From the Neuropsychiatric Epidemiology Unit (H.H., L.J., X.G., S.K., S.Ö., I.S.), Institute of Neuroscience and Physiology, Sahlgrenska Academy, Centre for Ageing and Health-AGECAP, and Department of Clinical Neuroscience (G.G.), Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden.
Neurology. 2018 Apr 10;90(15):e1298-e1305. doi: 10.1212/WNL.0000000000005290. Epub 2018 Mar 14.
To investigate whether greater cardiovascular fitness in midlife is associated with decreased dementia risk in women followed up for 44 years.
A population-based sample of 1,462 women 38 to 60 years of age was examined in 1968. Of these, a systematic subsample comprising 191 women completed a stepwise-increased maximal ergometer cycling test to evaluate cardiovascular fitness. Subsequent examinations of dementia incidence were done in 1974, 1980, 1992, 2000, 2005, and 2009. Dementia was diagnosed according to DSM-III-R criteria on the basis of information from neuropsychiatric examinations, informant interviews, hospital records, and registry data up to 2012. Cox regressions were performed with adjustment for socioeconomic, lifestyle, and medical confounders.
Compared with medium fitness, the adjusted hazard ratio for all-cause dementia during the 44-year follow-up was 0.12 (95% confidence interval [CI] 0.03-0.54) among those with high fitness and 1.41 (95% CI 0.72-2.79) among those with low fitness. High fitness delayed age at dementia onset by 9.5 years and time to dementia onset by 5 years compared to medium fitness.
Among Swedish women, a high cardiovascular fitness in midlife was associated with a decreased risk of subsequent dementia. Promotion of a high cardiovascular fitness may be included in strategies to mitigate or prevent dementia. Findings are not causal, and future research needs to focus on whether improved fitness could have positive effects on dementia risk and when during the life course a high cardiovascular fitness is most important.
研究中年心血管健康状况与女性 44 年随访后痴呆风险降低之间的关系。
1968 年对一个基于人群的 1462 名 38 至 60 岁的女性进行了检查。其中，191 名女性进行了系统性的亚组研究，完成了一个逐步递增的最大测功自行车测试，以评估心血管健康状况。随后，在 1974 年、1980 年、1992 年、2000 年、2005 年和 2009 年进行了痴呆症发病率的检查。根据神经精神检查、知情者访谈、医院记录和登记数据，根据 DSM-III-R 标准对痴呆症进行诊断，直至 2012 年。采用 Cox 回归模型，调整了社会经济、生活方式和医学混杂因素。
与中等健康水平相比，在 44 年的随访期间，所有原因导致的痴呆症的调整后的危险比在高健康水平者中为 0.12（95%置信区间 0.03-0.54），在低健康水平者中为 1.41（95%置信区间 0.72-2.79）。与中等健康水平相比，高健康水平使痴呆症的发病年龄推迟了 9.5 年，使痴呆症发病时间推迟了 5 年。
在瑞典女性中，中年时心血管健康状况良好与随后痴呆症风险降低相关。促进较高的心血管健康状况可能被纳入减轻或预防痴呆症的策略中。研究结果并非因果关系，未来的研究需要关注提高健康状况是否对痴呆症风险有积极影响，以及在生命历程中何时心血管健康状况最重要。
