Dementia in China: East-west collaboration bears fruit

King's College London, Institute of Psychiatry, London SE5 8AF, UK.
The Lancet (Impact Factor: 45.22). 06/2013; 381(9882):1967-8. DOI: 10.1016/S0140-6736(13)60770-9
Source: PubMed
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    ABSTRACT: Dementia is the leading cause of disability worldwide among chronic disease in the elderly and is a major contributor to mortality. Importantly, dementia that develops as a comorbid condition significantly compounds the burden of disease on the person, their caregivers and the health care system. Dementia is a frequent comorbidity of Parkinson's disease (PD) and about 80% of people with PD will develop dementia during the course of the disease. Incidence of dementia in PD ranges from 54.7 to 107.14 per 1000 person-years while point prevalence estimates range from 19.7 to 35.3%. The range in incidence and point prevalence can be attributed to varying diagnostic criteria, sample biases, and sample size. Nosologically, there is still disagreement on the origins of dementia in PD. Dementia development may be most often caused by the progression of PD-type pathology; however, the occurrence of Alzheimer's disease (AD)-type pathology suggests that an interplay exists between the genes and proteins associated with PD and AD. Furthermore, these genes and proteins may increase the risk and severity of dementia development in people with PD. Understanding the mechanisms of neurodegeneration in PD and AD may, therefore, improve efforts to manage and treat PD dementia. Given this, it is important to adequately define the frequency of PD dementia for informed decision making, particularly in the areas of aged-care and government health policy.
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    ABSTRACT: Objective: There have been dramatic societal changes in East Asia over the last hundred years. Several of the established risk factors could have important period and cohort effects. This study explores temporal variation of dementia prevalence in mainland China, Hong Kong and Taiwan taking study methods into account. Methods: Seventy prevalence studies of dementia in mainland China, Hong Kong and Taiwan were identified from 1980 to 2012. Five period groups (before 1990, 1990 ~ 1994, 1995 ~ 1999, 2000 ~ 2004 and 2005 ~ 2012) and five birth cohort groups (1895 ~ 1909, 1910 ~ 1919, 1920 ~ 1929, 1930 ~ 1939 and 1940 ~ 1950) were categorised using the year of investigation and 5-year age groups. Pooled prevalence by age, period and birth cohort groups was estimated through meta-regression model and meta-analysis taking diagnostic criteria and age structure into account. Results: After adjusting for diagnostic criteria, the study age range and age structure, the prevalence of dementia in the older population aged 60 years and over fluctuated across periods but not reaching significance and were estimated as 1.8%, 2.5%, 2.1%, 2.4% and 3.1% for the five periods from pre-1990 to 2005 ~ 2012. A potential increasing pattern from less to more recent birth cohort groups was found in the major studies using older diagnostic criteria with wider differences in the age groups over 70 years. Conclusions: This study found no significant variation across periods but suggested a potential cohort effect. The influence of societal changes might moderate early life experiences across different generations with substantial impact on mental health in older age.
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