NEUROLOGY:重度创伤性脑损伤是痴呆危险因素

2022-06-24 影像小生 MedSci原创

因重度脑外伤住院3天以上与痴呆之间存在关联。

2020年痴呆症预防、干预和护理柳叶刀委员会将TBI作为一种新的、潜在的特定的可改变的老年痴呆症风险因素,同一篇综述还发现了其他11个可能混淆TBI与痴呆相关性的痴呆症风险因素。其中,认知能力低下、受教育程度低、物质使用(大量饮酒和吸烟)以及身体素质低下除了与痴呆有关外,还与脑外伤和早死有关。因此,在评估TBI和痴呆之间的联系时,有必要对这些因素进行调整。

Rahul Raj等在NEUROLOGY杂志发表题为Risk of Dementia After Hospitalization Due to Traumatic Brain Injury: A Longitudinal Population-Based Study的研究文章,其目的是为确定在调整其他相关痴呆风险因素时,TBI是否确实增加了痴呆的风险。

这是一项国家前瞻性纵向队列研究,包括1992年至2012年芬兰不同地区25 - 64岁患者的随机和代表性人群样本。重度创伤性脑损伤被定义为外伤性颅内出血和住院天数(LOS) ≥3天轻度创伤性脑损伤被定义为脑震荡和住院天数(LOS)≤ 1天痴呆被定义为任何第一次在医院接触到痴呆诊断,第一次使用抗痴呆药物,或痴呆作为潜在或促成死亡的原因。随访至患者死亡或2017年底。

31909名参与者中,288人因重度创伤性脑损伤住院,406人因轻度创伤性脑损伤住院。

在平均15.8年的随访中,共发生976例痴呆。

1.在调整年龄和性别后,因重度脑外伤住院(危险比[HR] 1.51, 95% CI 1.03 2.22)会增加痴呆的风险。

2. 在对教育状况、吸烟状况、饮酒、体育活动和高血压进行额外调整后,重度脑外伤与痴呆之间的关联减弱(风险比1.30,95%可信区间0.86 1.97)。最能减弱重度脑外伤和痴呆之间联系的危险因素是饮酒和体育活动

显示痴呆危险因素的完全调整Cox比例风险回归模型的结果

综上所述,该研究发现因重度脑外伤住院3天以上与痴呆之间存在关联。在调整了其他与痴呆症相关的风险因素,尤其是饮酒和体育活动后,这种关联性减弱了。因轻微脑外伤住院1天或更短时间与痴呆之间没有相关性。二级预防过度饮酒和身体活动不足可降低重度创伤性脑损伤幸存者患痴呆的风险。

原文出处

Risk of Dementia After Hospitalization Due to Traumatic Brain Injury: A Longitudinal Population-Based Study

https://doi.org/10.1212/WNL.0000000000200290

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    2022-07-11 yinhl1978
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    2022-08-01 amyloid
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    2022-06-21 neuro.Dr

    老年性痴呆,未来还是希望借助神经电生理吧,也许更为有效!

    0

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