Alz Res Therapy: 抑郁+脑血管病,痴呆风险大大增加

2021-11-14 Freeman MedSci原创

抑郁症和心血管疾病与痴呆风险的增加有关

痴呆症是一种神经退行性疾病,其特点是认知能力逐渐下降。它使患者无法独立地进行日常生活活动,并常常对患者及其护理人员的生活产生破坏性影响。尽管痴呆症的发病率和疾病负担在不断增加,但迄今为止,在治疗方案方面还没有明显的突破。因此,识别高危人群并提供有针对性的护理,对于成本效益的公共卫生管理至关重要。

抑郁症已被认为是痴呆症的一个风险因素。根据最近对一些流行病学研究的荟萃分析,晚年抑郁症与痴呆症风险的增加有关。一些研究人员提出了间接的证据,表明抑郁症对痴呆风险的影响被合并的脑血管疾病(CVD)所改变,CVD的典型特征是脑缺血和出血。在最近的一项大规模的回顾性研究中,包括35791人,随访13年,发现抑郁症对中风患者的痴呆症有特别明显的影响。

一项系统的审查报告指出,晚年抑郁症患者的认知能力下降与血管功能紊乱有关,包括白质增生。反过来说,心血管疾病患者痴呆的风险因素也包括抑郁症疾病。Armstrong等人进行了一项纵向研究,并报告说晚年抑郁症部分地介导了心血管疾病和认知能力下降之间的联系。

然而,抑郁症和心血管疾病的交互作用,即一种疾病是否会加强另一种疾病与痴呆症风险的关联,仍不清楚。与痴呆症相比,这两种疾病的预防和治疗已经很成熟,并且已知是有效的。

因此,澄清抑郁症和心血管疾病对痴呆症风险的相互影响,可以帮助识别那些在相同费用下可以从医疗保健服务中获得更多益处的人。

藉此,韩国Seoul National University的Yoo Jin Jang等人,通过一个全国范围内的人口队列来评估抑郁症和心血管疾病与随后的痴呆症的关系。还调查这两种情况之间的相互作用是否与痴呆症风险的增加有附加关系。

他们进行了一项基于人口的队列研究,分析了韩国国家健康保险服务-国家样本队列的所有50岁以上的个人数据。纳入基线时未被诊断为痴呆症的个体,并从2005年1月1日到2013年12月31日进行随访。在分析中使用了一个时间变化的Cox比例危险回归模型,对潜在的混杂因素进行了调整。

抑郁症和心血管疾病之间的相互作用是根据归因比例(AP)、相互作用导致的相对超额风险(RERI)、协同指数(SI)和乘法规模(multiplication)的相互作用来估计的。

共有242,237名参与者被纳入分析样本,其中12,735人(5.3%)患上痴呆症。

与没有抑郁症或CVD的参与者相比,单纯抑郁症患者的痴呆症发病率调整后的危险比为2.35(95%置信区间[CI]2.21-2.49),单纯CVD为3.25(95%CI 3.11-3.39),而合并抑郁症和CVD为5.02(95%CI 4.66-5.42)。

抑郁症和CVD之间的加法交互作用具有统计学意义(AP-0.08,95%CI 0.01-0.16;RERI-0.42,95%CI 0.03-0.82;SI-1.12,95%CI 1.01-1.24)。乘法交互作用也是显著的,但效果是负的(0.66,95% CI 0.60-0.73)。

这个研究的重要意义在于:在这个以人口为基础的全国性队列的长期随访中,抑郁症和心血管疾病与痴呆风险的增加有关,它们的共存对痴呆风险的增加比单个风险的总和更大。


原文出处:
Jang YJ, Kang C, Myung W, et al. Additive interaction of mid- to late-life depression and cerebrovascular disease on the risk of dementia: a nationwide population-based cohort study. Alz Res Therapy. 2021;13(1):61. doi:10.1186/s13195-021-00800-z

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    2021-11-15 moyanju2796

    老年人抑郁应该得到重视。

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1644922, encodeId=7675164492239, content=<a href='/topic/show?id=e3eb89e17fb' target=_blank style='color:#2F92EE;'>#血管病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89717, encryptionId=e3eb89e17fb, topicName=血管病)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=64bb23195917, createdName=Luyuxie_17, createdTime=Fri Dec 03 23:06:47 CST 2021, time=2021-12-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1739094, encodeId=b4171e3909458, content=<a href='/topic/show?id=6e566913df' target=_blank style='color:#2F92EE;'>#ERA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=6913, encryptionId=6e566913df, topicName=ERA)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e36234488643, createdName=124988c7m106暂无昵称, createdTime=Mon May 09 01:06:47 CST 2022, time=2022-05-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1316808, encodeId=814c131680831, content=<a href='/topic/show?id=d3d0e121576' target=_blank style='color:#2F92EE;'>#痴呆风险#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=71215, encryptionId=d3d0e121576, topicName=痴呆风险)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a98f453, createdName=pcw106, createdTime=Mon Nov 15 20:06:47 CST 2021, time=2021-11-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1070327, encodeId=390b10e032774, content=老年人抑郁应该得到重视。, beContent=null, objectType=article, channel=null, level=null, likeNumber=137, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=cbcd5675699, createdName=moyanju2796, createdTime=Mon Nov 15 08:16:56 CST 2021, time=2021-11-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1246354, encodeId=58b0124635490, content=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!, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=neuro.Dr, createdTime=Sun Nov 14 08:06:47 CST 2021, time=2021-11-14, status=1, ipAttribution=)]
    2021-11-14 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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心血管风险负担与痴呆风险的正相关关系也适用于主要的痴呆亚型。心血管风险负担与全因痴呆的关系在很大程度上与心血管疾病的发病和痴呆的遗传易感性无关。

IJNS:老年痴呆症患者营养不良患病率和营养不良风险

结果表明,大约三分之一的痴呆症老年人存在营养不良,近一半的老年人有营养不良的风险。

2022 欧洲共识:MCI和轻度痴呆初级阶段的诊断和治疗

意大利阿尔兹海默病专家组 · 2022-10-09

适合痴呆症患者的急救护理:老年急救护理应用研究网络范围审查和共识会议的结果

急性期后和长期护理学会(AMDA,The Society for Post-Acute and Long-Term Care Medicine) · 2022-08-01

痴呆及阿尔茨海默病进展要点简析

四川大学华西医院 · 2022-07-26