medical managementof parkinsons disease（帕金森病的医疗管理）.docVIP

1 Epidemiology of Parkinson’s Disease Professor Y Ben-Shlomo Professor of Clinical Epidemiology, Department of Social Medicine, Canynge Hall, University of Bristol, 39 Whatley Road, Bristol BS8 2PS This paper is largely taken and updated from an earlier published review: Ben-Shlomo Y. The epidemiology of Parkinsons disease. Baillieres Clinical Neurology. 1997; 6:55-68. Epidemiology has essentially four roles: (i) measuring the health status of a population and identifying groups at high risk or clusters of disease, (ii) determining aetiological risk factors that may be amenable to intervention and hence preventing disease, (iii) describing the natural history of disease and measuring the impact of interventions, (iv) planning and evaluating the provision of health services. Past epidemiological effort has centred mainly on describing the frequency of Parkinson’s disease (PD) with respect to time, place and person and identifying potential risk factors with relatively less concern on the natural history and planning services for PD patients. Temporal Patterns Temporal data are difficult to interpret, especially mortality rates, as variations may reflect chance, increased diagnostic awareness, improved survival due to treatment or secular changes in life expectancy as well as true differences in incidence of disease. Death certification data provides us with information over the longest time span, although they have additional problems with accuracy and completeness. Mortality patterns from several different countries show fairly consistent results; mortality rates amongst older populations (75 years) show a steady increase, whilst the rates for younger populations ( 65 years) have been declining. This pattern has been seen in several different countries. 1 2 3 4 5 6 Almost certainly diagnostic awareness increased after the introduction of levodopa therapy in the 1970s. However, the increase in mortality appears to predate this period. It also cannot explain why the p