School of Public Health and Community Medicine, UNSW Sydney, Sydney, NSW, Australia.
Dementia Centre for Research Collaboration, School of Psychiatry, UNSW Sydney, Sydney, NSW, Australia.
J Alzheimers Dis. 2018;62(4):1747-1758. doi: 10.3233/JAD-171027.
Several brain reserve, vascular risk, and other modifiable factors have been associated with late-onset dementia, but their association with young onset dementia (YOD) has not been adequately explored.
To examine the association of cognitive reserve enhancing factors, cardiovascular risk factors (including smoking), depression, alcohol use, and traumatic brain injury (TBI) with non-autosomal dominant degenerative and/or vascular YOD.
Data for this matched case-control study were taken from two larger studies conducted in NSW, Australia. One comprised all people with YOD within a geographical region, while the other exclusively included Aboriginal and Torres Strait Islander participants. Dementia diagnosis was confirmed by clinical consensus, and risk exposure was retrospectively self- and/or informant-reported.
Participants were 96 people with YOD (58.4% with probable Alzheimer's disease) and 175 age-group, sex, and sample matched control participants. Poor educational attainment, low participation in cognitive leisure activity, stroke, transient ischemic attack, and self-reported very heavy alcohol use were related to the risk of primary degenerative and/or vascular YOD. The effect of hypertension and depression varied depending on when they occurred relative to dementia onset. Current smoking was significantly associated with risk in univariate analyses but did not retain significance in multivariate modelling. There was no association with hypercholesterolemia, diabetes, or TBI of any kind. Some compensation for low educational attainment was possible via a complex occupation later in life.
Non-genetic factors have a role in YOD, though the relative importance of each factor may be different to late onset dementia. The timing and severity of exposure, as well as the potential for compensation with later protective exposures, are important considerations for potential prevention strategies.
一些脑储备、血管风险和其他可改变的因素与迟发性痴呆有关，但它们与早发性痴呆（YOD）的关系尚未得到充分探讨。
研究认知储备增强因素、心血管危险因素（包括吸烟）、抑郁、饮酒和创伤性脑损伤（TBI）与非常染色体显性退行性和/或血管性 YOD 的关系。
本匹配病例对照研究的数据来自澳大利亚新南威尔士州进行的两项较大的研究。一项包括该地理区域内所有 YOD 患者，另一项则专门包括原住民和托雷斯海峡岛民参与者。痴呆症诊断通过临床共识确认，风险暴露则通过自我和/或知情者报告进行回顾性评估。
参与者包括 96 名 YOD 患者（58.4%为可能的阿尔茨海默病患者）和 175 名年龄、性别和样本匹配的对照参与者。教育程度低、认知休闲活动参与度低、中风、短暂性脑缺血发作以及自我报告的重度饮酒与原发性退行性和/或血管性 YOD 的风险有关。高血压和抑郁的影响取决于它们与痴呆症发病的时间关系。在单变量分析中，当前吸烟与风险显著相关，但在多变量建模中则不具有显著性。高胆固醇血症、糖尿病或任何类型的 TBI 与风险均无关联。通过复杂的后期职业，可能在一定程度上弥补教育程度低的不足。
非遗传因素在 YOD 中起作用，尽管每种因素的相对重要性可能与迟发性痴呆不同。暴露的时间和严重程度，以及后期保护性暴露的潜在补偿作用，都是潜在预防策略的重要考虑因素。
