Department of Ophthalmology, National Yang-Ming University Hospital, Yilan, Taiwan; National Yang-Ming University School of Medicine, Taipei, Taiwan.
National Yang-Ming University School of Medicine, Taipei, Taiwan; Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan.
Ophthalmology. 2015 Nov;122(11):2327-2335.e2. doi: 10.1016/j.ophtha.2015.07.033. Epub 2015 Sep 1.
To investigate the relationship between age-related macular degeneration (AMD) and future development of Alzheimer's disease (AD) or senile dementia.
A longitudinal case-control study using the Taiwan National Health Insurance Research Database.
From 2001 to 2009, the newly diagnosed AMD cases aged ≥65 years in the database were recruited as the AMD cohort (n=4993). Of those, there were 540 with and 4453 without exudative AMD diagnoses. Subjects without any AMD, matched for age, gender, and time of enrollment, were randomly sampled as the control cohort (n=24,965) for comparison.
Alzheimer's disease/senile dementia-free survival analysis was assessed using a Kaplan-Meier method. Cox proportional hazard regressions were performed to calculate the hazard ratios (HR) of AD or senile dementia for the 2 cohorts after adjusting for preexisting comorbidities and number of clinical visits.
The first-ever diagnosis of AD or senile dementia during the observation period.
Of the 29 958 sampled subjects, 1589 (5.3%) were diagnosed with AD or senile dementia during a mean follow-up period of 4.4 years, including 294 (5.9%) from the AMD cohort and 1295 (5.2%) from the control cohort. The incidence of AD or senile dementia was higher in patients with AMD than in the controls (P=0.044), with an HR of 1.44 (95% confidence interval [CI], 1.26-1.64) after adjusting for covariates. The stratified analysis showed that the adjusted HR for AD or senile dementia was 1.35 (95% CI, 0.89-2.06) for exudative AMD versus the controls and 1.44 (95% CI, 1.26-1.65) for nonexudative AMD versus the controls.
This study provides large-scale, population-based evidence that AMD, especially nonexudative AMD, is independently associated with an increased risk of subsequent AD or senile dementia development.
研究年龄相关性黄斑变性（AMD）与未来阿尔茨海默病（AD）或老年痴呆症发展之间的关系。
使用台湾全民健康保险研究数据库进行的纵向病例对照研究。
2001 年至 2009 年，数据库中诊断为年龄≥65 岁的新诊断 AMD 患者被招募为 AMD 队列（n=4993）。其中，有 540 例患有渗出性 AMD，4453 例无渗出性 AMD 诊断。无任何 AMD 的患者，按年龄、性别和入组时间进行匹配，随机抽取 24965 例作为对照组进行比较。
使用 Kaplan-Meier 方法评估阿尔茨海默病/老年痴呆症无事件生存分析。使用 Cox 比例风险回归计算调整了既往合并症和就诊次数后，两组发生 AD 或老年痴呆症的风险比（HR）。
观察期间首次诊断为 AD 或老年痴呆症。
在 29958 名抽样患者中，1589 例（5.3%）在平均 4.4 年的随访期间被诊断为 AD 或老年痴呆症，其中 294 例（5.9%）来自 AMD 队列，1295 例（5.2%）来自对照组。AMD 患者的 AD 或老年痴呆症发生率高于对照组（P=0.044），调整协变量后，HR 为 1.44（95%置信区间[CI]，1.26-1.64）。分层分析显示，渗出性 AMD 与对照组相比，AD 或老年痴呆症的调整 HR 为 1.35（95%CI，0.89-2.06），非渗出性 AMD 与对照组相比，AD 或老年痴呆症的调整 HR 为 1.44（95%CI，1.26-1.65）。
本研究提供了大规模、基于人群的证据，表明 AMD，特别是非渗出性 AMD，与随后发生 AD 或老年痴呆症的风险增加独立相关。
Zotero 插件