Department of Neurology, Ninewells Hospital, Dundee, UK.
Department of Primary Care, University of Glasgow, Glasgow, UK.
J Neurol Neurosurg Psychiatry. 2015 Sep;86(9):959-64. doi: 10.1136/jnnp-2014-309033. Epub 2014 Nov 18.
There is growing evidence of an aetiological relationship between vascular risk factors and the development of dementia in later life. Dementia in the under-65s has historically been considered to be more driven by genetic factors, but previous epidemiological studies in the young have been relatively small. This study aims to determine the prevalence of vascular comorbidity in people aged <65 with dementia in comparison to the general population.
Analysis of routine clinical data from 314 (30%) general medical practices in Scotland.
From an overall population of 616 245 individuals, 1061 cases of 'all-cause' dementia were identified (prevalence 172/100 000 population, 95% CI 161 to 182). The prevalence of dementia was higher in people with vascular morbidities, and prevalence progressively increased from 129/100 000 in people with no vascular comorbidity to 999/100 000 in people with four or more (p=0.01). The strength of association was greatest with a previous transient ischaemic attack (TIA) or stroke and chronic kidney disease (adjusted OR=3.1 and 2.9, respectively). Statistically significant, but smaller associations were seen with the presence of hypertension, diabetes, ischaemic heart disease and peripheral vascular disease (adjusted OR=1.4, 2.0, 1.9 and 2.2, respectively).
Vascular comorbid diseases were more commonly recorded in people aged 40-64 with dementia than those without. This finding indicates that vascular disease may be more important in the aetiology of young-onset dementia than previously believed, and is of concern given the continuing rise in obesity and diabetes internationally.
越来越多的证据表明血管危险因素与晚年痴呆的发生之间存在病因关系。 历史上，65 岁以下的痴呆症被认为更多地受遗传因素驱动，但以前针对年轻人的流行病学研究相对较少。 本研究旨在确定与普通人群相比，年龄<65 岁且患有痴呆症的人群中血管合并症的患病率。
对苏格兰 314 家（30%）普通医疗实践的常规临床数据进行分析。
从 616245 名总体人群中，共确定了 1061 例“所有原因”痴呆病例（患病率为 172/100000 人口，95%CI 161 至 182）。 患有血管疾病的人群中痴呆症的患病率更高，且患病率从无血管合并症的人群中 129/100000 逐渐增加至患有四种或更多合并症的人群中 999/100000（p=0.01）。 与短暂性脑缺血发作（TIA）或中风和慢性肾病的关联最强（校正后的 OR 分别为 3.1 和 2.9）。 存在高血压、糖尿病、缺血性心脏病和外周血管疾病时，也存在统计学上显著但较小的关联（校正后的 OR 分别为 1.4、2.0、1.9 和 2.2）。
患有血管合并症的 40-64 岁痴呆症患者比无血管合并症的患者更常见记录这些疾病。 这一发现表明血管疾病在年轻发病的痴呆症的病因中可能比以前认为的更为重要，鉴于国际上肥胖症和糖尿病的持续增加，这令人担忧。
