Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA.
Neurology. 2012 Oct 9;79(15):1534-9. doi: 10.1212/WNL.0b013e31826e25bd. Epub 2012 Sep 19.
The purpose of the study was to test the hypothesis that a higher level of childhood adversity is associated with increased risk of cerebral infarction in old age.
Older participants in a longitudinal clinical-pathologic study rated adverse childhood experiences (e.g., emotional neglect, parental intimidation and violence) on a previously established 16-item scale. During a mean of 3.5 years of follow-up, there were 257 deaths, with 206 brain autopsies (80.2). Number of chronic cerebral infarcts (gross plus microscopic; expressed as 0, 1, or >1) was determined in a uniform neuropathologic examination, which had been completed in 192 individuals at the time of these analyses.
Childhood adversity scores ranged from 0 to 31 (mean = 8.3, SD = 6.4). In an ordinal logistic regression model adjusted for age, sex, and education, higher adversity was associated with higher likelihood of chronic cerebral infarction. In analyses of childhood adversity subscales, only emotional neglect was associated with infarction (odds ratio [OR] = 1.097; 95% confidence interval [CI] 1.048-1.148). The likelihood of infarction was 2.8 times higher (95% CI 2.0-4.1) in those reporting a moderately high level of childhood emotional neglect (score = 6, 75th percentile) vs a moderately low level of neglect (score = 1, 25th percentile). Results were comparable in subsequent analyses that controlled for lifetime socioeconomic status, cardiovascular risk factors, and an anxiety-related trait.
Emotional neglect in childhood may be a risk factor for cerebral infarction in old age.
本研究旨在验证以下假设，即儿童期逆境经历程度较高与老年时发生脑梗死的风险增加相关。
在一项纵向临床病理研究中，较年长的参与者使用先前建立的 16 项量表对儿童期不良经历（例如情感忽视、父母恐吓和暴力）进行评分。在平均 3.5 年的随访期间，共有 257 人死亡，其中 206 人进行了脑部尸检（80.2%）。在统一的神经病理学检查中确定了慢性脑梗死的数量（肉眼加显微镜下；表示为 0、1 或>1），在这些分析时，已经对 192 人完成了检查。
儿童期逆境评分范围为 0 至 31 分（平均值=8.3，标准差=6.4）。在调整年龄、性别和教育程度的有序逻辑回归模型中，较高的逆境评分与慢性脑梗死的发生几率较高相关。在对儿童期逆境亚量表的分析中，只有情感忽视与梗死相关（比值比[OR] = 1.097；95%置信区间[CI] 1.048-1.148）。与报告中度低水平情感忽视（评分=1，25%分位）相比，报告中度高水平情感忽视（评分=6，75%分位）的人发生梗死的几率高 2.8 倍（95% CI 2.0-4.1）。在随后的分析中，当控制终生社会经济地位、心血管危险因素和与焦虑相关的特质时，结果仍然具有可比性。
儿童期的情感忽视可能是老年发生脑梗死的一个危险因素。
