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作者：Pauline Anderson  
出處：WebMD醫學新聞

　　September 24, 2009 — 根據一篇新的報告，阿茲海默氏症與其他失智的全球流行率，在未來的40年將會急遽增加，對於家庭、政府、健康照護制度的影響將非常巨大。
　　
　　由71個阿茲海默氏症機構組成的國際阿茲海默氏症非營利聯盟，提出2009年世界阿茲海默氏症報告，估計全球的失智發生率在2010年會超過3,500萬人，且每20年會加倍，在2030年為6,507萬人、2050年為11,540萬人。
　　
　　根據對147篇研究進行的系統性回顧，此篇報告呼籲全球各國政府將失智列為優先合作研究目標，且致力將服務分布於需要之處。
　　
　　McGill大學精神科教授、阿茲海默氏症國際聯合研究策略執行長Remi Quirion博士在訪問中表示，美國、加拿大與歐洲等已開發國家的下一步，是說服政府投資更多於阿茲海默氏症或阿滋海默相關失智之研究與照護支持體系。
　　
　　Quirion博士指出，開發中國家也需如此，但是他們首先應確保每個人瞭解阿茲海默氏症的確是個疾病，而不是正常老化的後遺症。
　　
　　【中低收入國家】
　　推測2010年的阿茲海默氏症流行率為3,500萬人，這表示比之前登載於The Lancet期刊中的2005年阿茲海默氏症國際研究中預估的增加了10%，這其中多數的增加來自於亞洲部份中低收入國家、非洲與南美洲的新資料。
　　
　　根據該報告，全球有57.7%失智患者居住在中低收入國家，但是這個百分比在2050年將增加到70.5%，預估的增加數據在東亞為117%、南亞為107%、拉丁美洲部份地區為134%至146%、北非和中東為125%。該報告也預測歐洲的失智患者增加40%、北美增加63%、拉丁美洲南部為77%、已開發的亞太國家為89%。
　　
　　加州大學洛杉磯分校神經科臨床副教授、Mary S. Easton阿茲海默氏症研究中心副主任John M. Ringman醫師表示，中低收入國家所增加的數據，有部份是因為這些區域近來有較佳的健康照護，以及感染症減少，而有較長的預期壽命。
　　
　　他表示，流行率增加是因為人口老化且壽命變得比較長，另外，也因為人們對於疾病有較多警覺，我們比較能確認誰失智以及誰不在這些國家之列。
　　
　　【情緒與財務影響】
　　該報告列出失智對病患與家庭的情緒和財務、以及對健康照護體系和一般社會的影響。估計有40%至75%的照護提供者有明顯的心理疾病、15%至32%有臨床診斷重度憂鬱。全球每年失智相關經濟損耗約3,150億美元。
　　
　　Quirion博士表示，與其他一些疾病不同的是，阿茲海默氏症患者在診斷後可以活10或15年，對於家庭的巨大影響可想而知。在一些社會中，這個負擔可能相當重。例如，在中國，政府強力要求單一家庭一胎化政策，當這些家庭的父母親發生阿茲海默氏症，他們的獨生子女將是責無旁貸的照護者。
　　
　　該報告列出八項建議作為全球對於失智採取之行動的一部份。Ringman醫師認為，最重要的一項建議是，不論失智病患的年紀、性別、財富、失能狀態或居住地區，皆確保可接受醫療服務。他表示，他看到有些來自農村地區的人前往他服務的三級照護中心時已經是相當嚴重的失智，如果他們住家附近即有醫療服務，應可以獲得更佳的治療。
　　
　　這是個高標準要求，但是很重要，因為此疾病對於鄉村地區的影響和對都會區是一樣的，對所有區域的家庭均能提供醫療服務，應列為優先要務。此外，語言也是一個健康照護障礙。如果不能使用病患的語言，就難以評估他們的認知狀態。
　　
　　【資助更多研究】
　　Ringman醫師表示，另一項建議也很重要：資助與進行更多失智的預防和治療、以及流行率和影響之研究。如果你可以實際預防疾病且有更好的治療，其他的諸多建議相較之下就沒那麼必要了。
　　
　　Quirion博士指出，聯合研究的努力為當務之急。我們必須投資更多於研究中，不論是遺傳學或生活品質。且我們應以全球的層級來進行它，加拿大的科學家不一定只能在加拿大研究，而是可以和世界其他國家合作與建構合作網絡。
　　
　　Quirion博士也認為，各個國家、特別是開發中國家，可能是首次處理失智相關議題，此時應試著減少此一疾病的污名化印象。
　　
　　其他重要建議包括：
　　* 世界衛生組織宣告失智為健康優先事項；
　　* 各國政府宣告失智為健康優先事項，發展全國性策略，以提供醫療服務和支持給失智患者及其家庭；
　　* 中低收入國家建立失智策略，優先促進一線健康照護與其他社會服務；
　　* 高收入國家發展全國性失智行動計畫且指定資源分配；
　　* 發展適合未來失智病程的醫療服務；且
　　* 與政府、失智患者、照護者、阿茲海默氏症協會、其他相關非政府機構、專業健康照護團體合作。
　　
　　作者們皆宣告沒有相關財務關係。
　　
　　2009年世界阿茲海默氏症報告。

Global Prevalence of Alzheimer's Disease Set to Double Every 20 Years

By Pauline Anderson
Medscape Medical News

September 24, 2009 — The worldwide prevalence of Alzheimer's disease and other dementias will rise dramatically during the next 40 years, and the effect on families, governments, and healthcare systems will be immense, according to a new report.

