全因痴呆和阿尔茨海默氏痴呆的发病率下降：韩国一项为期12年的农村队列研究外文翻译资料

基线特性

至少一次随访^a

(n = 483)

无法跟进^b

(n = 146)

死亡

(n = 72)

P值

事后

社会人口因素

年龄

71.7 plusmn; 5.4

71.5 plusmn; 6.3

77.7 plusmn; 7.4

lt; 0.001

a lt; c, b lt; c

65-74

360 (74.5)

109 (74.7)

26 (36.1)

lt; 0.001

ge;75

123 (25.5)

37 (25.3)

46 (63.9)

女性

286 (59.2)

97 (66.4)

37 (51.4)

0.752

教育年限

4.2 plusmn; 3.9

3.9 plusmn; 3.9

2.8 plusmn; 4.1

0.022

a gt; c

未受正规教育

149 (30.8)

52 (35.6)

43 (59.7)

lt; 0.001

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Decline in the Incidence of All-Cause and Alzheimers Disease Dementia: a 12-Year-Later Rural Cohort Study in Korea

Jee Eun Park ,^1,2 Byung-Soo Kim ,³ Ki Woong Kim ,^1,4,5 Bong Jin Hahm ,^1,2

Jee Hoon Sohn ,^1,6 Hye Won Suk ,⁷ Jun-Young Lee ,^1,8 and Maeng Je Cho ¹

¹Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea

²Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Korea

³Department of Psychiatry, Kyungpook National University School of Medicine, Daegu, Korea

⁴Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea

⁵Department of Brain and Cognitive Science, Seoul National University College of Natural Sciences, Seoul, Korea

⁶Department of Public Health Medical Service, Seoul National University Hospital, Seoul, Korea

⁷Department of Psychology, Sogang University, Seoul, Korea

⁸Department of Neuropsychiatry, Seoul Metropolitan Boramae Medical Center, Seoul, Korea

ABSTRACT Background: There has been no study on the time trends of dementia incidence in Korea. We report the 5-year incidence and its correlates of all-cause and Alzheimers disease (AD) dementia, and compared our results with those of a 12-year-prior cohort study conducted in the same area. Methods: A total of 751 community-dwelling older adults were followed up for a mean duration of 5.4 years. The age-, gender-, and educational attainment-specific incidence of all-cause and AD dementia were reported as cases per 1,000 person-years. We performed univariate and multivariate cox proportional hazard regression analyses to determine whether baseline sociodemographic, lifestyle, and clinical variables were associated with the risk of all-cause and AD dementia. A 12-year-prior cohort study was used for descriptive comparison to indicate the time trends of dementia incidence. Results: The incidence rates were 16.2 and 13.0 cases per 1,000 person-years for all-cause and AD dementia, respectively. The baseline diagnosis of mild cognitive impairment increased the 5-year incidence of all-cause dementia by more than 4-fold. Old age and low baseline global cognitive function were noted as risk factors for both all-cause and AD dementia. Conclusion: Upon comparing the results with those from the earlier cohort study in Yeoncheon, the incidence of all-cause and AD dementia decreased by approximately 40% over 12 years; it has been mainly driven by the increase in the educational level of older adults. The declining time trends of incidence should be taken into account for estimating the future prevalence of dementia in Korea.

Keywords: Dementia; Alzheimers Disease; Incidence; Time Trends; Risk Factors

INTRODUCTION

In 2040, more than two million dementia cases are expected in Korea.¹ The current rates of increase for dementia are estimated to be 3-fold higher in Asia compared to those in developed countries,² which are mainly due to the rapid increase of the aged population in Asian countries. Korea is one of the countries with the fastest-growing aging population; it has taken only 17 years to move from an lsquo;aging societyrsquo; to an lsquo;aged-society.rsquo;³

Meanwhile, recent studies conducted in Western countries have reported declining trends for dementia incidence and suggested that improvements in living conditions, education, and healthcare may have reduced the risk of dementia.^4-10 In contrast, increasing trends of dementia incidence were noted in China and Japan, even though their follow-up intervals and the reported incidence rates were very different. A Chinese study showed a 1.73-fold increase over a decade, with incidence rates of 9.0 cases per 1,000 person-years (PY) in 1999, while a Japanese study reported a 1.68-fold increase over three decades, with incidence rates of 41.6 cases per 1,000 PY in 2012.^11,12 No study has investigated the time trends of dementia incidence in Korea. One study reported the trends of dementia prevalence in Korea by comparison of previous epidemiologic studies conducted in different areas. Although it noted only a slight increase after 2005, from 7.3% to 8.7% (without significance), it predicted a large increase of dementia prevalence in Korea due to the enormous aging population.¹³ The increasing number of older people is the most potent driving factor of the dementia epidemic. However, there have also been recent changes in educational level, lifestyle, and health conditions in older Korean adults that may have influenced the risk of dementia during recent decades. Therefore, we should estimate the future prevalence of dementia based on the changeable incidence over time.

There have been two previous studies on dementia incidence in Korea: a nationwide study and a community-based study.^14-17 The latter was conducted in Yeoncheon, a rural area in Korea, in which baseline assessment was conducted in 1996 in adults aged 65 years and older (n = 1,035). Subjects were followed up with a 5.4-year period, and the incidence rates of all-cause and Alzheimers disease (AD) dementia were reported as 27.2 cases (95% confidence interval [CI], 22.3–33.2) and 21.0 cases (95% CI, 16.5–26.4) per 1,000 PY, respectively.^15,16 Yeoncheon is a small rural area in Korea with a current population of 43,990.³ Because all administrative areas in Yeoncheon are designated as a military protected zone due to its location adjacent to North Korea, the migration rates have been low, even compared to other rural areas.³

In the current study, we again investigated the incidence of dementia by an independ

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