Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
Veterans Affairs Medical Center, 921 NE 13th Street, Oklahoma City, OK, 73104, USA.
Geroscience. 2019 Feb;41(1):69-76. doi: 10.1007/s11357-019-00055-5. Epub 2019 Feb 6.
As data on prevalence and etiology of dementia in American Indians are limited, we sought to determine rates and patterns of memory loss among American Indian veterans with vascular risk factors. Sixty consecutive outpatient American Indian veterans with a mean age of 64 years (range 50-86), without prior dementia or mild cognitive impairment (MCI), and with ≥ 2 vascular risk factors were enrolled. The Montreal Cognitive Assessment (MoCA) and the Beck Depression Inventory-II were used to screen for cognitive impairment and depression. Patients with MoCA scores < 26 were referred for additional evaluation, including imaging, serology, and neuropsychological testing. Overall rates, types, and distribution of cognitive impairment were determined. Most prevalent vascular risk factors included hypertension (92%), hyperlipidemia (88%), diabetes (47%), and smoking (78%). Eight patients (13%) with severe depression were excluded, leaving 23/52 with abnormal MoCA scores (44%, 95%CI 30%-59%). Fifteen completed additional evaluation for memory loss, including four with normal MoCA scores who requested evaluation based on symptoms. Results were adjudicated as normal (4), non-amnestic MCI (4), vascular MCI (5), and vascular dementia (2). These results show that rates of undiagnosed cognitive impairment among American Indian veterans with vascular risk factors exceed rates previously published in non-American Indian cohorts. The most common etiology is vascular. Our findings support the need to improve vascular risk reduction in this understudied population.
由于有关美洲印第安人痴呆症的患病率和病因的数据有限，我们试图确定有血管危险因素的美洲印第安退伍军人的记忆丧失率和模式。连续招募了 60 名门诊就诊的平均年龄为 64 岁（范围为 50-86 岁）的美洲印第安退伍军人，他们没有先前的痴呆症或轻度认知障碍（MCI），且有≥2 个血管危险因素。使用蒙特利尔认知评估（MoCA）和贝克抑郁量表第二版（Beck Depression Inventory-II）来筛查认知障碍和抑郁。MoCA 评分<26 的患者被转诊进行额外评估，包括影像学、血清学和神经心理学测试。确定了认知障碍的总体发生率、类型和分布。最常见的血管危险因素包括高血压（92%）、高脂血症（88%）、糖尿病（47%）和吸烟（78%）。由于 8 名（13%）严重抑郁的患者被排除在外，因此有 23/52 名 MoCA 评分异常（44%，95%CI 30%-59%）。有 15 名患者因记忆丧失完成了额外的评估，包括 4 名 MoCA 评分正常但根据症状要求评估的患者。结果判定为正常（4）、非遗忘性 MCI（4）、血管性 MCI（5）和血管性痴呆（2）。这些结果表明，有血管危险因素的美洲印第安退伍军人中未确诊的认知障碍发生率高于先前在非美洲印第安人群中发表的发生率。最常见的病因是血管性的。我们的研究结果支持在这一研究不足的人群中需要改善血管危险因素的降低。
