Jama Network Open:超10万人研究,酒精相关的意识丧失可增加老年痴呆的风险

2020-09-12 liangying MedSci原创

想饮酒又想远离痴呆风险?千万不要喝到“烂醉如泥”

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患有酒精相关障碍的人会增加老年痴呆风险,防止滥用酒精是预防痴呆症的一个手段。酒精可导致大脑萎缩,并伴有神经元丢失(尤其是在额叶皮质);滥用酒精还会导致中枢神经系统炎症、低血糖癫痫、抑郁症等,所有这些都会增加痴呆风险。此外,酒精对痴呆的影响可能是间接的,因为酒精摄入过多会导致一些其他疾病,如肝肾疾病、糖尿病、高血压、心律失常、冠心病和中风等。

酒精相关障碍(alcohol-related disorders)是指是由于长期或大量饮酒对中枢神经系统造成损害,导致发生精神症状的一组精神障碍。包括酒滥用与酒依赖。

酒与人们的生活有着密切联系。 少量或适量饮酒,使人愉悦、活跃生活,缓解紧张情绪,减轻焦虑,对抗打击或不幸,克服睡眠障碍,激发创作灵感,解除疲劳,舒筋活血,祛风湿,增进食欲,促进消化等中等剂量饮酒,可产生镇静、抑制人的兴奋作用进行性的大剂量饮酒,可削弱人的认知能力过量饮酒,则导致意识障碍、昏迷和死亡。

根据世界卫生组织公布的“人类健康十大危机”报告,酒精是影响人类健康的第五大危险因素。除此之外,由于酗酒而发的家庭暴力、刑事案件和交通事故层出不穷,对社会造成极大的危害。

虽然在临床上酒精相关障碍与痴呆症的关联很明显,但总体酒精摄入在一般人群痴呆发展中的作用尚不确定。以人群为基础的研究的荟萃分析表明重度饮酒的个体与中度饮酒的个体相比痴呆的发病率更高,这一观察结果并不普遍,并且没有在使用遗传变异作为饮酒替代变量的孟德尔随机化研究中被复制。

在大多数关于饮酒与痴呆之间关系的研究中,还有一个限制是缺乏对饮酒量的考虑。短时间内大量饮酒会导致血液中酒精含量的神经毒性,但这种情况并没有完全反映在平均饮酒水平上。很少有研究将酒精引起的意识丧失作为痴呆症的一个潜在的长期危险因素,而且还没有发现任何关于酒精引起的意识丧失对适度饮酒人群的影响的研究。

近日,Jama Network Open上发表了一项名为Association of Alcohol-Induced Loss of Consciousness and Overall Alcohol Consumption With Risk for Dementia(酒精性意识丧失和总体饮酒量与痴呆风险的关系)的研究。研究的主要作者Mika Kivimäki教授称:“在这篇研究中,我们根据平均饮酒量和饮酒导致的意识丧失来研究痴呆症的发生率。此外,还研究了14种潜在的酒精相关疾病,包括糖尿病、高血压、血管、肾脏和肝脏疾病等是否可以介导意识丧失和痴呆症之间的联系。”

研究纳入了来自英国、法国、瑞典和芬兰(IPD-Work consortium)的七个队列研究,包括13415名参与者。在基线检查时(1986-2012年)参与者年龄在1877岁之间,有饮酒报告且没有被诊断为痴呆。随访时间平均为14.4(范围:12.3-30.1)数据分析时间为20191117日至2020523日。两个阈值来定义总饮酒量:每周大于14单位(U)(英国定义)和大于21单位(美国定义)

酒精消费、酒精引起的意识丧失和痴呆的相关研究的选择

研究结果显示,13415名参与者(平均[SD]年龄43.0[10.4]岁;80344[61.1%]女性)1081(0.8%)发展为痴呆。在对潜在混杂因素进行调整后,每周饮酒超过14 1- 14 U的危险比(HR)1.16 (95% CI, 0.98-1.37),大于211- 21 U/wk的危险比(HR)1.22 (95% CI, 1.01-1.48)96 591名有丧失意识数据的参与者中,10 004(10.4%)报告在过去12个月里由于饮酒而失去意识。

总体饮酒与痴呆风险之间关联的荟萃分析

饮酒是否导致意识丧失与痴呆的相关性

这项研究中的主要发现是:无论总体饮酒与否,饮酒导致的意识丧失与随后发生痴呆的风险增加一倍有关。那些在过去一年内曾喝酒失去意识的人患痴呆症的风险是那些适度饮酒但没有失去意识的人的两倍。与全因痴呆一样,早、晚发性痴呆、阿尔茨海默病和动脉粥样硬化性心血管疾病特征的痴呆也存在这种相关性。分析中考虑的其他14种酒精相关疾病的调解作用是适度的,暗示失去意识的神经毒性可以解释与痴呆的联系。

