The Irish Longitudinal Study on Ageing, Department of Medical Gerontology, Trinity College Dublin, Dublin, Ireland.
Curr Alzheimer Res. 2012 Jul;9(6):687-96. doi: 10.2174/156720512801322654.
Vascular disease is associated with increased risk of dementia. Vascular health worsens with age. We investigated the relationship between self-reported vascular disease and brain pathology.
Brain donations to the population-based MRC Cognitive Function and Ageing Study (n=456, age range 66-103 years) were assessed using a standard protocol for Alzheimer's disease (AD) and cerebrovascular pathology. History of stroke, angina, diabetes, medicated hypertension and heart attack were identified from self- and proxy-report interviews, retrospective informant interviews and death certificates. Logistic regression was used to estimate associations between each health condition and dichotomised neuropathological variables adjusted for age and sex.
Stroke (36%), angina (23%), diabetes (12%), medicated hypertension (35%) and heart attack (22%) were frequently reported. Self-reported stroke was strongly associated with vascular, but not AD pathology. Medicated hypertension was associated with increased microinfarcts (OR=2.1, 95% CI=1.3-3.7) and less severe neocortical tangles (OR=0.5, 95% CI=0.3-0.8) and cerebral amyloid angiopathy (OR=0.5, 95% CI=0.3-0.8). Heart attack was associated with increased microinfarcts (OR=2.1, 95% CI=1.2-3.9).
Vascular risk factors were not associated with an increased burden of AD pathology at death in old age. A positive association between indices of systemic cardiovascular health (treated hypertension and ischaemic heart disease) and cerebral microinfarcts emerged. The findings support the view that cerebral small vessel disease and cardiovascular disease are interrelated. Microinfarcts are emerging as an important correlate of age-related vascular cognitive impairment and the findings add weight to the argument for strategies to improve general cardiovascular health as a potential preventative strategy against cognitive decline in later life.
血管疾病与痴呆风险增加有关。血管健康随年龄恶化。我们研究了自述血管疾病与脑病理之间的关系。
对基于人群的 MRC 认知功能与衰老研究（n=456，年龄 66-103 岁）的脑捐献进行了评估，采用阿尔茨海默病（AD）和脑血管病理的标准方案。从自我和代理报告访谈、回顾性知情者访谈和死亡证明中确定了中风、心绞痛、糖尿病、药物治疗的高血压和心脏病发作的病史。使用逻辑回归来估计每种健康状况与二分神经病理学变量之间的关联，这些变量根据年龄和性别进行了调整。
中风（36%）、心绞痛（23%）、糖尿病（12%）、药物治疗的高血压（35%）和心脏病发作（22%）经常被报告。自述中风与血管但与 AD 病理强相关。药物治疗的高血压与微梗死增加（OR=2.1，95%CI=1.3-3.7）和更严重的皮质神经缠结（OR=0.5，95%CI=0.3-0.8）和脑淀粉样血管病（OR=0.5，95%CI=0.3-0.8）相关。心脏病发作与微梗死增加（OR=2.1，95%CI=1.2-3.9）相关。
在老年时，血管危险因素与 AD 病理负担的增加无关。系统心血管健康指数（治疗高血压和缺血性心脏病）与脑微梗死之间存在正相关。这些发现支持脑小血管疾病和心血管疾病相互关联的观点。微梗死作为与年龄相关的血管性认知障碍的重要相关因素出现，这一发现为改善一般心血管健康作为预防策略以防止晚年认知能力下降的论点提供了更多支持。
