Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands.
Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands.
J Neurol Neurosurg Psychiatry. 2016 Apr;87(4):356-62. doi: 10.1136/jnnp-2014-309968. Epub 2015 Apr 27.
The N-terminal pro B-type natriuretic peptide (NT-proBNP) has a well-documented prognostic value for cardiovascular disease (CVD) and higher levels are associated with cognitive-dysfunction in patients with CVD. However, how NT-proBNP relates to incident dementia and cognitive-decline in community-dwelling persons is unknown.
Between 1997 and 2001, serum NT-proBNP was measured in 6040 participants (mean age 69 years, 57% women) free of heart-failure and dementia from the Rotterdam Study. Participants were continuously followed-up for incident dementia until 2012, for 56,616 person-years. Cognition was assessed at baseline and reassessed between 2002 and 2006 by Letter-Digit-Substitution-task, Stroop test and Word-Fluency test. Associations of NT-proBNP with dementia (555 cases), Alzheimer's disease (357 cases) and vascular dementia (32 cases) were assessed linearly, and in quartiles using Cox regression. Associations of NT-proBNP with cognitive-decline were assessed using multiple linear regression. All analyses were repeated after excluding patients with CVD.
Higher NT-proBNP was associated with a higher risk of dementia, even after excluding patients with CVD and adjusting for cardiovascular risk factors, HR per SD 1.27 (95% CI 1.13 to 1.44). Associations were particularly strong for vascular dementia, HR per SD 2.04 (95% CI 1.18 to 3.55), but also for Alzheimer's disease when comparing the second and third quartile with first. Higher NT-proBNP was cross-sectionally associated with poorer performance in multiple cognitive tests but longitudinally only in Letter-Digit-Substitution-task.
NT-proBNP reflecting subclinical CVD is associated with dementia, particularly vascular dementia. NT-proBNP can be a useful marker of imminent cognitive-decline and dementia in absence of clinical CVD.
N 端脑利钠肽前体（NT-proBNP）对心血管疾病（CVD）具有良好的预后价值，其水平升高与 CVD 患者的认知功能障碍有关。然而，在社区居住的人群中，NT-proBNP 与痴呆症的发生和认知能力下降之间的关系尚不清楚。
1997 年至 2001 年，在无心力衰竭和痴呆的 Rotterdam 研究中，对 6040 名参与者（平均年龄 69 岁，57%为女性）进行了血清 NT-proBNP 测量。参与者连续随访至 2012 年，随访时间为 56616 人年。在基线时评估认知功能，并在 2002 年至 2006 年期间通过字母数字替代任务、Stroop 测试和单词流畅性测试进行重新评估。使用 Cox 回归分析线性和四分位数评估 NT-proBNP 与痴呆症（555 例）、阿尔茨海默病（357 例）和血管性痴呆症（32 例）的关系。使用多元线性回归分析 NT-proBNP 与认知能力下降的关系。所有分析均在排除 CVD 患者后重复进行。
即使在排除 CVD 患者并调整心血管危险因素后，较高的 NT-proBNP 与痴呆症的风险增加相关，SD 每增加 1 个单位的 HR 为 1.27（95%CI 1.13 至 1.44）。与血管性痴呆症相比，相关性特别强，SD 每增加 1 个单位的 HR 为 2.04（95%CI 1.18 至 3.55），而与阿尔茨海默病相比，第二和第三四分位数与第一四分位数相比，HR 为 1.38（95%CI 1.04 至 1.82）。较高的 NT-proBNP 与多项认知测试的表现较差呈横断面相关，但仅在字母数字替代任务中与纵向相关。
反映亚临床 CVD 的 NT-proBNP 与痴呆症相关，特别是血管性痴呆症。在没有临床 CVD 的情况下，NT-proBNP 可以作为即将发生的认知能力下降和痴呆症的有用标志物。
