青年期认知能力与癫痫之间的双向关联：一项基于人群的队列研究。

A bidirectional association between cognitive ability in young adulthood and epilepsy: a population-based cohort study.

机构信息

Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospitals, Frederiksberg, Denmark.

Department of Public Health, University of Copenhagen, Copenhagen, Denmark.

出版信息

Int J Epidemiol. 2018 Aug 1;47(4):1151-1158. doi: 10.1093/ije/dyy018.

DOI:10.1093/ije/dyy018

PMID:29452371

Abstract

AIM

To investigate the bidirectional association between cognitive ability in young adulthood and epilepsy.

METHODS

This cohort study included 1 159 076 men enrolled in the mandatory conscription board examination from the Danish Conscription Database (DCD; 658 465 men examined 1957-84), the Danish Defence Personnel Organization Database (DPOD; 216 509 men examined 1987-2005) and the Danish Conscription Registry (DCR; 284 102 men examined 2006-15). A supplementary analysis included 14 814 female volunteers. Cognitive ability was measured at conscription, and epilepsy was ascertained by physician diagnoses in the Danish National Patient Registries 1977-2016 [using International Classification of Diseases (ICD) codes: ICD-8-345; ICD-10-G40-G41]. Differences in cognitive ability in relation to epilepsy status at the time of conscription (age 19) were calculated using linear regression. The risk of epilepsy associated with cognitive ability was estimated using Cox regression models, split at age at follow-up (40 and 60 years) and adjusted for year of birth, cerebrovascular disease, traumatic brain injury and education.

RESULTS

In all, 5097 (1.0%) men from the DPOD and DCR were diagnosed with epilepsy before conscription, and they had about 0.25 standard deviation (SD) lower cognitive scores than men without epilepsy. The largest difference in cognition was seen for those with the largest number of hospital contacts. A total of 22 364 (1.9%) men developed epilepsy, and cognitive ability was inversely associated with the risk of epilepsy. With the end of follow-up at age 40 years, the adjusted hazard ratio (HR)per SD increase was 0.75 (95% confidence interval = 0.73-0.77). The association attenuated with increasing age at diagnosis. The findings were replicated in female conscripts.

CONCLUSIONS

The cognitive impairment seen in adults with epilepsy seems to reflect combined effects of epileptic processes and lower premorbid cognitive ability.

摘要

目的

研究青年期认知能力与癫痫之间的双向关联。

方法

本队列研究纳入了来自丹麦征兵数据库（DCD；658465 名男性，1957-84 年接受检查）、丹麦国防人员组织数据库（DPOD；216509 名男性，1987-2005 年接受检查）和丹麦征兵登记处（DCR；284102 名男性，2006-15 年接受检查）的 1159076 名男性。一项补充分析纳入了 14814 名女性志愿者。在入伍时测量认知能力，通过丹麦国家患者登记处 1977-2016 年的医生诊断确定癫痫[使用国际疾病分类（ICD）代码：ICD-8-345；ICD-10-G40-G41]。使用线性回归计算入伍时（19 岁）癫痫状态与认知能力差异。使用 Cox 回归模型估计与认知能力相关的癫痫风险，该模型根据随访年龄（40 岁和 60 岁）进行划分，并根据出生年份、脑血管疾病、创伤性脑损伤和教育程度进行调整。

结果

在 DPOD 和 DCR 中，共有 5097（1.0%）名男性在入伍前被诊断患有癫痫，他们的认知评分比没有癫痫的男性低约 0.25 个标准差。认知差异最大的是那些有最多住院记录的人。共有 22364（1.9%）名男性患上了癫痫，认知能力与癫痫风险呈负相关。在随访结束时，即 40 岁时，每增加一个标准差，调整后的危险比（HR）为 0.75（95%置信区间=0.73-0.77）。随着诊断年龄的增加，相关性减弱。女性入伍者的结果也得到了验证。