From the College of Medicine (T.T.), The Pennsylvania State University, State College; Departments of Neurology (S.A.S., C.H.K., M.M.C.), Neurobiology and Behavior (C.H.K.), and Epidemiology (M.M.C.), University of California, Irvine; and Department of Pathology, University of Kentucky Sanders-Brown Center on Aging (P.T.N.), University of Kentucky, Lexington.
Neurology. 2018 Nov 6;91(19):e1788-e1798. doi: 10.1212/WNL.0000000000006455. Epub 2018 Oct 12.
To examine the risk factors and comorbidities of hippocampal sclerosis (HS) in the oldest-old.
A total of 134 participants with dementia from The 90+ Study with longitudinal evaluations and autopsy were included in this investigation. Participants were divided into 2 groups, one with and one without HS pathology, and differences in clinical and pathologic characteristics were compared.
Persons with HS tended to have a longer duration of dementia compared to participants without HS (mean 4.0 years vs 6.7 years, odds ratio [OR] 1.26; 95% confidence interval [CI] 1.11-1.42; < 0.001). HS was more likely in participants with a history of autoimmune diseases (rheumatoid arthritis or thyroid disease, OR 3.15; 95% CI 1.30-7.62; = 0.011), high thyroid-stimulating hormone (OR 4.94; 95% CI 1.40-17.46; = 0.013), or high thyroid antibodies (OR 3.45; 95% CI 1.09-10.88; = 0.035). Lewy body disease (LBD) pathology was also associated with an increased likelihood of HS (OR 5.70; 95% CI 1.22-26.4; = 0.027).
We identified autoimmune conditions (rheumatoid arthritis and thyroid disease) as potential risk factors for HS in our cohort. LBD was the only pathology that was associated with increased odds of HS and those harboring HS pathology had a longer duration of dementia. This suggests multiple pathways of HS pathology among the oldest-old.
研究最年长人群中海马硬化（HS）的危险因素和合并症。
本研究纳入了纵向评估和尸检的 134 名来自 90+研究的痴呆症患者。参与者分为两组，一组有 HS 病理学，另一组没有，比较两组的临床和病理特征差异。
与没有 HS 病理学的参与者相比，有 HS 病理学的参与者痴呆持续时间更长（平均 4.0 年比 6.7 年，优势比 [OR] 1.26；95%置信区间 [CI] 1.11-1.42；<0.001）。有自身免疫性疾病（类风湿性关节炎或甲状腺疾病，OR 3.15；95%CI 1.30-7.62；=0.011）、高促甲状腺激素（OR 4.94；95%CI 1.40-17.46；=0.013）或高甲状腺抗体（OR 3.45；95%CI 1.09-10.88；=0.035）病史的参与者更有可能患有 HS。路易体病（LBD）病理学也与 HS 发生的可能性增加相关（OR 5.70；95%CI 1.22-26.4；=0.027）。
我们确定了自身免疫性疾病（类风湿性关节炎和甲状腺疾病）是我们队列中 HS 的潜在危险因素。LBD 是唯一与 HS 发生几率增加相关的病理学，并且患有 HS 病理学的人痴呆持续时间更长。这表明最年长人群中存在多种 HS 病理学途径。
