Alzheimers Dement. 2011 Mar;7(2):208-44. doi: 10.1016/j.jalz.2011.02.004.
Alzheimer's disease (AD) is the sixth leading cause of all deaths in the United States and is the fifth leading cause of death in Americans aged ≥65 years. Although other major causes of death have been on the decrease, deaths because of AD have been rising dramatically. Between 2000 and 2008 (preliminary data), heart disease deaths decreased by 13%, stroke deaths by 20%, and prostate cancer-related deaths by 8%, whereas deaths because of AD increased by 66%. An estimated 5.4 million Americans have AD; approximately 200,000 people aged <65 years with AD comprise the younger-onset AD population. Every 69 seconds, someone in America develops AD; by 2050, the time is expected to accelerate to every 33 seconds. Over the coming decades, the baby boom population is projected to add 10 million people to these numbers. In 2050, the incidence of AD is expected to approach nearly a million people per year, with a total estimated prevalence of 11 to 16 million people. Dramatic increases in the numbers of "oldest-old" (those aged ≥85 years) across all racial and ethnic groups will also significantly affect the numbers of people living with AD. In 2010, nearly 15 million family and other unpaid caregivers provided an estimated 17 billion hours of care to people with AD and other dementias, a contribution valued at more than $202 billion. Medicare payments for services to beneficiaries aged ≥65 years with AD and other dementias are almost 3 times higher than for beneficiaries without these conditions. Total payments in 2011 for health care, long-term care, and hospice services for people aged ≥65years with AD and other dementias are expected to be $183 billion (not including the contributions of unpaid caregivers). This report provides information to increase understanding of the public health effect of AD, including incidence and prevalence, mortality, health expenditures and costs of care, and effect on caregivers and society in general. The report also examines the current state of AD detection and diagnosis, focusing on the benefits of early detection and the factors that present challenges to accurate diagnosis.
阿尔茨海默病(AD)是美国第六大死亡原因,也是≥65 岁美国人第五大死亡原因。尽管其他主要死因一直在减少,但 AD 导致的死亡人数却急剧上升。2000 年至 2008 年(初步数据),心脏病死亡人数下降了 13%,中风死亡人数下降了 20%,前列腺癌相关死亡人数下降了 8%,而 AD 导致的死亡人数却增加了 66%。估计有 540 万美国人患有 AD;大约 20 万年龄<65 岁的 AD 患者构成了早发性 AD 人群。在美国,每 69 秒就有一人患上 AD;到 2050 年,预计这一时间将加速至每 33 秒。在未来几十年,婴儿潮一代的人口预计将使这些数字增加 1000 万人。到 2050 年,AD 的发病率预计将接近每年近 100 万人,估计总患病率为 1100 万至 1600 万人。所有种族和族裔的“最年长”(年龄≥85 岁)人数的急剧增加也将显著影响 AD 患者的人数。2010 年,近 1500 万家庭和其他无薪照顾者为 AD 和其他痴呆症患者提供了约 170 亿小时的护理,其价值超过 2020 亿美元。医疗保险向≥65 岁的 AD 和其他痴呆症患者支付的服务费用几乎是没有这些疾病的患者的 3 倍。2011 年,用于≥65 岁的 AD 和其他痴呆症患者的医疗保健、长期护理和临终关怀服务的总支出预计为 1830 亿美元(不包括无薪照顾者的贡献)。本报告旨在提供更多信息,以提高对 AD 的公共卫生影响的认识,包括发病率和患病率、死亡率、卫生支出和护理成本,以及对照顾者和整个社会的影响。该报告还审查了 AD 检测和诊断的现状,重点关注早期检测的好处以及准确诊断面临的挑战因素。