Dementia Japan 24 : 469-478, 2010 469 原著 要旨 65 early - onset dementia : EOD EOD EOD 2,626 Epidemiology of Early - Onset Dementia in Ehime Tetsuo Kashibayashi 1,2, Tomohisa Ishikawa 3, Kenjiro Komori 2, Hideaki Shimizu 2, Ryuji Hukuhara 2, Satoshi Tanimukai 2 1 679-5165 1 7 1 Department of Rehabilitation, Rehabilitation Nishi - Harima Hospital, Hyogo Prefectural Rehabilitation Center at Nishi - Harima 1-7 - 1 Koto, Shingu - cho, Tatsuno, Hyogo 679-5165, Japan 2 791-0295 Department of Neuropsychiatry, Neuroscience Ehime University Graduate School of Medicine Shitsukawa, Touon - shi, Ehime 791-0295, Japan 3 670-0981 520 Institute for Aging Brain and Cognitive Disorders, Hyogo Brain and Heart Center at Himeji 520 Saishoko, Himeji - shi, Hyogo 670-0981, Japan EOD EOD 18 64 10 53.4 40.3% 25.1% 31.4% 33.9% 29.1% 57.4% はじめに 65 1997
470 Dementia Japan Vol. 24 No. 4 December 2010 Freyne A et al., 1999, Sampson E et al., 2004 目的 方法と対象 19 6 30 7 1 18 65 2,626 147 870 1,262 92 62 246 102 19 7 1 12 31 1 19 7 12 2 1 1 the Diagnostic and Statistical Manual of Mental Disorders, 3rd edition revised DSM - III R APS 1987 2 Alzheimer AD VaD The Diagnostic and Statistical Manual of Mental Disorders, 4th Edition DSM - IV APS 1993 DLB Parkinson McKeith McKeith IG et al., 1996 FTLD Neary Lund and Manchester criteria Neary D et al., 1998 19 7 1
愛 県における若年性認知症の実態調査 471 図 1-a. 1 次調査用紙 とも近い人口動態調査の結果を使用し有病率を算出 を実施したところ 94 施設から回答を得 重複を した 今回の調査では頭部外傷後遺症の患者は若年 含めた受診または利用者数は 341 人であった 施設 性認知症には加えなかった また アルコールによ 回収率は 71.2% であった 調査基準日の年齢が 65 る認知機能障害はその他に加えた 推定有病率は年 歳以上であった 7 人と 2 つの機関の重複例 11 人 齢階層別 施設別の報告数をそれぞれの施設別の回 3 つの機関の重複例 1 人を除外し 頭部外傷後遺症 収率で除し推定患者実数を計算し さらに推定患者 の患者を除外した結果 若年性認知症患者は 282 人 実数を 2005 年 10 月の愛媛県年齢階層別人口 18 65 であった 表 1 今回の調査票の回収率をもとに 歳男性 416,274 人 女性 435,367 人 で割り 10 万 すると 愛媛県内の若年性認知症患者数は 453.5 人当たりの有病率として算出した 人と推定された また 若年性認知症の発症率は - 18 歳 か ら 64 歳 人 口 に お け る 人 口 10 万 人 あ た り 結 果 53.4 人であった 5 歳ごとの階層別では 男女とも に年齢が高くなるに従って認知症患者は増える傾向 1 次調査では 愛媛県下の 2,626 機関中 2,117 関 連機関から回答を得た 回収率は 80.6% であった を認めた 図 2, 表 2 本調査にて明らかになった若年性認知症患者につ このうち 若年性認知症の受診または施設利用が いて解析すると 若年性認知症患者の調査基準時に あったのは 132 施設で 重複も含めた受診または利 おける平均年齢は 57.4±6.8 歳で 発症年齢の平均 用者数は 457 人であった これらに対し 2 次調査 は 50.8±10.3 歳 男女比は 男性 65.4% で 35 歳 39 -
472 Dementia Japan Vol. 24 No. 4 December 2010 図 1 - b. 2 次調査用紙 表 1. 施設別回収状況 1 2 % % 862 689 79.9 42 34 81.0 205 196 1,262 963 76.3 35 22 62.9 41 35 92 88 95.7 10 9 90.0 12 10 62 57 91.9 17 13 76.5 25 24 246 225 91.5 27 15 55.6 17 16 102 95 93.1 1 1 100 1 1 2,626 2,117 80.6 132 94 71.2 301 282 2 7 VaD 113 40.1% AD 71 25.2% FTLD9 3.2% 89 31.6%
473 図 2. 年齢階層別有病率各年齢階層別人口で各実数を除し, 有病率を算出した. 表 2. 年齢階層別有病率 Male Female Total n prevalence n prevalence n prevalence 20-24 1 6.1 0 0.0 1 3.1 25-29 1 4.1 0 0.0 1 2.0 30-34 2 5.6 1 3.2 3 4.4 35-39 1 4.6 3 9.9 4 7.3 40-44 4 15.1 1 3.6 5 9.2 45-49 14 56.1 8 29.9 22 42.5 50-54 23 77.1 6 19.0 29 47.5 55-59 73 191.2 27 66.5 100 128.4 60-64 66 225.3 51 158.8 117 192.7 VaD 42.7% AD 20.5% 2 VaD 35.7% AD 33.7% 3 VaD 31 37.5% 46 34.1% 21 20.1% 5 4.4% 4 3.5% 7 6.1% 27 8.4% 3 59 92 116 29.1% VaD 23 34.3% AD 10 16.9% 4 VaD 1 2 93 157 VaD
