Department of School of Medicine, Graduate School of Public Health, University of Pittsburgh, PA, USA.
Neurology. 2013 Jun 4;80(23):2112-20. doi: 10.1212/WNL.0b013e318295d776. Epub 2013 May 8.
We examined the incidence of mild cognitive impairment (MCI) and its potential vascular risk factors in a prospective population-based study.
An age-stratified random population-based cohort (baseline n = 1,982), followed for up to 4 years, was annually assessed for cognitive and everyday functioning. Incidence rates were calculated for both cognitive (neuropsychological [NP]-MCI) and functional (Clinical Dementia Rating [CDR] = 0.5) definitions of MCI. Several measures of vascular, metabolic, and inflammatory risk were assessed at baseline. Risk factor analyses used interval censoring survival models, followed by joint modeling of both MCI and attrition due to mortality and illness.
Incidence rates for NP-MCI and CDR = 0.5 were 95 and 55 per 1,000 person-years. In individual joint models, risk factors for NP-MCI were diabetes and adiposity (waist: hip ratio), while APOE ε4 genotype and heart failure increased risk of attrition. Adiposity, stroke, heart failure, and diabetes were risk factors for nonamnestic MCI. For CDR = 0.5, risk factors were stroke and heart failure; heart failure and adiposity increased risk of attrition. In multivariable joint models combining all risk factors, adiposity increased risk of NP-MCI, while stroke and heart failure increased risk for CDR = 0.5. Current alcohol use appeared protective against all subtypes.
Incidence of MCI increased with age regardless of definition and did not vary by sex or education. Several vascular risk factors elevated the risk of incident MCI, whether defined cognitively or functionally, but most were associated with nonamnestic MCI and CDR = 0.5. Controlling vascular risk may potentially reduce risk of MCI.
我们在一项前瞻性的基于人群的研究中，研究了轻度认知障碍（MCI）的发生率及其潜在的血管危险因素。
我们对一个按年龄分层的随机人群队列（基线 n = 1982）进行了随访，最长可达 4 年，每年对认知和日常功能进行评估。计算了认知（神经心理学[NP]-MCI）和功能（临床痴呆评定[CDR] = 0.5）定义的 MCI 的发生率。在基线时评估了几种血管、代谢和炎症危险因素的测量值。使用间隔 censoring 生存模型进行风险因素分析，然后对 MCI 和因死亡和疾病而导致的失访进行联合建模。
NP-MCI 和 CDR = 0.5 的发生率分别为 95 和 55 每 1000 人年。在个体联合模型中，NP-MCI 的危险因素是糖尿病和肥胖（腰臀比），而 APOE ε4 基因型和心力衰竭增加了失访的风险。肥胖、中风、心力衰竭和糖尿病是非遗忘性 MCI 的危险因素。对于 CDR = 0.5，危险因素是中风和心力衰竭；心力衰竭和肥胖增加了失访的风险。在结合所有危险因素的多变量联合模型中，肥胖增加了 NP-MCI 的风险，而中风和心力衰竭增加了 CDR = 0.5 的风险。目前的饮酒习惯似乎对所有亚型都有保护作用。
无论定义如何，MCI 的发病率都随年龄增长而增加，且不受性别或教育程度的影响。几种血管危险因素增加了发生 MCI 的风险，无论是认知还是功能定义，但大多数与非遗忘性 MCI 和 CDR = 0.5 相关。控制血管危险因素可能会降低 MCI 的风险。
