上海部分城乡地区血管性痴呆的发病率及危险因素研究

Incidence and risk factors of vascular dementia in Shanghai area

目的 调查上海部分城乡地区血管性痴呆 (VaD)的发病率及相关危险因素。方法 在上海地区基线患病率调查的基础上选择 5个居委会和 4个村委会的居民作为研究对象。通过简易精神状态量表 (MMSE) ,根据文化程度划分的分界值进行初筛 ,在分界值以下的对象和正常人群中随机选择 4 %进入细查。细查项目有体格检查、详细病史记录以及成套的神经心理学测试 ,包括 :Pfeffer功能活动、Fuld物体记忆、快速物体回忆、韦氏儿童智力量表积木测验和韦氏成人智力量表数字广度、日常生活功能量表 (ADL)、HachisKi缺血量表、汉密顿抑郁量表 (HAMD)等。以精神障碍诊断和统计手册作为痴呆的诊断标准。 6个月后对所有进入细查的对象进行复查 ,根据美国神经病学、语言障碍和卒中 老年性痴呆和相关疾病学会的标准诊断阿尔茨海默病 (AD) ;根据美国国立神经病卒中研究所和瑞士神经科学研究国际协会的标准诊断VaD。结果 在实际完成初筛的 35 4 5例中 ,确诊新发痴呆病例 112例 ,其中VaD 2 8例 ,发病率是 2 .5 4 3 千人年 (标化率为 2 .4 0 3 千人年 )。VaD与年龄呈正相关 ,其OR =1.12 7(95 %CI :1.0 76～ 1.179,P =0 .0 0 0 ) ,与教育呈负相关 ,其OR =0 .6 5 4 (95 %CI:0 .4 5 1～ 0 .94 3,P =0 .0 2 3)。

Objective To investigate the incidence and risk factors of vascular dementia(VaD) in Shanghai area.Methods Subjects were the people screened in prevalence survey from the population in selected 5 urban and 4 rural communities investigated between 1997 and 1998. Incidence survey was carried out by a brief memory testing with MMSE. In phase Ⅱ, those who scored below the cutoff points and 4% of those whose score was in the normal range were interviewed to identify dementia through a set of diagnostic examinations according to the DSM-Ⅳ criteria. In phase Ⅲ six months later, a follow-up program was conducted for all persons who were involved in phase Ⅱ to identify those with Alzheimer's dementia (AD) and VaD according to NINCDS-ADRDA and NINDS-AIREN criteria and other types of dementia.Results Among the follow-up sample of 5?672 people,because 266 people died and 1?865 people missed to be interviewed during the follow-up period, 3?545 people were finally finished the first screen. There were 112 new dementia cases, of whom 28 were VaD with a total incidence of VaD 2.543/1000 person-years (standard incidence 2.403/1000 person-years). VaD was correlated positively with age,with OR value being 1.127(95%CI, 1.076～1.179,P=0.000), negatively with education,with OR value being 0.654(95%CI, 0.451～0.943,P=0.023).Conclusions Compared with other areas in the world, the incidence of VaD in some rural and urban areas of Shanghai was at the average level. Aging was a risk factor and high education was a protective factor for VaD. The incidence was higher in males than in females.