Department of Neurology and Center for Clinical Neuroscience, Daping Hospital, No. 10 Changjiang Branch Road, Daping, Chongqing, China.
Neurology. 2011 Apr 26;76(17):1485-91. doi: 10.1212/WNL.0b013e318217e7a4. Epub 2011 Apr 13.
Growing evidence suggests that vascular risk factors (VRF) contribute to cognitive decline. The aim of this study was to investigate the impact of VRF on the conversion from mild cognitive impairment (MCI) to Alzheimer disease (AD) dementia.
A total of 837 subjects with MCI were enrolled at baseline and followed up annually for 5 years. The incidence of AD dementia was investigated. A mixed random effects regression model was used to analyze the association between VRF and the progression of MCI assessed with Mini-Mental State Examination and instrumental Activities of Daily Living. Cox proportional hazard models were used to identify the association between VRF and dementia conversion, and to examine whether treatment of VRF can prevent dementia conversion.
At the end of the follow-up, 298 subjects converted to AD dementia, while 352 remained MCI. Subjects with VRF had a faster progression in cognition and function relative to subjects without. VRF including hypertension, diabetes, cerebrovascular diseases, and hypercholesterolemia increased the risk of dementia conversion. Those subjects with MCI in whom all VRF were treated had a lower risk of dementia than those who had some VRF treated. Treatment of individual VRF including hypertension, diabetes, and hypercholesterolemia was associated with the reduced risk of AD conversion.
VRF increased the risk of incident AD dementia. Treatment of VRF was associated with a reduced risk of incident AD dementia. Although our findings are observational, they suggest active intervention for VRF might reduce progression in MCI to AD dementia.
越来越多的证据表明血管危险因素（VRF）与认知能力下降有关。本研究旨在探讨 VRF 对轻度认知障碍（MCI）向阿尔茨海默病（AD）痴呆转化的影响。
共纳入 837 例 MCI 患者作为研究对象，基线时进行评估，每年随访一次，共随访 5 年。调查 AD 痴呆的发生率。采用混合随机效应回归模型分析 VRF 与使用简易精神状态检查和工具性日常生活活动评估的 MCI 进展之间的关系。采用 Cox 比例风险模型确定 VRF 与痴呆转化之间的关系，并检验 VRF 的治疗是否可以预防痴呆转化。
随访结束时，298 例患者转化为 AD 痴呆，352 例患者仍为 MCI。与无 VRF 的患者相比，有 VRF 的患者认知和功能的进展更快。存在 VRF（包括高血压、糖尿病、脑血管疾病和高胆固醇血症）会增加痴呆转化的风险。所有 VRF 得到治疗的 MCI 患者的痴呆风险低于部分 VRF 得到治疗的患者。治疗单个 VRF（包括高血压、糖尿病和高胆固醇血症）与 AD 转化风险降低相关。
VRF 增加了 AD 痴呆的发病风险。治疗 VRF 与 AD 痴呆的发病风险降低有关。尽管我们的研究结果是观察性的，但它们提示积极干预 VRF 可能会减缓 MCI 向 AD 痴呆的进展。