The 2009 World Alzheimer Report, released by Alzheimer's Disease International, a nonprofit federation of 71 national Alzheimer organizations, estimates that the global prevalence of dementia, predicted to be more than 35 million in 2010, will almost double every 20 years to 65.7 million in 2030 and 115.4 million in 2050.

Based on a systematic review of 147 studies, the report represents a call for governments around the world to make dementia a priority, to collaborate on research, and to coordinate service distribution.

"The next step in the developed world, in countries like the United States, Canada, and Europe, is to convince our governments to invest more in Alzheimer's disease or Alzheimer's-related dementia — to invest more in research and in support systems," Remi Quirion, PhD, executive director, International Collaborative Research Strategy for Alzheimer's Disease, and professor, Department of Psychiatry, McGill University, Montreal, Canada, said in an interview.

"Developing countries should do that as well, but they should first make sure that everyone is aware that Alzheimer's disease is a real disease — it's not just a consequence of normal aging," Dr. Quirion added.

Low- and Middle-Income Countries

The projected prevalence of 35 million patients with Alzheimer's disease in 2010 represents a 10% increase over previous estimates reported in a 2005 Alzheimer's Disease International study published in The Lancet. Much of this increase is to the result of new data from low- and middle-income countries in parts of Asia, Africa, and South America.

According to the report, 57.7% of individuals with dementia worldwide live in low- and middle-income countries, but this percentage will rise to 70.5% by 2050. Forecasted growth figures for East Asia are 117% and 107% for South Asia, 134% to 146% in parts of Latin America, and 125% in North Africa and the Middle East. The report also forecasts an increase of 40% in the number of people with dementia in Europe, 63% in North America, 77% in southern Latin America, and 89% in the developed Asia Pacific countries.

Increased figures for low- and middle-income countries are partly explained by longer life expectancy in these regions as a result of better healthcare and the elimination of infectious diseases, said John M. Ringman, MD, assistant director, Mary S. Easton Center for Alzheimer's Disease Research, and associate clinical professor, Department of Neurology, University of California–Los Angeles.

"The prevalence is increasing because the population is aging and people are living to an older age, but also because people are more aware of the illness and we are becoming better able to identify who is demented and who is not in these countries," he said.

Emotional and Financial Impact

The report outlines the emotional and financial impact of dementia on patients and their families, on the healthcare system, and on society in general. An estimated 40% to 75% of caregivers have significant psychological illness, and 15% to 32% have clinically diagnosable major depression. The economic cost of dementia across the globe is estimated at $315 billion annually.

Unlike with some diseases, patients with Alzheimer's disease may live 10 or 15 years after diagnosis, so the effect on families can be huge, said Dr. Quirion. In some societies, the burden may be particularly heavy. For example, in China, where there is a government-mandated one family, one child policy, some of those parents are now developing Alzheimer's disease, and their only child may be called on to be the caregiver.

The report outlines 8 recommendations as part of a global framework for action on dementia. For Dr. Ringman, one of the most important recommendations is to ensure access to services for people with dementia regardless of age, sex, wealth, disability, or place of residence. He said he sees people from rural areas who come to his tertiary care center with "horrible dementias" that might be better treated if services were available closer to their home.

"That's a tall order, but it's important because this disease has an impact on rural communities as much as urban communities, and to be able to provide services to help out families in all these regions should be a priority."

As well, he said, language should not be a barrier to healthcare. "It's very hard to assess patients' cognitive status without being able to speak their language."

Fund More Research

Another recommendation — to fund and conduct more research into prevention and treatment for dementia, as well as its prevalence and impact — is also important, said Dr. Ringman. "If you could actually prevent the disease or treat it better, then a lot of the other recommendations are less necessary."

Dr. Quirion agreed that collaborative research efforts are a huge priority. "We have to have more investment into research, whether it's on genetics or quality of life. And we should do it at the global level — not necessarily Canadian scientists working in Canada, but Canadian scientists working and networking with the rest of the world."

Dr. Quirion also believes that countries, especially developing nations that may be dealing with issues related to dementia for the first time, should try to reduce the stigma surrounding this disease.

Other report recommendations include that:

the World Health Organization declare dementia a health priority;
national governments declare dementia a health priority and develop national strategies to provide services and support for people with dementia and their families;
low- and medium-income countries create dementia strategies based first on enhancing primary healthcare and other community services;
high-income countries develop national dementia action plans with designated resource allocations;
services be developed that reflect the progressive nature of dementia; and
collaborations among governments, people with dementia, caregivers, Alzheimer's associations, other relevant nongovernmental organizations, and professional healthcare bodies be created.
The authors have disclosed no relevant financial relationships.

2009 World Alzheimer's Report.