与早发和晚发全因痴呆、阿尔茨海默病和动脉粥样硬化性心血管疾病特征的痴呆的相关性表明,酒精引起的意识丧失与广泛的神经病理学疾病有关。乙醇具有神经毒性,可以通过血脑屏障直接到达神经元,高浓度的乙醇及其代谢物乙醛可以引发病理过程,导致脑损伤。

研究者称:“据我们所知,这是迄今为止最大的一项研究,旨在了解饮酒和酒精导致的意识丧失与痴呆症的关系,我们发现,每周大量饮酒与适度饮酒相比发生意识丧失的风险是1.2倍,而在过去12个月内有过酒精相关意识丧失的人,不管他们每周饮酒量总体如何患痴呆症的风险是都是适度饮酒者的2倍。这种风险增加表明饮酒模式(是否过量导致意识丧失)比每周饮酒总量更需要把控。也提醒大众饮酒在适量的基础上最重要的是不能酗酒,即不要喝到烂醉如泥。

 

参考文献:Kivimäki, M., Singh-Manoux, A., Batty, G. D., Sabia, S., Sommerlad, A., Floud, S., … Strandberg, T. (2020). Association of Alcohol-Induced Loss of Consciousness and Overall Alcohol Consumption With Risk for Dementia. JAMA Network Open, 3(9), e2016084. doi:10.1001/jamanetworkopen.2020.16084 

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    2021-01-23 feather89
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    2021-05-16 canlab
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  4. [GetPortalCommentsPageByObjectIdResponse(id=1728658, encodeId=1b651e28658dd, content=<a href='/topic/show?id=986913980dd' target=_blank style='color:#2F92EE;'>#PE#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13980, encryptionId=986913980dd, topicName=PE)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f06c33759375, createdName=feather89, createdTime=Sat Jan 23 01:07:50 CST 2021, time=2021-01-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1734255, encodeId=4e7f1e3425582, content=<a href='/topic/show?id=d4f412668a4' target=_blank style='color:#2F92EE;'>#NET#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12668, encryptionId=d4f412668a4, topicName=NET)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=7ea033781210, createdName=canlab, createdTime=Sun May 16 06:07:50 CST 2021, time=2021-05-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1360733, encodeId=61911360e3356, content=<a href='/topic/show?id=db8853241e3' target=_blank style='color:#2F92EE;'>#意识丧失#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=53241, encryptionId=db8853241e3, topicName=意识丧失)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7d40148, createdName=hyf028, createdTime=Mon Sep 14 10:07:50 CST 2020, time=2020-09-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=884875, encodeId=5df58848e5e1, content=每周大量<a href='/topic/show?id=c37e1012082d' target=_blank style='color:#2F92EE;'>#饮酒#</a>与适度饮酒相比发生意识丧失的风险是1.2倍,多次意识丧失,可以增加<a href='/topic/show?id=bdb78016436' target=_blank style='color:#2F92EE;'>#老年性痴呆#</a>的风险。总之,少饮为妙!, beContent=null, objectType=article, channel=null, level=null, likeNumber=220, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=101208, encryptionId=c37e1012082d, topicName=饮酒), TopicDto(id=80164, encryptionId=bdb78016436, topicName=老年性痴呆)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=lovetcm, createdTime=Sun Sep 13 08:39:02 CST 2020, time=2020-09-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1036268, encodeId=9d2a103626816, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Sat Sep 12 22:07:50 CST 2020, time=2020-09-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1048659, encodeId=495a104865977, content=老年人痴呆何药可用??, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=junJUN, createdTime=Sat Sep 12 22:07:50 CST 2020, time=2020-09-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=884803, encodeId=aa3a8848033a, content=学习了吗, beContent=null, objectType=article, channel=null, level=null, likeNumber=114, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6EF3hKja8nER8RMzxQdria9eCYFhgLTLsDOeqnvIYdeLDz5eP6EnicLuE5gibiawgno4zUA0jAR7Nbtp2llQ9fs3Mk/0, createdBy=278f1986883, createdName=医鸣惊人, createdTime=Sat Sep 12 19:56:37 CST 2020, time=2020-09-12, status=1, ipAttribution=)]
    2020-09-13 lovetcm

    每周大量#饮酒#与适度饮酒相比发生意识丧失的风险是1.2倍,多次意识丧失,可以增加#老年性痴呆#的风险。总之,少饮为妙!

