Tapiainen V, Hartikainen S, Taipale H, Tiihonen J, Tolppanen A-M
School of Pharmacy, University of Eastern Finland, Kuopio, Finland; Research Centre for Comparative Effectiveness and Patient Safety (RECEPS), University of Eastern Finland, Kuopio, Finland.
School of Pharmacy, University of Eastern Finland, Kuopio, Finland; Department of Psychiatry, Kuopio University Hospital, Kuopio, Finland; Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland.
Eur Psychiatry. 2017 Jun;43:92-98. doi: 10.1016/j.eurpsy.2017.02.486. Epub 2017 Mar 9.
Studies investigating psychiatric disorders as Alzheimer's disease (AD) risk factors have yielded heterogeneous findings. Differences in time windows between the exposure and outcome could be one explanation. We examined whether (1) mental and behavioral disorders in general or (2) specific mental and behavioral disorder categories increase the risk of AD and (3) how the width of the time window between the exposure and outcome affects the results.
A nationwide nested case-control study of all Finnish clinically verified AD cases, alive in 2005 and their age, sex and region of residence matched controls (n of case-control pairs 27,948). History of hospital-treated mental and behavioral disorders was available since 1972.
Altogether 6.9% (n=1932) of the AD cases and 6.4% (n=1784) of controls had a history of any mental and behavioral disorder. Having any mental and behavioral disorder (adjusted OR=1.07, 95% CI=1.00-1.16) or depression/other mood disorder (adjusted OR=1.17, 95% CI=1.05-1.30) were associated with higher risk of AD with 5-year time window but not with 10-year time window (adjusted OR, 95% CI 0.99, 0.91-1.08 for any disorder and 1.08, 0.96-1.23 for depression).
The associations between mental and behavioral disorders and AD were modest and dependent on the time window. Therefore, some of the disorders may represent misdiagnosed prodromal symptoms of AD, which underlines the importance of proper differential diagnostics among older persons. These findings also highlight the importance of appropriate time window in psychiatric and neuroepidemiology research.
调查精神疾病作为阿尔茨海默病（AD）风险因素的研究结果各异。暴露与结局之间时间窗的差异可能是一种解释。我们研究了（1）一般精神和行为障碍或（2）特定精神和行为障碍类别是否会增加AD风险，以及（3）暴露与结局之间时间窗的宽度如何影响结果。
一项全国性巢式病例对照研究，纳入2005年存活的所有芬兰临床确诊AD病例及其年龄、性别和居住地区匹配的对照（病例对照对数量为27948）。自1972年起可获取医院治疗的精神和行为障碍病史。
AD病例中共有6.9%（n = 1932）以及对照中有6.4%（n = 1784）有任何精神和行为障碍病史。有任何精神和行为障碍（校正OR = 1.07，95% CI = 1.00 - 1.16）或抑郁/其他情绪障碍（校正OR = 1.17，95% CI = 1.05 - 1.30）与5年时间窗下较高的AD风险相关，但与10年时间窗无关（任何障碍的校正OR，95% CI为0.99，0.91 - 1.08；抑郁的校正OR为1.08，0.96 - 1.23）。
精神和行为障碍与AD之间的关联较弱且取决于时间窗。因此，某些障碍可能代表AD误诊的前驱症状，这凸显了老年人进行正确鉴别诊断的重要性。这些发现还强调了精神科和神经流行病学研究中合适时间窗的重要性。
