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      Epidemiology of Alzheimer's disease: occurrence, determinants, and strategies toward intervention Translated title: Epidemíologia de la Enfermedad de Alzheimer: frecuencia, determinantes y estrategias orientadas a la intervención Translated title: Épidémiologie de la maladie d'Alzheimer: survenue, déterminants et stratégies d'intervention

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          Abstract

          More than 25 million people in the world today are affected by dementia, most suffering from Alzheimer's disease. In both developed and developing nations, Alzheimer's disease has had tremendous impact on the affected individuals, caregivers, and society. The etiological factors, other than older age and genetic susceptibility, remain to be determined. Nevertheless, increasing evidence strongly points to the potential risk roles of vascular risk factors and disorders (eg, cigarette smoking, midlife high blood pressure and obesity, diabetes, and cerebrovascular lesions) and the possible beneficial roles of psychosocial factors (eg, high education, active social engagement, physical exercise, and mentally stimulating activity) in the pathogenetic process and clinical manifestation of the dementing disorders. The long-term multidomain interventions toward the optimal control of multiple vascular risk factors and the maintenance of socially integrated lifestyles and mentally stimulating activities are expected to reduce the risk or postpone the clinical onset of dementia, including Alzheimer's disease.

          Translated abstract

          Hoy en día más de 25 millones de personas en el mundo están afectadas por demencia, la mayor parte con Enfermedad de Alzheimer. Tanto en los países desarrollados como en aquellos en vías de desarrollo, la Enfermedad de Alzheimer ha tenido un tremendo impacto en los individuos que la padecen, en los cuidadores y en la sociedad. Los factures etiológicos, más allá de la edad avanzada y la susceptibilidad genética, tienen que ser determinados. Sin embargo, hay una creciente evidencia que apunta fuertemente al papel potencialmente dañino de los factores de riesgo vascular y otros trastornos (fumar cigarrillos, presión alta y obesidad en la edad media de la vida, diabetes y lesiones cerebrovasculares) y al posible papel benéfico de los factores psicosociales (mayor escolaridad, participación social activa, ejercicio físico y actividades de estimulación mental) en el proceso patogénico y en las manifestaciones clínicas de las demencias.

          Se espéra que las intervenciones a largo plazo, desde múltiples áreas, orientadas al control óptimo de los múltiples factores de riesgo vascular y el mantenimiento de estilos de vida con buena integración social y actividades de estimulación mental reduzcan el riesgo o retarden la instalación de las demencias, incluyendo la Enfermedad de Alzheimer.

          Translated abstract

          Plus de 25 millions de personnes dans le monde sont aujourd'hui touchées par la démence, la plupart par la maladie d'Alzheimer. Cette maladie affecte de façon très importante les patients atteints, leurs soignants et la société qu'il s'agisse des pays développés ou en voie de développement. Les facteurs étiologiques autres qu'un âge avancé et une susceptibilité génétique restent à déterminer. Le rôle potentiel des facteurs de risque et des maladies vasculaires (tabagisme, hypertension artérielle et obésité de la quarantaine, diabète, lésions cérébrovasculaires) et l'éventuel rôle bénéfique des facteurs psychosociaux (niveau élevé d'éducation, engagement social actif, exercice physique, activité mentalement stimulante) sont cependant de plus en plus fortement mis en évidence dans le processus de la pathogenèse et les manifestations cliniques des troubles démentiels. Les interventions dans plusieurs domaines à long terme pour un contrôle optimal des multiples facteurs de risque vasculaire et le maintien d'un style de vie intégré socialement et d'activités mentalement stimulantes font espérer une réduction du risque ou un report du début clinique de la démence, y compris de la maladie d'Alzheimer.

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          Alzheimer's disease.

          Alzheimer's disease is the most common cause of dementia. Research advances have enabled detailed understanding of the molecular pathogenesis of the hallmarks of the disease--ie, plaques, composed of amyloid beta (Abeta), and tangles, composed of hyperphosphorylated tau. However, as our knowledge increases so does our appreciation for the pathogenic complexity of the disorder. Familial Alzheimer's disease is a very rare autosomal dominant disease with early onset, caused by mutations in the amyloid precursor protein and presenilin genes, both linked to Abeta metabolism. By contrast with familial disease, sporadic Alzheimer's disease is very common with more than 15 million people affected worldwide. The cause of the sporadic form of the disease is unknown, probably because the disease is heterogeneous, caused by ageing in concert with a complex interaction of both genetic and environmental risk factors. This seminar reviews the key aspects of the disease, including epidemiology, genetics, pathogenesis, diagnosis, and treatment, as well as recent developments and controversies.
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            Systematic meta-analyses of Alzheimer disease genetic association studies: the AlzGene database.