474 Dementia Japan Vol. 24 No. 4 December 2010 図 3. 男女別背景疾患の内訳 表 3. その他の背景疾患の内訳 n 27 10 10 CO 9 4 4 3 MS, DNTC,, 7 2 14 図 4. 障害年金受給状況 48 48.0% AD 11 16.2% 5 2 40 143 57.4% 106 42.6% AD 3 1-5 10.0% 17.4% 20.1% 22.1% 26.1% 6 考察 18 64 10 53.4 Molsa PK et al., 1982. Kokmen E et al., 1989. 1994. Ratanavalli E et al., 2002. Har-
475 図 5. 障害者手帳の取得状況図 6. 介護保険申請状況 vey RJ et al., 2003. 1993. McMurtray A et al., 2006. Williams T et al., 2001 10 11 81.4 VaD VaD AD Kitamura A et al., 2008 AD Lin RT et al., 1998, Gao S et al., 1998 1 6 6
476 Dementia Japan Vol. 24 No. 4 December 2010 VaD AD VaD AD VaD Toyota Y et al., 2007 Freyne A et al., 1999, Sampson E et al., 2004 3 4 VaD VaD 1993, Fujihara S et al., 2004. VaD まとめ 18 64 2,000 1 VaD AD
477 105 2009, H18 - - - 022 文献 American Psychiatric Association 1987 Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised. Washington, DC : American Psychiatric Association American Psychiatric Association 1993 Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Washington, DC : American Psychiatric Association Freyne A, Kidd N, Coen R, Lawlor BA 1999 Burden in carers of dementia patients : higher levels in carers of younger sufferers. Int J Geriatr Psychiatry 14 : 784-788 Fujishima M, Kiyohara Y. Incidence and risk factors of dementia in a defined elderly Japanese population : The Hisayama study. 2002 ; Ann N Y Acad Sci 977 : 1-8 Fujihara S, Brucki SMD, Rocha MSG, Carvalho AA, Piccolo AC 2004 Prevalence of presenile dementia in a tertiary outpatient clinic. Arq Neuropsiquiatr 62 : 592-595 Gao S, Hendrie HC, Hall KS, Hui S 1998 The Relationships Between Age, Sex, and the Incidence of Dementia and Alzheimer Disease. Arch Gen Psychiatry 55 : 809-815 Harvey RJ, Skelton - Robinson M, Rossor MN 2003 The prevalence and causes of dementia in people under the age of 65 years. J Neurol Neurosurg Psychiatry 74 : 1206-1209 : 8 1997 Kitamura A, Sato S, Kiyama M, Imano H, Iso H, Okada T, Ohira T, Tanigawa T, Yamagichi K, Nakamura M, Konishi M, Shimamoto T, Iida M, Komachi Y 2008 Trends in the incidence of coronary heart disease and stroke and their risk factors in Japan, 1964 to 2003. The Akita - Osaka Study. J Am Coll Cardiol 52 : 71-79 Kokmen E, Beard CM, Offord KP, Kurland LT 1989 Prevalence of medically diagnosed dementia in a defined United States population : Rochester, Minnesota, January 1 1975. Neurology 39 : 773-776 Lin R - T, Lai C - L, Tai C - T, Liu C - K, Yen Y - Y, Howng S - L 1998 Prevalence and subtypes of dementia in southern Taiwan : Impact of age, sex, education, and urbanization. J Neurol Sci 18 : 67-75 McKeith IG, Galasko D, Kosaka K, Perry EK, Dickson DW, Hansen LA, Salmon DP, Lowe J, Mirra SS, Byrne EJ, Lennox G, Quinn NP, Edwardson JA, Ince PG, Bergeron C, Burns A, Miller BL, Lovestone S, Collerton D, Jansen EN, Ballard C, de Vos RA, Wilcock GK, Jellinger KA, Perry RH 1996 Consensus guidelines for the clinical and pathologic diagnosis of dementia with Lewy bodies DLB : report of the consortium on DLB International Workshop. Neurology 47 : 1113-1124 McMurtray A, Clark DG, Christine D, Mendez MF 2006 Early - onset dementia : Frequency and causes compared to late - onset