engleski

Neuroepidemiological Research in Dementias

Clinical neurologists gained in the last decades from neuroepidemiological research important information on causes, risks and possible protection of dementias. The concept of "senile dementias" and Alzheimer's Disease has been changing from the fatalistic concept of degenerative diseases due to aging, through a unitary concept of senile dementias of the Alzheimer's type (SDAT), to the present concept, distinguishing the primary and secondary degenerative, from the vascular and symptomatic, potentially treatable ones. The differentiation of the last group, however small, has an important clinical, but in some situations, e.g. in developing countries, also epidemiological impact. Critically analyses of sometimes contrasting results in the worldwide neuroepidemiological investigations of the SDAT, pointed to differences in applied methodologies, leading to their constant improvement. Some of the investigated elements have been shown as proven or possible risk factors, while to others a protective potential has been attributed. The age is a single most important risk factor for all kinds of dementias, responsible for their exponential rise in the age groups between 65 and 85. Most investigators do not accept hypothesis that the AD is a normal consequence of aging, believing that a combination of genetic predisposition and certain environmental influences allow the manifestation of the disease. The factor gender, with a greater risk for women, is being recently related to hormonal factors. Lower education, found in many studies as a risk for both AD and vascular dementia, is more probably related to social, economic and cultural influences. A family history is a complex factor, indicating possible various types of SDAT, with different age of manifestation of the disease, having its counterparts in the proved genetic characteristics of AD (APP, APO E-e4, presenilin genes). A number of risk factors (hypertension, hypotension, diabetes, withdrawal, physical inactivity), but also protective factors (postmenopausal estrogen use, non-steroid anti-inflammatory drugs, APO E-e2, nicotine), may play a role in a complex interplay of multiple inherited and environmental factors, determining the mode and time of manifestation of various types of dementias. More recently the distinctive clinical characteristics of the dementia with Lewy bodies (D/LB) has been shown, with specific genetic traits. Future neuroepidemiological investigations, based on the past experience, supported by genetic and biochemical research, should lead to a better classification of dementia syndrome, permitting new modes of more successful management and rational medical therapy and prevention.

dementia; neuroepidemiology; risk factors; prevention

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