Deschaintre Yan, Richard Florence, Leys Didier, Pasquier Florence
Université Lille Nord de France, INSERM UMR 744, Institut Pasteur de Lille, 1 rue Calmette, 59019 Lille Cedex, France.
Neurology. 2009 Sep 1;73(9):674-80. doi: 10.1212/WNL.0b013e3181b59bf3.
There is growing evidence that vascular risk factors (VRF) contribute to cognitive decline. Whether their treatment can slow down the progression of Alzheimer disease (AD) remains unsettled. The aim of this observational study was to evaluate whether the treatment of VRF is associated with a slower cognitive decline in patients who have AD without cerebrovascular disease (CVD).
We recruited 301 consecutive patients who had AD without CVD (mean age 71.7 years; 69.4% women; first Mini-Mental State Examination [MMSE] mean score 21.6; mean follow-up 2.3 years), who had attended a memory clinic between 1997 and 2003. VRF sought were high blood pressure, dyslipidemia, diabetes mellitus, tobacco smoking, and atherosclerotic disease. Only 21 patients (7.0%) had no VRF. Others were classified as having no VRF treated (n = 72; 25.7%), some VRF treated (n = 119; 42.5%), or all VRF treated (n = 89; 31.8%). We compared MMSE progression over time among these 3 groups using a mixed random effects regression model.
Baseline MMSE scores were similar in the 3 groups. With adjustment for confounding factors, MMSE progression over time differed significantly between groups (p = 0.002). Patients with all their VRF treated declined less than those with none of their VRF treated. Those with some VRF treated tended to have an intermediate decline.
In patients who have Alzheimer disease without CVD, treatment of vascular risk factors (VRF) is associated with a slower decline in Mini-Mental State Examination score. Randomized controlled trials are needed to confirm this association, but our data suggest that dementia should not prevent treatment of VRF.
越来越多的证据表明血管危险因素（VRF）会导致认知功能下降。对其进行治疗是否能减缓阿尔茨海默病（AD）的进展仍未确定。这项观察性研究的目的是评估在没有脑血管疾病（CVD）的AD患者中，VRF治疗是否与较慢的认知功能下降相关。
我们招募了1997年至2003年间在记忆门诊就诊的301例连续的无CVD的AD患者（平均年龄71.7岁；69.4%为女性；首次简易精神状态检查表[MMSE]平均得分21.6；平均随访2.3年）。所探寻的VRF包括高血压、血脂异常、糖尿病、吸烟和动脉粥样硬化疾病。只有21例患者（7.0%）没有VRF。其他患者被分类为未治疗VRF（n = 72；25.7%）、部分VRF接受治疗（n = 119；42.5%）或所有VRF均接受治疗（n = 89；）。我们使用混合随机效应回归模型比较了这3组患者随时间的MMSE进展情况。
3组患者的基线MMSE得分相似。在对混杂因素进行校正后，各组随时间的MMSE进展情况存在显著差异（p = 0.002）。所有VRF均接受治疗的患者的下降程度小于未治疗任何VRF的患者。部分VRF接受治疗的患者的下降程度则趋于中等。
在没有CVD的阿尔茨海默病患者中，血管危险因素（VRF）的治疗与简易精神状态检查表得分的较慢下降相关。需要进行随机对照试验来证实这种关联，但我们的数据表明痴呆不应妨碍对VRF的治疗。 31.8%）。我们使用混合随机效应回归模型比较了这3组患者随时间的MMSE进展情况。
3组患者的基线MMSE得分相似。在对混杂因素进行校正后，各组随时间的MMSE进展情况存在显著差异（p = 0.002）。所有VRF均接受治疗的患者的下降程度小于未治疗任何VRF的患者。部分VRF接受治疗的患者的下降程度则趋于中等。
在没有CVD的阿尔茨海默病患者中，血管危险因素（VRF）的治疗与简易精神状态检查表得分的较慢下降相关。需要进行随机对照试验来证实这种关联，但我们的数据表明痴呆不应妨碍对VRF的治疗。
