老年癡呆逐年減少，為什麽呢？
據新英格蘭醫學雜誌2016年2月11日報告，美國著名的“Framingham 研究”跟蹤了5千2百多人40年後發現，老年癡呆發病率逐年降低，累積減少44%之多。這個“鐵證”（robust evidence ），再加上2005年的一項類似研究報告，讓醫學界著實興奮起來，可問題是為什麽呢？藥物科學家不敢聲明“有功”，因為到目前為止還沒有發現一個公認抗老年癡呆的有效藥；心髒科醫生嚐試“領功”，因為血管性癡呆有減少，可是與血管病無關的阿爾茨海默癡呆同樣減少。也就是說，盡管投入巨額研究經費和努力，沒發現什麽靈丹妙藥，老年癡呆自己減少了！這個深奧的現象或許能給醫學界點啟示，現在實行的“疾病主攻戰略”是否有一定局限性，常常是“按了葫蘆起了瓢”，剛降低了一個疾病，另外一又高發起來。而人體的健康和各種疾病之間很可能存在一種“平衡狀態”，類似中醫所說的“天人合一”和“整體觀”，醫療要做的不僅是抗病，還要幫助患者提高身體素質和生活質量。這裏還要指出研究中發現的一個細節，老年癡呆的減少隻發生在有高中以上文化的人，可見老師也有功。 （李永明）
下麵是報道原文：
Incidence of Dementia over Three Decades in the Framingham Heart Study
February 11, 2016
N Engl J Med 2016; 374:523-532
Participants in the Framingham Heart Study have been under surveillance for incident dementia since 1975. In this analysis, which included 5205 persons 60 years of age or older, we used Cox proportional-hazards models adjusted for age and sex to determine the 5-year incidence of dementia during each of four epochs. We also explored the interactions between epoch and age, sex, apolipoprotein E ε4 status, and educational level, and we examined the effects of these interactions, as well as the effects of vascular risk factors and cardiovascular disease, on temporal trends.
The 5-year age- and sex-adjusted cumulative hazard rates for dementia were 3.6 per 100 persons during the first epoch (late 1970s and early 1980s), 2.8 per 100 persons during the second epoch (late 1980s and early 1990s), 2.2 per 100 persons during the third epoch (late 1990s and early 2000s), and 2.0 per 100 persons during the fourth epoch (late 2000s and early 2010s). Relative to the incidence during the first epoch, the incidence declined by 22%, 38%, and 44% during the second, third, and fourth epochs, respectively. This risk reduction was observed only among persons who had at least a high school diploma (hazard ratio, 0.77; 95% confidence interval, 0.67 to 0.88). The prevalence of most vascular risk factors (except obesity and diabetes) and the risk of dementia associated with stroke, atrial fibrillation, or heart failure have decreased over time, but none of these trends completely explain the decrease in the incidence of dementia.
Conclusions
Among participants in the Framingham Heart Study, the incidence of dementia has declined over the course of three decades. The factors contributing to this decline have not been completely identified. (Funded by NIH)
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據新英格蘭醫學雜誌2016年2月11日報告，美國著名的“Framingham 研究”跟蹤了5千2百多人40年後發現，老年癡呆發病率逐年降低，累積減少44%之多。這個“鐵證”（robust evidence ），再加上2005年的一項類似研究報告，讓醫學界著實興奮起來，可問題是為什麽呢？藥物科學家不敢聲明“有功”，因為到目前為止還沒有發現一個公認抗老年癡呆的有效藥；心髒科醫生嚐試“領功”，因為血管性癡呆有減少，可是與血管病無關的阿爾茨海默癡呆同樣減少。也就是說，盡管投入巨額研究經費和努力，沒發現什麽靈丹妙藥，老年癡呆自己減少了！這個深奧的現象或許能給醫學界點啟示，現在實行的“疾病主攻戰略”是否有一定局限性，常常是“按了葫蘆起了瓢”，剛降低了一個疾病，另外一又高發起來。而人體的健康和各種疾病之間很可能存在一種“平衡狀態”，類似中醫所說的“天人合一”和“整體觀”，醫療要做的不僅是抗病，還要幫助患者提高身體素質和生活質量。這裏還要指出研究中發現的一個細節，老年癡呆的減少隻發生在有高中以上文化的人，可見老師也有功。 （李永明）
下麵是報道原文：
Incidence of Dementia over Three Decades in the Framingham Heart Study
February 11, 2016
N Engl J Med 2016; 374:523-532
Participants in the Framingham Heart Study have been under surveillance for incident dementia since 1975. In this analysis, which included 5205 persons 60 years of age or older, we used Cox proportional-hazards models adjusted for age and sex to determine the 5-year incidence of dementia during each of four epochs. We also explored the interactions between epoch and age, sex, apolipoprotein E ε4 status, and educational level, and we examined the effects of these interactions, as well as the effects of vascular risk factors and cardiovascular disease, on temporal trends.
The 5-year age- and sex-adjusted cumulative hazard rates for dementia were 3.6 per 100 persons during the first epoch (late 1970s and early 1980s), 2.8 per 100 persons during the second epoch (late 1980s and early 1990s), 2.2 per 100 persons during the third epoch (late 1990s and early 2000s), and 2.0 per 100 persons during the fourth epoch (late 2000s and early 2010s). Relative to the incidence during the first epoch, the incidence declined by 22%, 38%, and 44% during the second, third, and fourth epochs, respectively. This risk reduction was observed only among persons who had at least a high school diploma (hazard ratio, 0.77; 95% confidence interval, 0.67 to 0.88). The prevalence of most vascular risk factors (except obesity and diabetes) and the risk of dementia associated with stroke, atrial fibrillation, or heart failure have decreased over time, but none of these trends completely explain the decrease in the incidence of dementia.
Conclusions
Among participants in the Framingham Heart Study, the incidence of dementia has declined over the course of three decades. The factors contributing to this decline have not been completely identified. (Funded by NIH)
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