    0

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    2020-09-12 旺医

    顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=1728658, encodeId=1b651e28658dd, content=<a href='/topic/show?id=986913980dd' target=_blank style='color:#2F92EE;'>#PE#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13980, encryptionId=986913980dd, topicName=PE)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f06c33759375, createdName=feather89, createdTime=Sat Jan 23 01:07:50 CST 2021, time=2021-01-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1734255, encodeId=4e7f1e3425582, content=<a href='/topic/show?id=d4f412668a4' target=_blank style='color:#2F92EE;'>#NET#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12668, encryptionId=d4f412668a4, topicName=NET)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=7ea033781210, createdName=canlab, createdTime=Sun May 16 06:07:50 CST 2021, time=2021-05-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1360733, encodeId=61911360e3356, content=<a href='/topic/show?id=db8853241e3' target=_blank style='color:#2F92EE;'>#意识丧失#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=53241, encryptionId=db8853241e3, topicName=意识丧失)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7d40148, createdName=hyf028, createdTime=Mon Sep 14 10:07:50 CST 2020, time=2020-09-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=884875, encodeId=5df58848e5e1, content=每周大量<a href='/topic/show?id=c37e1012082d' target=_blank style='color:#2F92EE;'>#饮酒#</a>与适度饮酒相比发生意识丧失的风险是1.2倍,多次意识丧失,可以增加<a href='/topic/show?id=bdb78016436' target=_blank style='color:#2F92EE;'>#老年性痴呆#</a>的风险。总之,少饮为妙!, beContent=null, objectType=article, channel=null, level=null, likeNumber=220, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=101208, encryptionId=c37e1012082d, topicName=饮酒), TopicDto(id=80164, encryptionId=bdb78016436, topicName=老年性痴呆)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=lovetcm, createdTime=Sun Sep 13 08:39:02 CST 2020, time=2020-09-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1036268, encodeId=9d2a103626816, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Sat Sep 12 22:07:50 CST 2020, time=2020-09-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1048659, encodeId=495a104865977, content=老年人痴呆何药可用??, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=junJUN, createdTime=Sat Sep 12 22:07:50 CST 2020, time=2020-09-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=884803, encodeId=aa3a8848033a, content=学习了吗, beContent=null, objectType=article, channel=null, level=null, likeNumber=114, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6EF3hKja8nER8RMzxQdria9eCYFhgLTLsDOeqnvIYdeLDz5eP6EnicLuE5gibiawgno4zUA0jAR7Nbtp2llQ9fs3Mk/0, createdBy=278f1986883, createdName=医鸣惊人, createdTime=Sat Sep 12 19:56:37 CST 2020, time=2020-09-12, status=1, ipAttribution=)]
    2020-09-12 junJUN

    老年人痴呆何药可用??

    0

  7. [GetPortalCommentsPageByObjectIdResponse(id=1728658, encodeId=1b651e28658dd, content=<a href='/topic/show?id=986913980dd' target=_blank style='color:#2F92EE;'>#PE#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13980, encryptionId=986913980dd, topicName=PE)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f06c33759375, createdName=feather89, createdTime=Sat Jan 23 01:07:50 CST 2021, time=2021-01-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1734255, encodeId=4e7f1e3425582, content=<a href='/topic/show?id=d4f412668a4' target=_blank style='color:#2F92EE;'>#NET#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12668, encryptionId=d4f412668a4, topicName=NET)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=7ea033781210, createdName=canlab, createdTime=Sun May 16 06:07:50 CST 2021, time=2021-05-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1360733, encodeId=61911360e3356, content=<a href='/topic/show?id=db8853241e3' target=_blank style='color:#2F92EE;'>#意识丧失#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=53241, encryptionId=db8853241e3, topicName=意识丧失)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7d40148, createdName=hyf028, createdTime=Mon Sep 14 10:07:50 CST 2020, time=2020-09-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=884875, encodeId=5df58848e5e1, content=每周大量<a href='/topic/show?id=c37e1012082d' target=_blank style='color:#2F92EE;'>#饮酒#</a>与适度饮酒相比发生意识丧失的风险是1.2倍,多次意识丧失,可以增加<a href='/topic/show?id=bdb78016436' target=_blank style='color:#2F92EE;'>#老年性痴呆#</a>的风险。总之,少饮为妙!, beContent=null, objectType=article, channel=null, level=null, likeNumber=220, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=101208, encryptionId=c37e1012082d, topicName=饮酒), TopicDto(id=80164, encryptionId=bdb78016436, topicName=老年性痴呆)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=lovetcm, createdTime=Sun Sep 13 08:39:02 CST 2020, time=2020-09-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1036268, encodeId=9d2a103626816, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Sat Sep 12 22:07:50 CST 2020, time=2020-09-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1048659, encodeId=495a104865977, content=老年人痴呆何药可用??, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=junJUN, createdTime=Sat Sep 12 22:07:50 CST 2020, time=2020-09-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=884803, encodeId=aa3a8848033a, content=学习了吗, beContent=null, objectType=article, channel=null, level=null, likeNumber=114, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6EF3hKja8nER8RMzxQdria9eCYFhgLTLsDOeqnvIYdeLDz5eP6EnicLuE5gibiawgno4zUA0jAR7Nbtp2llQ9fs3Mk/0, createdBy=278f1986883, createdName=医鸣惊人, createdTime=Sat Sep 12 19:56:37 CST 2020, time=2020-09-12, status=1, ipAttribution=)]
    2020-09-12 医鸣惊人

    学习了吗

    0

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