The burden of dementia continues to increase as the population ages, with no disease-modifying treatments available. However, dementia risk appears to be decreasing, and progress has been made in understanding its multifactorial etiology. The 2018 National Institute on Aging-Alzheimer's Association (NIA-AA) research framework for Alzheimer's disease (AD) defines AD as a biological process measured by brain pathology or biomarkers, spanning the cognitive spectrum from normality to dementia. This framework facilitates interventions in the asymptomatic space and accommodates knowledge that many additional pathologies (e.g., cerebrovascular) contribute to the Alzheimer's dementia syndrome. The framework has implications for how we think about risk factors for "AD": Many commonly accepted risk factors are not related to AD pathology and would no longer be considered risk factors for AD. They may instead be related to other pathologies or resilience to pathology. This review updates what is known about causes, risk factors, and changing patterns of dementia, addressing whether they are related to AD pathology/biomarkers, other pathologies, or resilience.

中文翻译：

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痴呆的原因和模式：重新定义阿尔茨海默氏病时代的更新。

随着人口的老龄化，痴呆症的负担继续增加，目前尚无可改善疾病的治疗方法。但是，痴呆症的风险似乎正在降低，并且在了解其多因素病因方面已经取得了进展。2018年美国衰老阿尔茨海默氏症协会（NIA-AA）研究框架将阿尔茨海默氏病（AD）定义为通过脑病理学或生物标记物测量的生物过程，涵盖了从正常到痴呆的认知范围。该框架有助于在无症状空间进行干预，并提供有关许多其他病理（例如脑血管）导致阿尔茨海默氏痴呆综合症的知识。该框架对我们如何考虑“ AD”的风险因素有影响：许多公认的危险因素与AD病理无关，因此不再被认为是AD的危险因素。相反，它们可能与其他病理或与病理的适应性有关。这篇评论更新了已知的原因，风险因素和痴呆模式的变化，解决了它们是否与AD病理学/生物标志物，其他病理学或适应力有关。