Strandberg Timo E, Pitkala Kaisu H, Linnavuori Kimmo H, Tilvis Reijo S
Department of Medicine, Geriatric Clinic, University of Helsinki, PO Box 340, FIN-00029 HUS Helsinki, Finland.
Stroke. 2003 Sep;34(9):2126-31. doi: 10.1161/01.STR.0000086754.32238.DA. Epub 2003 Aug 14.
Inflammation and infectious etiology have been implicated in the pathogenesis of dementia. We sought to investigate whether the seropositivity of common infections was associated with cognitive function.
Viral burden (seropositivity for herpes simplex virus type 1 [HSV-1], herpes simplex virus type 2 [HSV-2], or cytomegalovirus [CMV]) and bacterial burden (Chlamydia pneumoniae and Mycoplasma pneumoniae) were related to cognitive status and its impairment among 383 home-dwelling elderly with cardiovascular diseases (mean age, 80 years). The Mini-Mental State Examination (MMSE) and its changes and the Clinical Dementia Rating (CDR) were used to define cognitive impairment.
At baseline, 0 to 1, 2, and 3 positive titers toward viruses were found in 48 (12.5%), 229 (59.8%), and 106 individuals (27.7%), respectively. MMSE points decreased with increasing viral burden (P=0.03). At baseline, 58 individuals (15.1%) had cognitive impairment, which after adjustments was significantly associated with seropositivity for 3 viruses (hazard ratio, 2.5; 95% CI, 1.3 to 4.7). MMSE score decreased in 150 (43% of 348) during 12-month follow-up. After adjustment for MMSE score at baseline and with 0 to 1 seropositivities as reference (1.0), the hazard ratios were 1.8 (95% CI, 0.9 to 3.6) and 2.3 (95% CI, 1.1 to 5.0) for 2 and 3 seropositivities, respectively. The prevalence of possible or definite dementia according to CDR also increased with viral burden. No significant associations were observed between bacterial burden and cognition.
Viral pathogen burden of HSV and CMV was associated with cognitive impairment in home-dwelling elderly persons with cardiovascular diseases. The results need to be tested in larger databases, but they may offer a preventable cause of cognitive decline.
炎症和感染病因与痴呆的发病机制有关。我们试图研究常见感染的血清学阳性是否与认知功能相关。
在383名患有心血管疾病的居家老年人（平均年龄80岁）中，病毒负荷（1型单纯疱疹病毒[HSV-1]、2型单纯疱疹病毒[HSV-2]或巨细胞病毒[CMV]的血清学阳性）和细菌负荷（肺炎衣原体和肺炎支原体）与认知状态及其损害相关。使用简易精神状态检查表（MMSE）及其变化以及临床痴呆评定量表（CDR）来定义认知损害。
在基线时，分别在48名（12.5%）、229名（59.8%）和106名个体（27.7%）中发现针对病毒的0至1、2和3个阳性滴度。MMSE得分随病毒负荷增加而降低（P=0.03）。在基线时，58名个体（15.1%）有认知损害，调整后与3种病毒的血清学阳性显著相关（风险比，2.5；95%置信区间，1.3至4.7）。在12个月的随访期间，150名（348名中的43%）的MMSE得分下降。以基线时的MMSE得分以及0至1个血清学阳性作为参照（1.0）进行调整后，2个和3个血清学阳性的风险比分别为1.8（95%置信区间，0.9至3.6）和2.3（95%置信区间，1.1至5.0）。根据CDR，可能或确诊痴呆的患病率也随病毒负荷增加。未观察到细菌负荷与认知之间有显著关联。
HSV和CMV的病毒病原体负荷与患有心血管疾病的居家老年人的认知损害相关。结果需要在更大的数据库中进行验证，但它们可能提供了一个可预防的认知衰退原因。
