Uppsala Clinical Research Center (E.H., J.Ä.), Departments of Public Health and Caring Sciences/Geriatrics (L.K.), Radiology (R.N., E.-M.L., H.A., L.J.), Surgical Sciences (K.M.), and Medical Sciences (E.H., H.M., L.L., J.Ä.), Uppsala University, 75185 Uppsala, Sweden; and the School of Health and Social Studies (J.Ä.), Dalarna University, 79131 Falun, Sweden.
J Clin Endocrinol Metab. 2014 Nov;99(11):4181-9. doi: 10.1210/jc.2014-1736. Epub 2014 Aug 20.
In diseases with increased PTH such as hyperparathyroidism and chronic renal failure, dementia is common. Little is known of PTH and dementia in the community.
We sought to investigate relations between PTH, clinical dementia and cerebral micro-vascular disease.
The Uppsala Longitudinal Study Of Adult Men (ULSAM) was prospective, baseline, 1991-1995; followup, 15.8 years. The Prospective Investigation Of The Vasculature In Uppsala Seniors (PIVUS) was cross-sectional, baseline, 2001. Both settings were community based. PARTICIPANTS AND MAIN OUTCOME MEASURE: In the ULSAM study of 998 men (age 71) the association between PTH and dementia was investigated. In the PIVUS study of 406 men and women (age 70) the relation between PTH and magnetic resonance imaging signs of cerebral small vascular disease was investigated.
During followup, 56 individuals were diagnosed with vascular, 91 with Alzheimer's, and 59 with other dementias. In Cox-regression analyses, higher PTH was associated with vascular dementia (hazard ratio per 1 SD increase of PTH, 1.41; P < .01), but not with other dementias. The top tertile of PTH accounted for 18.5% of the population-attributable risk for vascular dementia, exceeding all other risk factors. In linear regression analysis in PIVUS, PTH was associated with increasing white matter hyperintensities (WMHI), reflecting increasing burden of cerebral small vessel disease (1 SD PTH increase, 0.31 higher category of WMHI; P = .016). All models were adjusted for vascular risk factors and mineral metabolism.
In two community-based samples, PTH predicted clinically diagnosed vascular dementia as well as neuroimaging indices of cerebral small vessel disease. Our data suggest a role for PTH in the development of vascular dementia.
在甲状旁腺激素（PTH）升高的疾病中，如甲状旁腺功能亢进症和慢性肾衰竭，痴呆较为常见。但对于社区中 PTH 与痴呆的关系知之甚少。
我们旨在研究 PTH、临床痴呆与脑小血管疾病之间的关系。
乌普萨拉老年男性纵向研究（ULSAM）为前瞻性研究，基线期为 1991-1995 年；随访期为 15.8 年。乌普萨拉老年人血管前瞻性研究（PIVUS）为横断面研究，基线期为 2001 年。这两个研究均为社区基础研究。
在 ULSAM 研究中，我们对 998 名（年龄 71 岁）男性的 PTH 与痴呆之间的关系进行了研究。在 PIVUS 研究中，我们对 406 名男性和女性（年龄 70 岁）的 PTH 与磁共振成像脑小血管疾病的关系进行了研究。
在随访期间，56 例被诊断为血管性痴呆，91 例为阿尔茨海默病，59 例为其他类型痴呆。在 Cox 回归分析中，较高的 PTH 与血管性痴呆相关（PTH 每增加 1 SD 的风险比，1.41；P <.01），但与其他类型痴呆无关。PTH 最高三分位数占血管性痴呆人群归因风险的 18.5%，超过了所有其他危险因素。在 PIVUS 的线性回归分析中，PTH 与脑白质高信号（WMHI）的增加相关，这反映了脑小血管疾病负担的增加（PTH 增加 1 SD，WMHI 增加 0.31 个类别；P =.016）。所有模型均调整了血管危险因素和矿物质代谢。
在两个社区样本中，PTH 预测了临床诊断的血管性痴呆以及脑小血管疾病的神经影像学指标。我们的数据提示 PTH 在血管性痴呆的发生中起作用。
