Tackling age-related disease: time for a step forward

Age-Related Disease Burden in China, 1997-2017: Findings From the Global Burden of Disease Study

Background: The population is aging much faster in China than other low- and middle-income countries. With the accelerated aging of the population, incidence and disease burden of age-related diseases have also continued to increase. Exploring the burden of age-related diseases is crucial for early disease prevention, assessing the extent of population aging, and achieving the goal of healthy aging.

Methods: We used the dataset from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD), and selected data on incidence, prevalence, and disease burden in China, in 1997, 2007, and 2017. We classified age-related diseases, which were defined as diseases in which the incidence rate increased quadratically with age in the adult population. Additionally, we described the changes in age-related diseases during the study period by different GBD categories. It also measured changes in the age-related disease burden in our study period, including disability-adjusted life years (DALY), years of life lost (YLL), and years lived with disability (YLD). Finally, we compared the differences in the age-related disease burdens for men and women.

Results: Among the 293 diseases listed in the GBD study, 69 in 2017, 78 in 1997 and 72 in 2007 were identified as age-related diseases. More than half of the age-related diseases belonged to non-communicable diseases (NCDs) in our study period. The rate of age-standardized age-related disease burden decreased between 1997 and 2017. DALYs decreased by 24.89% for non-age-related diseases and by 50.15% in age-related diseases from 1997 to 2017. The age-related disease burden of men was higher than that of women; we found a decreasing trend, with −46.23% in men and −54.90% in women.

Conclusions: Comparing characteristics of the aging population in China and the world, we found that China does not have the typical disease characteristics of aging society. Currently, China faces the dual threat of NCDs and communicable diseases, and NCDs account for the vast majority of the age-related disease burden. Our health systems should focus on disease prevention and early detection among the entire population, instead of treatment. Further studies should focus on reducing the duration and severity of morbidity in later life.

Rapid cognitive decline in Alzheimer's disease: a literature review

BACKGROUND

The rate of cognitive decline in Alzheimer's disease (AD) varies considerably between individuals. Predicting rapid cognitive decline might help clinicians provide prognostic information, select subjects for trial intervention and/or reduce costs.

METHODS

PubMed and PsycINFO were searched for all the English written studies published until the end of 2010 on rapid cognitive decline in AD and factors associated with it.

RESULTS

More than 300 individual articles were retrieved. We selected 82 relevant studies. The main findings of these papers are that younger, more educated and more impaired patients are more likely to show rapid cognitive decline. ApoE alleles seem not to modify the velocity of clinical progression of dementia, or at most could have a very small effect. No inference can be made for all the other variables analysed.

CONCLUSIONS

There are many studies on rapid cognitive decline. Results are heterogeneous and often contradictory. No reliable conclusions about factors that may be associated with rapid cognitive decline can yet be drawn.

World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the biological treatment of Alzheimer's disease and other dementias

OBJECTIVES

To define a practice guideline for biological treatment of dementia and to make transparent the development of the guideline connecting the original data with the resulting recommendations.

METHODS

This guideline includes pharmacologic treatment considerations for patients with Alzheimer's disease, vascular dementia, DLB, and fronto-temporal dementia. Studies were selected that represent double-blind placebo-controlled trials of at least 3 months duration in patients with a diagnosis of dementia according to accepted international diagnostic criteria (for example the NINCDS/ADRDA or NINDS/AIREN criteria). Moreover, to be included studies had to fulfill a restrictive set of methodological criteria. Original studies and not meta-analyses determined the evaluation and the development of recommendations.

RESULTS

Antidementia pharmaceuticals neither cure nor arrest the disease. A modest effect of improvement of symptoms compared with placebo can be observed. Antidementia pharmaceuticals show different efficacy and side effect profiles. The type of dementia, the individual symptom constellation and the tolerability should determine what medication should be used. There are hints that combination therapy of drugs with different therapeutic mechanisms might improve the efficacy. In treating neuropsychiatric symptoms (NPS), psychosocial intervention should be the treatment of first choice. Pharmaceuticals can only be recommended when psychosocial interventions is not adequate. However, even then the side effects of pharmaceuticals limit their use.

CONCLUSIONS

Depending on the diagnostic entity and the pathology treated different anti-dementia drugs can be recommended to improve symptoms. In the management of NPS, side effects limit the use of medications even when psychosocial interventions have failed. Thus, there is an urgent need to develop more efficacious medications for the treatment of dementia.