Suemoto Claudia Kimie, Ferretti Renata Eloah, Grinberg Lea Tenenholz, de Oliveira Kátia Cristina, Farfel José Marcelo, Leite Renata Elaine Paraizo, Nitrini Ricardo, Jacob Filho Wilson, Pasqualucci Carlos Augusto
Department of Geriatrics, University of São Paulo, School of Medicine, São Paulo SP, Brazil.
Department of Pathology, University of São Paulo, School of Medicine, São Paulo SP, Brazil.
Dement Neuropsychol. 2009 Oct-Dec;3(4):308-314. doi: 10.1590/S1980-57642009DN30400008.
Longitudinal studies have shown association between cardiovascular risk factors and dementia. However, these studies are not capable of detecting asymptomatic cardiovascular alterations and thus may provide erroneous estimates of association. Autopsy studies could be more useful in elucidating these questions. The present clinicopathological study sought to examine the relationship between dementia, cardiovascular risk factors and disease.
603 subjects, who underwent autopsy, were classified regarding the presence of dementia, according to cognitive classification. Demographics, cardiovascular risk factors, and anatomically-proven cardiovascular disease (myocardial hypertrophy, cerebral and carotid atherosclerosis) were compared among cognitively normal persons and individuals with dementia.
Cognitive deficit was associated with advanced age, stroke, physical inactivity and low body mass index (p< 0.05). Circle of Willis atherosclerosis was greater in patients with dementia than in controls on univariate analysis (p=0.01). However, this association lost significance when adjusted by age and gender (p=0.61). Heart failure and anatomopathological cardiac parameters were more severe in the control group than in demented individuals (p< 0.05). Carotid artery atherosclerosis and intima-media thickness were similar in both groups.
Advanced age, stroke, physical inactivity and low body mass index were linked to dementia. Circle of Willis atherosclerosis was associated with dementia only when age was not considered. Our results suggest that cerebral artery atherosclerosis was not directly associated with clinical expression of dementia.
纵向研究表明心血管危险因素与痴呆症之间存在关联。然而，这些研究无法检测到无症状的心血管改变，因此可能会提供错误的关联估计。尸检研究可能对阐明这些问题更有用。本临床病理学研究旨在探讨痴呆症、心血管危险因素与疾病之间的关系。
对603名接受尸检的受试者，根据认知分类，就痴呆症的存在情况进行分类。对认知正常者和痴呆症患者的人口统计学、心血管危险因素以及经解剖证实的心血管疾病（心肌肥大、脑和颈动脉粥样硬化）进行比较。
认知缺陷与高龄、中风、缺乏身体活动和低体重指数相关（p<0.05）。在单变量分析中，痴呆症患者的Willis环动脉粥样硬化程度高于对照组（p=0.01）。然而，在按年龄和性别进行调整后，这种关联失去了显著性（p=0.61）。对照组的心力衰竭和解剖病理学心脏参数比痴呆症患者更严重（p<0.05）。两组的颈动脉粥样硬化和内膜中层厚度相似。
高龄、中风、缺乏身体活动和低体重指数与痴呆症有关。仅在不考虑年龄时，Willis环动脉粥样硬化与痴呆症相关。我们的结果表明，脑动脉粥样硬化与痴呆症的临床表现没有直接关联。
