性风险因素,所以这个地区中风发生率高。而在农村,人们则可能面临其他不同的风险因素,比如农药中毒等。


Those studies started up and their purpose was to look at the prevalence and incidence of dementia, that is, the proportion of people who have dementia, and also the people who develop dementia over time. That allowed us also to look at risk over time because we measured risk factors at baseline and followed people. We also had a brain donation program which was linked to the study. Twenty years later, we resampled people of the same age, that is 65 and over, in three of the same geographical localities in order to test for cross-generational differences in dementia.

这项研究的目的是调查认知症的流行率和发病率,即了解认知症患者的占比及随着时间推移认知症患者的数量变化。随时间推移我们对风险进行观察,因为我们从基线开始确定了这些风险因素并且保持随访,我们也启动了大脑捐献项目来支持我们的研究。在二十年后,我们对上述三个地区65岁及以上的同一年龄组进行再次抽样,为了检测认知症跨年龄层的不同。


So from the first study, we were able to estimate what numbers of people there were in the United Kingdom who might have dementia at any one time and also what numbers of people would develop dementia in a given time period, and from the second study we were able to say whether dementia itself had changed across time.

从第一次的研究我们可以估计英国在某一时间认知症患者的数量,以及多少人在某个特定的时间段会发展为认知症,而从第二次研究结果中看出,认知症本身是否随着时间推移已经发生了变化。


The brain donation studies allowed us to look at the underlying neurobiology or neuropathology of dementia in relation to the measures, the in life measurements. So the major findings of the study were the age relationship of dementia, the fact that women are more at risk, that people with higher education are at lower risk, that people with stroke have roughly double the risk, and so on. So these are the sorts of broad findings that we've been able to report.

大脑捐赠项目使我们能够观察与我们评估标记物相关的潜在神经生物学及神经病理学的大脑变化。这个研究项目的主要发现是:老龄化跟认知症的密切关系,女性的风险要大于男性,受教水平高的人们患认知症的风险低于低教育水平的人们,中风患者的风险水平大约是是平常人的两倍等等。这些是我们能报告给大家的一些研究结果。


The brain findings really tested the paradigms that we have of dementia and show that it's more complicated than the simplistic view which is understood by most of the biomedical community, of Alzheimer's disease tau and beta amyloid plaques and tangles always being associated with dementia in life. And we found that that is not the case, that there are protective factors such as education, and the cross-generational aspect of the study showed us that dementia has declined age for age. Prevalence has declined by more than 20%. That means that age for age the risk of having dementia for an individual is substantially lower, particularly in the 75-plus age group. Incidence has also declined by 20% and that is largely accounted for by a large decrease in the incidence in men across the different generations.

大脑研究项目真正意义上检验了我们认为的认知症范式,并告诉我们它比大多数生物医学界所持有的简单观点其实要复杂很多,阿尔茨海默病tau蛋白和β淀粉样蛋白形成的斑块和缠结总是与认知症密切相关。不过我们发现情况并非都如此,我们发现高教育水平是有利保护性因素,跨年龄段研究也证明认知症发生率随年龄下降而下降,流行率下降超过20%。这意味着年龄越小,个体患认知症的概率越低,特别是75岁以上的年龄组。发病率下降20%很大程度上是因为男性在不同年龄层发病率普遍大量下降所致。


Currently CFAS is funded to experiment and to bring a trial into the cohort study, which is an unusual thing to do, so we have done a lot of ethical, legal, social implication work on what it means for cohort participants to be asked whether they'd like to take part in an intervention trial. This trial is a translation of a European prevention trial which is based on internet counselling so that an individual sets their own goals for reduction of their own risk factor profile for dementia and they're supported by a counsellor, and we'll be doing a feasibility study of that in 2018.

目前CFAS资助了这个试验并开展了队列研究,这不是一件简单的事情,所以我们做了大量关于道德,法律和社会影响方面的工作,像询问他们是否愿意参与队列研究以及这个试验的意义。该试验是一项欧洲预防试验的另外一个版本,它建立在互联网咨询的基础上,以便参与者在咨询顾问的支持下设定自己个性化目标来减少自身认知症风险因素,我们将在2018年开展这个可行性研究。

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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