Helzner Elizabeth P, Luchsinger José A, Scarmeas Nikolaos, Cosentino Stephanie, Brickman Adam M, Glymour M Maria, Stern Yaakov
Gertrude H. Sergievsky Center, Columbia University Medical Center, NY, New York, USA.
Arch Neurol. 2009 Mar;66(3):343-8. doi: 10.1001/archneur.66.3.343.
Vascular factors including medical history (heart disease, stroke, diabetes, and hypertension), smoking, and prediagnosis blood lipid measurements (cholesterol: total, high-density lipoprotein, low-density lipoprotein [LDL-C], and triglyceride concentrations) may be predictors for progression of Alzheimer disease (AD).
To determine whether prediagnosis vascular risk factors are associated with progression of AD.
Inception cohort followed up longitudinally for a mean of 3.5 (up to 10.2) years.
Washington Heights/Inwood Columbia Aging Project, New York, New York. Patients One hundred fifty-six patients with incident AD (mean age at diagnosis, 83 years). Main Outcome Measure Change in a composite score of cognitive ability from diagnosis onward.
In generalized estimating equation models (adjusted for age, race/ethnicity, and years of education), higher cholesterol (total cholesterol and LDL-C) concentrations and history of diabetes were associated with faster cognitive decline. Each 10-U increase in cholesterol and LDL-C was associated with a 0.10-SD decrease in cognitive score per year of follow-up (P < .001 for total cholesterol; P = .001 for LDL-C). High-density lipoprotein cholesterol and triglyceride concentrations were not associated with rate of decline. A history of diabetes was associated with an additional 0.05-SD decrease in cognitive score per year (P = .05). History of heart disease and stroke were associated with cognitive decline only in carriers of the apolipoprotein E epsilon4 (APOE-epsilon4) gene. In a final generalized estimating equation model that included high-density lipoprotein cholesterol and LDL-C concentrations and history of diabetes, only higher LDL-C was independently associated with faster cognitive decline.
Higher prediagnosis total cholesterol and LDL-C concentrations and history of diabetes were associated with faster cognitive decline in patients with incident AD, which provides further evidence for the role of vascular risk factors in the course of AD.
血管因素，包括病史（心脏病、中风、糖尿病和高血压）、吸烟以及诊断前血脂测量值（胆固醇：总胆固醇、高密度脂蛋白、低密度脂蛋白[LDL-C]和甘油三酯浓度）可能是阿尔茨海默病（AD）进展的预测因素。
确定诊断前血管危险因素是否与AD的进展相关。
起始队列纵向随访，平均随访3.5年（最长10.2年）。
纽约华盛顿高地/因伍德哥伦比亚衰老项目。
156例新发AD患者（诊断时平均年龄83岁）。
从诊断开始认知能力综合评分的变化。
在广义估计方程模型中（校正年龄、种族/族裔和受教育年限），较高的胆固醇（总胆固醇和LDL-C）浓度以及糖尿病史与认知功能下降更快相关。随访期间，总胆固醇和LDL-C每升高10个单位，认知评分每年下降0.10标准差（总胆固醇P <.001；LDL-C P =.001）。高密度脂蛋白胆固醇和甘油三酯浓度与下降速率无关。糖尿病史与认知评分每年额外下降0.05标准差相关（P =.05）。心脏病和中风病史仅在载脂蛋白E ε4（APOE-ε4）基因携带者中与认知功能下降相关。在最终纳入高密度脂蛋白胆固醇、LDL-C浓度和糖尿病史的广义估计方程模型中，只有较高的LDL-C与更快的认知功能下降独立相关。
诊断前较高的总胆固醇和LDL-C浓度以及糖尿病史与新发AD患者认知功能下降更快相关，这为血管危险因素在AD病程中的作用提供了进一步证据。
