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《柳叶刀-老龄健康》(The Lancet Healthy Longevity)发表一项前瞻性队列研究,探究人口统计学、临床和生活方式因素与早发型痴呆(发病年龄<65岁)之间的关联,并将这些估计值与它们与晚发型痴呆(发病年龄≥65岁)之间的关联进行了比较。研究发现,与男性相比,女性患早发性痴呆症的风险较低。黑人与白人相比、小学及以下学历、糖尿病、抑郁症、吸烟、肥胖、缺乏运动和过量饮酒均与早发性痴呆症风险升高独立相关。除种族、缺乏运动和过量饮酒外,所有风险因素与早发性痴呆症的关联均强于晚发性痴呆症。识别图中二维码或点击文末阅读原文,查阅原文。

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背景

早发型痴呆(发病年龄<65岁)是一项重要的健康问题,但目前对其风险因素的认知大多是从晚发型痴呆(发病年龄≥65岁)的研究中推断而来。本研究旨在探讨多种人口学、临床及生活方式因素与早发型痴呆的关联,并将估算结果与这些因素同晚发型痴呆的关联进行比较。

方法

汇总英国和美国的五项社区纵向队列研究数据并统一清理,包括英国生物银行(UK Biobank)、社区动脉粥样硬化风险研究(Atherosclerosis Risk in Communities Study)、Framingham心脏研究(Framingham Heart Study)、动脉粥样硬化多种族研究(Multi-Ethnic Study of Atherosclerosis)和Whitehall II期研究(Whitehall II Study)。基于各队列的研究方案,通过住院记录和死亡记录(伴或不伴临床评估)来判断是否发生痴呆。风险因素包括性别、自我报告的种族或族裔(西班牙裔、白人、黑人、亚裔及其他)、低教育水平、高血压、糖尿病、肥胖、高胆固醇血症、抑郁、酗酒、吸烟及缺少体力活动。以年龄为时间尺度并采用时变协变量拟合Cox回归模型,用以估算早发型痴呆和晚发型痴呆的风险比(HR),并检验不同发病年龄下HR是否存在差异。

结果

在544,442名参与者中,中位随访时间为13.7年(IQR:12.9-14.4),共新发807例早发型痴呆和14,253例晚发型痴呆。与男性相比,女性参与者的早发型痴呆风险较低(HR=0.70[95%CI:0.61-0.80])。黑人(相较于白人;1.61[1.23-2.11])、小学及以下教育水平(1.99[1.67-2.38])、糖尿病(2.45[1.99-3.03])、抑郁(2.73[2.34-3.20])、吸烟(1.86[1.56-2.22])、肥胖(1.24[1.04-1.48])、缺少体力活动(1.33[1.11-1.59])以及酗酒(1.22[1.01-1.47])均独立与更高的早发型痴呆风险相关。1级高血压(HR=1.19[95%CI:0.97-1.47])、2级高血压(1.16[0.94-1.43])及高胆固醇血症(1.11[0.92-1.34])的效应估算值为阳性,但差异没有统计学意义。除种族、缺少体力活动和酗酒外,所有风险因素与早发型痴呆的关联强度均大于其与晚发型痴呆的关联强度。

解释

研究结果表明,可控风险因素在早发型痴呆的发生发展中具有重要作用,可为未来识别一级预防的优先干预目标提供指导。END

Funding
US National Institutes of Health, the National Institute for Neurologic Disorders and Stroke, and the National Institute of Aging.

Declaration of interests

PLL declares receiving grants from the National Institutes of Health (NIH) to her institution. AEA declares receiving grants from the NIH to her institution and providing expert testimony on a case related to infectious disease transmission which was not related to this paper in any way. BS declares receiving grants from the NIH which supported his efforts on this paper. CLS declares receiving grants from the NIH and the Texas Alzheimer’s Research and Care Consortium to her institution, receiving support for attending meetings and/or travel from the NIH and the University of Rio Grande Valley, and receiving payments for her role on the Framingham Heart Study Executive Committee. DS declares receiving grants from the NIH as a co-investigator on a grant for this project. EMB declares receiving grants from the NIH to her institution and to herself. JSP declares receiving grants from the NIH to his institution. JJS declares receiving grants from the NIH to his institution. NBA declares receiving grants from the NIH. FJW declares receiving grants from The Netherlands Organization for Health Research and Development (ZonMw); Alzheimer’s Association; Dutch Heart Foundation; Erasmus Trust Fund; Alzheimer Nederland; and ABOARD partnership funded by the Netherlands Organization for Health Research and Development (ZonMw), Health Holland, and Topsector Life Sciences & Health to his institution; participating on a data and safety monitoring board (DSMB) or advisory board for European Medicines Agency (payment to self) and Health Council of the Netherlands (payment to institution); and serving on the executive committee for ISTAART and The International Society of Vascular Behavioural and Cognitive Disorders, both roles unpaid. TMH declares receiving grants from the NIH. SEJ declares receiving grants from the NIH, receiving funding from the NIH for travel to a meeting, and serving on two NIH DSMBs. PSdV declares receiving grants from the NIH to his institution. RM declares receiving grants from the NIH. JJH declares receiving grants from the NIH, Alzheimer’s Association, and William Castella Family to his institution. AF declares receiving grants from the NIH. DAL declares receiving grants from the NIH, receiving consulting fees for work on NIH grants from Northwestern University and Tufts University, and participating on a DSMB for an NIH grant testing the effectiveness of a health services intervention for improving blood pressure control in older adults. KY declares receiving grants from the NIH. DML-J declares receiving grants from the NIH to his institution, participating on an NIH DSMB or advisory board, serving in a leadership or fiduciary role for the American Heart Association (unpaid), and part-time employment by the American Heart Association. All other authors declare no competing interests.




DOI:  10.1016/j.lanhl.2026.100831

中文翻译仅供参考,所有内容以英文原文为准。

题图copyright: TEK IMAGE/SCIENCE PHOTO LIBRARY


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#柳叶刀老龄健康 #痴呆的风险因素 #早发型痴呆和晚发型痴呆