dementia. Dement Geriatr Cogn Disord 21 : 59-64 1993 4 : 1029-1033 Molsa PK, Mattila RJ, Rinne UK 1994 Epidemiology of dementia in a Finnish population. Acta Neurol Scand 65 : 541-552 Neary D, Snowden JS, Gustafson L, Passant U, Stuss D, Black S, Freedman M, Kertesz A, Robert PH, Albert M, Boone K, Miller BL, Cummings J, Benson DF 1998 Frontotemporal lobar degeneration : a consensus on clinical diagnostic criteria. Neurology 51 : 1546-1554 1994 41 : 424-427 Ratanavalli E, Brayne C, Dawson K, Hodges JR 2002 The prevalence of frontotemporal dementia. Neurology 58 : 1615-1621 Sampson E, Warren J, Rossor M 2004 Young onset dementia. Postgrad Med J 80 : 125-139 Toyota Y, Ikeda M, Shinagawa S, Matsumoto T, Matsumoto N, Hokoishi K, Fukuhara R, Ishikawa T, Mori T, Adachi H, Komori K, Tanabe H 2007 Comparison of behavioral and psychological symptoms in early - onset and late - onset al.zheimer s disease. Int J Geriatr Psychiatry 22 : 896-901 Williams T, Dearden AM, Cameron IH 2001 From pillar to post - A study of younger people with dementia. Psychiatr Bull R Coll Psychiatr 25 : 384-387
478 Dementia Japan Vol. 24 No. 4 December 2010 Epidemiology of Early - Onset Dementia in Ehime Tetsuo Kashibayashi 1,2, Tomohisa Ishikawa 3, Kenjiro Komori 2, Hideaki Shimizu 2, Ryuji Hukuhara 2, Satoshi Tanimukai 2 1 Department of Rehabilitation, Rehabilitation Nishi - Harima Hospital, Hyogo Prefectural Rehabilitation Center at Nishi - Harima 2 Department of Neuropsychiatry, Neuroscience Ehime University Graduate School of Medicine, Ehime, Japan 3 Institute for Aging Brain and Cognitive Disorders, Hyogo Brain and Heart Center at Himeji Patients with onset of dementia before the age of 65 years, defined as early - onset dementia EOD, play in strain the family budget and are a considerable socio - economic burden. Despite this there have been very few systematic studies on the prevalence of EOD and the use of related social welfare services. The aim of this study was to investigate the prevalence of EOD and the use of social welfare services by families with an EOD family member in Ehime. A postal survey requesting information on EOD cases was sent to 2,626 institutions in Ehime, including hospitals, medical office, and healthcare facilities for the elderly. Survey questions concerned EOD diagnosis, as well as the existence or absence of a disability certificate, disability pension, and care insurance. The estimated prevalence rate of EOD was 53.4 per 100,000 population of the age 18 to 64 years. Of the illnesses that cause EOD, vascular dementia was the most frequent 40.3% followed by Alzheimer s disease 31.4%. As for social security systems, only 33.9% of EOD patients had a disability certificate, 29.1% disability pension, and 57.4% care insurance. This low prevalence of social security systems was found to greatly increase the burden on patients and caregivers. Address correspondence to Dr. Tetsuo Kashibayashi : Department of Rehabilitation, Rehabilitation Nishi - Harima Hospital, Hyogo Prefectural Rehabilitation Center at Nishi - Harima 1-7 - 1 Koto, Shingu - cho, Tatsuno, Hyogo 679-5165, Japan