            The past decade has witnessed hundreds of reports declaring or refuting genetic association with putative Alzheimer disease susceptibility genes. This wealth of information has become increasingly difficult to follow, much less interpret. We have created a publicly available, continuously updated database that comprehensively catalogs all genetic association studies in the field of Alzheimer disease (http://www.alzgene.org). We performed systematic meta-analyses for each polymorphism with available genotype data in at least three case-control samples. In addition to identifying the epsilon4 allele of APOE and related effects, we pinpointed over a dozen potential Alzheimer disease susceptibility genes (ACE, CHRNB2, CST3, ESR1, GAPDHS, IDE, MTHFR, NCSTN, PRNP, PSEN1, TF, TFAM and TNF) with statistically significant allelic summary odds ratios (ranging from 1.11-1.38 for risk alleles and 0.92-0.67 for protective alleles). Our database provides a powerful tool for deciphering the genetics of Alzheimer disease, and it serves as a potential model for tracking the most viable gene candidates in other genetically complex diseases.
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              Prevalence of Dementia in the United States: The Aging, Demographics, and Memory Study

              Aim: To estimate the prevalence of Alzheimer’s disease (AD) and other dementias in the USA using a nationally representative sample. Methods: The Aging, Demographics, and Memory Study sample was composed of 856 individuals aged 71 years and older from the nationally representative Health and Retirement Study (HRS) who were evaluated for dementia using a comprehensive in-home assessment. An expert consensus panel used this information to assign a diagnosis of normal cognition, cognitive impairment but not demented, or dementia (and dementia subtype). Using sampling weights derived from the HRS, we estimated the national prevalence of dementia, AD and vascular dementia by age and gender. Results: The prevalence of dementia among individuals aged 71 and older was 13.9%, comprising about 3.4 million individuals in the USA in 2002. The corresponding values for AD were 9.7% and 2.4 million individuals. Dementia prevalence increased with age, from 5.0% of those aged 71–79 years to 37.4% of those aged 90 and older. Conclusions: Dementia prevalence estimates from this first nationally representative population-based study of dementia in the USA to include subjects from all regions of the country can provide essential information for effective planning for the impending healthcare needs of the large and increasing number of individuals at risk for dementia as our population ages.
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                Author and article information

                Contributors
                Aging Research Center, Karolinska Institutet-Stockholm University and Stockholm Gerontology Research Center, Stockholm, Sweden
                Aging Research Center, Karolinska Institutet-Stockholm University and Stockholm Gerontology Research Center, Stockholm, Sweden
                Aging Research Center, Karolinska Institutet-Stockholm University and Stockholm Gerontology Research Center, Stockholm, Sweden
                Journal
                Dialogues Clin Neurosci
                Dialogues Clin Neurosci
                Dialogues in Clinical Neuroscience
                Les Laboratoires Servier (France )
                1294-8322
                1958-5969
                June 2009
                : 11
                : 2
                : 111-128
                Affiliations
                Aging Research Center, Karolinska Institutet-Stockholm University and Stockholm Gerontology Research Center, Stockholm, Sweden
                Aging Research Center, Karolinska Institutet-Stockholm University and Stockholm Gerontology Research Center, Stockholm, Sweden
                Aging Research Center, Karolinska Institutet-Stockholm University and Stockholm Gerontology Research Center, Stockholm, Sweden
                Author notes
                Article
                10.31887/DCNS.2009.11.2/cqiu
                3181909
                19585947
                55348834-76e1-4185-8f92-f21ce617211d
                Copyright: © 2009 LLS

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by-nc-nd/3.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Categories
                State of the Art

                Neurosciences
                prevalence,intervention,epidemiology,alzheimer's disease,vascular risk factor,aging,incidence,psychosocial factor

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