Alzheimer's Dementia:法国千人研究-癌症患者的痴呆风险或更低

2021-03-16 Freeman MedSci原创

法国千人研究-癌症患者的痴呆风险或更低

流行病学研究发现,癌症对痴呆症,尤其是阿尔茨海默病(AD)类型的痴呆症有保护作用。在一项大型前瞻性社区队列研究中,科学家发现:新发癌症或可减低30%的AD痴呆风险。同样,一项基于英国的前瞻性队列估计,癌症不仅降低任何AD相关痴呆的风险,而且还将未来的癌症风险降低高达70%。

然而,不同文献的结果并不总是一致。例如,虽然最近的一项丹麦全国性队列研究也显示癌症最初对AD有保护作用,但随着时间的推移,这种作用的强度有所减弱。

癌症可增加痴呆风险的论点也在之前的文献中报道过。癌症患者可能不太可能存活足够长的时间而发展成痴呆症--或者那些存活下来的患者可能具有更多的有利特征,这些特征对痴呆症具有保护作用,所有这些都可能由于选择(幸存者偏倚)而导致保护效应。此外,癌症患者可能不太可能被筛查出痴呆症,这可能是由于怀疑 "化疗脑 "而不是痴呆症导致的认知障碍(监视偏差)。

另外,患有痴呆症的人可能被诊断为癌症的可能性较小,因为医疗从业人员筛查癌症的可能性降低,从而可能导致错误的结论。最后,与治疗效果相关的潜在的未测量的混杂因素也被认为是观察到的保护效果的驱动因素。

统计学方法可以解决许多潜在的偏差,尽管以前的研究大多局限于使用标准生存模型,忽略了竞争事件的潜在作用,或者局限于模拟研究。疾病-死亡模型(IDMs),类似于竞争风险分析,通过准确考虑差异死亡率,同时模拟疾病进展的风险(即竞争风险),可以帮助解释幸存者偏差。

藉此,法国波尔多大学的Jonviea D. Chamberlain等人,基于一个大型临床队列,即法国的多中心Memento队列,对轻度或孤立的认知症状者进行中位数5年的跟踪。疾病-死亡模型(IDMs)被用来估计自研究进入以来的时间内与痴呆症有关的新发癌症情况。


他们分析样本(N=2258)后,排除了65名没有后续资料的人。
在随访结束时,286人被诊断为痴呆,166人被诊断为新发癌症,95人死亡。
新发癌症与痴呆风险降低相关(HR=0.58,95%CI=0.35-0.97),相应的E值为2.84(lower CI=1.21)。

他们的研究结果更支持癌症或许能降低痴呆风险,当然这需要进一步的研究以了解潜在的机制。

原文出处:

Chamberlain, J. D., Rouanet, A., Dubois, B., Pasquier, F., Hanon, O., Gabelle, A., ... & Memento Study group. (2021). Investigating the association between cancer and the risk of dementia: Results from the Memento cohort. _Alzheimer's & Dementia_.

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    2021-03-17 neurowu
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    2021-03-16 123eef3dm93暂无昵称

    拆东墙 补西壁

    0

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    2021-03-16 海1991

    如何使痴呆风险减小呢

    0

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    2021-03-16 junJUN

    老年人痴呆何药可用??

    0

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    2021-03-16 学医无涯

    关上了一扇门,打开了一扇窗

    0

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Eur Heart J:经皮冠状动脉介入治疗的癌症患者90天内因急性心肌梗塞和出血再入院分析

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