Bleckwenn Markus, Kleineidam Luca, Wagner Michael, Jessen Frank, Weyerer Siegfried, Werle Jochen, Wiese Birgitt, Lühmann Dagmar, Posselt Tina, König Hans-Helmut, Brettschneider Christian, Mösch Edelgard, Weeg Dagmar, Fuchs Angela, Pentzek Michael, Luck Tobias, Riedel-Heller Steffi G, Maier Wolfgang, Scherer Martin
Department of Family Medicine, Institute of General Practice and Family Medicine, Faculty of Medicine, University of Bonn, Bonn, Germany.
Neuropsychology Unit.
Br J Gen Pract. 2017 Feb;67(655):e111-e117. doi: 10.3399/bjgp16X688813. Epub 2016 Dec 19.
Arteriosclerotic disorders increase the risk of dementia. As they have common causes and risk factors, coronary heart disease (CHD) could influence the course of dementia.
To determine whether CHD increases the speed of cognitive decline in Alzheimer's disease, and to discuss the potential for secondary cardiovascular prevention to modify this decline.
Prospective multicentre cohort study in general practices in six cities in Germany.
Participants were patients with probable mild-to-moderate Alzheimer's dementia or mixed dementia (n = 118; mean age 85.6 [±3.4] years, range 80-96 years). The authors assessed the presence of CHD according to the family physicians' diagnosis. Cognitive performance was measured during home visits for up to 3 years in intervals of 6 months, using Mini Mental State Examination (MMSE) and Clinical Dementia Rating Sum of Boxes (CDR-SoB). The authors also recorded whether patients died in the observation period.
At baseline, 65 patients (55%) had CHD and/or a heart condition following a myocardial infarction. The presence of CHD accelerated cognitive decline (MMSE, P<0.05) by about 66%, and reduced cognitive-functional ability (CDR-SoB, P<0.05) by about 83%, but had no impact on survival.
The study shows that CHD has a significant influence on cognitive decline in older patients with late-onset dementia. The dementia process might therefore be positively influenced by cardiovascular prevention, and this possible effect should be further investigated.
动脉粥样硬化性疾病会增加患痴呆症的风险。由于它们有共同的病因和风险因素，冠心病（CHD）可能会影响痴呆症的病程。
确定冠心病是否会加快阿尔茨海默病患者的认知衰退速度，并探讨二级心血管预防措施改善这种衰退的可能性。
在德国六个城市的普通诊所进行的前瞻性多中心队列研究。
参与者为可能患有轻度至中度阿尔茨海默病痴呆或混合性痴呆的患者（n = 118；平均年龄85.6 [±3.4]岁，范围80 - 96岁）。作者根据家庭医生的诊断评估冠心病的存在情况。在长达3年的家访期间，每隔6个月使用简易精神状态检查表（MMSE）和临床痴呆评定量表总和（CDR - SoB）测量认知表现。作者还记录了患者在观察期内是否死亡。
在基线时，65名患者（55%）患有冠心病和/或心肌梗死后的心脏疾病。冠心病的存在使认知衰退（MMSE，P<0.05）加快了约66%，并使认知功能能力（CDR - SoB，P<0.05）降低了约83%，但对生存没有影响。
该研究表明，冠心病对老年迟发性痴呆患者的认知衰退有显著影响。因此，心血管预防措施可能会对痴呆症进程产生积极影响，这种可能的效果应进一步研究。
