de Bruijn Renée F A G, Direk Nese, Mirza Saira Saeed, Hofman Albert, Koudstaal Peter J, Tiemeier Henning, Ikram M Arfan
Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands; Netherlands Consortium for Healthy Ageing, Leiden, The Netherlands.
Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands.
Am J Geriatr Psychiatry. 2014 Dec;22(12):1382-90. doi: 10.1016/j.jagp.2014.03.001. Epub 2014 Mar 15.
Anxiety and depression frequently co-occur in the elderly and in patients with dementia. Prior research has shown that depression is related to the risk of dementia, but the effect of anxiety on dementia remains unclear. We studied whether anxiety symptoms and anxiety disorders are associated with the risk of dementia and cognition.
We studied 2,708 nondemented participants from the prospective, population-based Rotterdam Study who underwent the Hospital Anxiety and Depression Scale (HADS) (sample I, baseline 1993-1995) and 3,069 nondemented participants who underwent screening for anxiety disorders (sample II, baseline 2002-2004). In 1993-1995, anxiety symptoms were assessed using the HADS. In 2002-2004, anxiety disorders were assessed using the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. In both study samples, participants were continuously monitored for dementia until January 1, 2011. Cognition was tested in 2002-2004 and at a follow-up visit in 2009-2011 in sample II only.
In sample I, 358 persons developed dementia, and in sample II, 248 persons developed dementia. We did not find an association with the risk of dementia for anxiety symptoms (hazard ratio 1.05, 95% confidence interval: 0.77-1.43, Wald statistic 0.08, p = 0.77, df = 1) or for anxiety disorders (hazard ratio 0.92, 95% confidence interval: 0.58-1.45, Wald statistic 0.14, p = 0.71, df = 1). We could demonstrate an association of anxiety disorders with poor cognition cross-sectionally, but this attenuated after additional adjustments.
Our findings do not offer evidence for an association between anxiety symptoms or anxiety disorders with the risk of dementia or with cognition. This suggests that anxiety is not a risk factor nor a prodrome of dementia in an elderly, community-dwelling population.
焦虑和抑郁在老年人及痴呆患者中经常同时出现。先前的研究表明，抑郁与痴呆风险相关，但焦虑对痴呆的影响仍不明确。我们研究了焦虑症状和焦虑症是否与痴呆风险及认知相关。
我们对来自基于人群的前瞻性鹿特丹研究的2708名非痴呆参与者进行了研究，这些参与者接受了医院焦虑抑郁量表（HADS）测试（样本I，基线时间为1993 - 1995年），以及3069名接受焦虑症筛查的非痴呆参与者（样本II，基线时间为2002 - 2004年）。1993 - 1995年，使用HADS评估焦虑症状。2002 - 2004年，使用《精神疾病诊断与统计手册》第四版评估焦虑症。在两个研究样本中，对参与者持续监测痴呆情况直至2011年1月1日。仅在样本II中，于2002 - 2004年及2009 - 2011年的随访中对认知进行了测试。
在样本I中，358人患上痴呆，在样本II中，248人患上痴呆。我们未发现焦虑症状（风险比1.05，95%置信区间：0.77 - 1.43，Wald统计量0.08，p = 0.77，自由度 = 1）或焦虑症（风险比0.92，95%置信区间：0.58 - 1.45，Wald统计量0.14，p = 0.71，自由度 = 1）与痴呆风险之间存在关联。我们能够证明焦虑症与认知功能差存在横断面关联，但在进一步调整后这种关联减弱。
我们的研究结果未提供焦虑症状或焦虑症与痴呆风险或认知之间存在关联的证据。这表明在老年社区居住人群中，焦虑既不是痴呆的风险因素也不是前驱症状。
