ABSTRACT

Social policies determine the distribution of factors (e.g. education, cardiovascular health) protecting against the development of dementia in Alzheimer’s disease (AD). However, the association between social policies and the likelihood of AD without dementia (ADw/oD) has yet to be evaluated. We estimated this association in an ecological study using systematic review and meta-analysis. Four reference databases were consulted; 18 studies were included in the final analysis. ADw/oD was defined as death without dementia in people with clinically significant AD brain pathology. The indicators of social policy were extracted from the Organisation for Economic Co-operation and Development database (OECD). The probability of ADw/oD with moderate AD brain pathology was inversely associated with the Gini index for disposable income, poverty rate, and certain public expenditures on healthcare. ADw/oD with advanced AD brain pathology was only associated with public expenditures for long-term care. Social policies may play a role in maintaining and sustaining cognitive health among older people with AD.

摘要

社会政策决定了预防阿尔茨海默病（AD）痴呆发展的因素（例如教育、心血管健康）的分布。然而，社会政策与不伴有痴呆的 AD 可能性 (ADw/oD) 之间的关联尚未得到评估。我们通过系统评价和荟萃分析在生态研究中估计了这种关联。查阅了四个参考数据库；18项研究纳入最终分析。ADw/oD 被定义为患有临床显着 AD 脑部病理的患者中无痴呆的死亡。社会政策指标取自经济合作与发展组织数据库（OECD）。患有中度 AD 脑部病变的 ADw/oD 的概率与可支配收入、贫困率和某些公共医疗支出的基尼指数呈负相关。患有晚期 AD 脑部病理学的 ADw/oD 仅与长期护理的公共支出相关。社会政策可能在维持和维持 AD 老年人的认知健康方面发挥作用。