Irimata Katherine E, Dugger Brittany N, Wilson Jeffrey R
School of Mathematical and Statistical Sciences, Arizona State University, Tempe, AZ, United States.
Department of Pathology and Laboratory Medicine, University of California Davis, Sacramento, CA, United States.
Curr Alzheimer Res. 2018;15(11):1032-1044. doi: 10.2174/1567205015666180702105119.
Studies have shown select associations between cardiovascular risk factors and dementia, but mostly focused on Alzheimer's Disease (AD).
We enhance these works by evaluating the relationship between the presence of cardiovascular risk factors and the rate of cognitive decline, measured using the Mini-Mental State Examination (MMSE) and Clinical Dementia Rating Sum of Boxes (CDR-SUM) on four common dementia subtypes (AD, dementia with Lewy bodies (DLB), frontotemporal dementia (FTD), and vascular dementia (VaD), as well as non-demented elderly individuals (normal)).
We used generalized linear mixed models with random intercepts to account for correlation at the patient and center levels for each dementia subtype adjusting for time since initial visit, baseline cognitive score, age, and demographic factors. The cardiovascular risk factors evaluated included body mass index, diabetes, years of smoking, atrial fibrillation, hypertension, and hypercholesterolemia.
Patients diagnosed with AD (n=1899), DLB (n=65), FTD (n=168), or VaD (n=13); or lacked cognitive impairment (normal) (n=3583) were evaluated using data from the National Alzheimer's Coordinating Centers. Cardiovascular risk factors were associated with select dementia subtypes including AD and FTD. Using MMSE and CDR-SUM, recent or active hypertension and hypercholesterolemia were associated with a slower cognitive decline for AD patients, while higher body mass index and years of smoking were associated with a slower cognitive decline for FTD patients. However, several cardiovascular factors demonstrated associations with more rapid cognitive decline.
These results demonstrate disease specific associations and can provide clinicians guidance on predicted cognitive changes at the group level using information about cardiovascular risk factors.
研究表明心血管危险因素与痴呆之间存在特定关联，但大多集中在阿尔茨海默病（AD）。
我们通过评估心血管危险因素的存在与认知衰退率之间的关系来拓展这些研究，认知衰退率采用简易精神状态检查表（MMSE）和临床痴呆评定量表总盒数（CDR-SUM）来衡量，涉及四种常见痴呆亚型（AD、路易体痴呆（DLB）、额颞叶痴呆（FTD）和血管性痴呆（VaD））以及非痴呆老年人（正常）。
我们使用具有随机截距的广义线性混合模型，以考虑每个痴呆亚型在患者和中心层面的相关性，并对自初次就诊以来的时间、基线认知得分、年龄和人口统计学因素进行调整。评估的心血管危险因素包括体重指数、糖尿病、吸烟年限、心房颤动、高血压和高胆固醇血症。
利用来自国家阿尔茨海默病协调中心的数据，对诊断为AD（n = 1899）、DLB（n = 65）、FTD（n = 168）或VaD（n = 13）；或无认知障碍（正常）（n = 3583）的患者进行了评估。心血管危险因素与特定痴呆亚型相关，包括AD和FTD。使用MMSE和CDR-SUM，近期或活动性高血压和高胆固醇血症与AD患者认知衰退较慢相关，而较高的体重指数和吸烟年限与FTD患者认知衰退较慢相关。然而，一些心血管因素与认知衰退更快相关。
这些结果表明了疾病特异性关联，并可为临床医生提供指导，使其能够利用心血管危险因素信息在群体层面预测认知变化。
