Bokenberger Kathleen, Pedersen Nancy L, Gatz Margaret, Dahl Anna K
Department of Medical Epidemiology and Biostatistics.
Health Psychol. 2014 Dec;33(12):1593-601. doi: 10.1037/hea0000028. Epub 2013 Dec 23.
Research has suggested that greater psychophysiological reactivity to stress increases risk of dementia and that those with the Type A behavior pattern (TABP) are predisposed to elevated stress reactivity and cardiovascular disease (CVD), but no study has evaluated the associations among TABP, CVD, and dementia, prospectively. Hence, the present study aimed to investigate dementia risk in relation to TABP and CVD.
A population-based cohort of 1,069 persons with a baseline mean age of 64.81 years from the Swedish Twin Registry was followed consecutively for up to 23 years. Based on self-reported items, TABP was measured using 6 scales: Ambition, Stress, Hard-driving, Neuroticism, Cynicism, and Paranoia. CVD was self-reported and dementia was diagnosed adhering to Diagnostic and Statistical Manual of Mental Disorders, third edition, revised (DSM-III-R) or Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) criteria.
TABP was generally not associated with dementia risk. However, significant interaction effects of stress, paranoia, and cynicism with CVD on dementia risk were observed. That is, for those with CVD, high scores on stress, paranoia, and cynicism were associated with increased risk of dementia (hazard ratio [HR] = 1.43, 95% confidence interval [CI] = 0.95-2.15; HR = 1.39, 95% CI = 0.83-2.33; HR = 1.25, 95% CI = 0.76-2.06, respectively), whereas for those who did not have CVD, high scores on these measures appeared to be protective (HR = 0.76, 95% CI = 0.50-1.14; HR = 0.55, 95% CI = 0.34-0.89; HR = 0.50, 95% CI = 0.29-0.84, respectively).
Some features of TABP confer an increased risk for dementia in those with CVD, whereas those without CVD are protected. When evaluating the risk of dementia, CVD and personality traits should be taken into consideration.
研究表明，对压力的心理生理反应增强会增加患痴呆症的风险，且具有A型行为模式（TABP）的人易出现压力反应增强和心血管疾病（CVD），但尚无研究对TABP、CVD和痴呆症之间的关联进行前瞻性评估。因此，本研究旨在调查与TABP和CVD相关的痴呆症风险。
对瑞典双胞胎登记处的1069名基线平均年龄为64.81岁的人群进行队列研究，连续随访长达23年。根据自我报告项目，使用6个量表测量TABP：抱负、压力、争强好胜、神经质、愤世嫉俗和偏执狂。CVD通过自我报告，痴呆症的诊断遵循《精神疾病诊断与统计手册》第三版修订本（DSM-III-R）或《精神疾病诊断与统计手册》第四版（DSM-IV）标准。
TABP通常与痴呆症风险无关。然而，观察到压力、偏执狂和愤世嫉俗与CVD对痴呆症风险有显著的交互作用。也就是说，对于患有CVD的人，压力、偏执狂和愤世嫉俗得分高与痴呆症风险增加相关（风险比[HR]=1.43，95%置信区间[CI]=0.95-2.15；HR=1.39，95%CI=0.83-2.33；HR=1.25，95%CI=0.76-2.06），而对于没有CVD的人，这些指标得分高似乎具有保护作用（HR=0.76，95%CI=0.50-1.14；HR=0.55，95%CI=0.34-0.89；HR=0.50，95%CI=0.29-0.84）。
TABP的某些特征会增加患有CVD的人患痴呆症的风险，而没有CVD的人则受到保护。在评估痴呆症风险时，应考虑CVD和人格特质。
