Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, PO Box 7057, 1007 MB, Amsterdam, the Netherlands.
Institute of Medical Informatics, Erasmus University Rotterdam, Rotterdam, the Netherlands.
Alzheimers Res Ther. 2019 May 17;11(1):47. doi: 10.1186/s13195-019-0496-x.
There is increasing evidence that dementia risk associated with vascular disorders is age dependent. Large population-based studies of incident dementia are necessary to further elucidate this effect. Therefore, the aim of the present study was to determine the association of vascular disorders with incident dementia in different age groups in a large primary care database.
We included 442,428 individuals without dementia aged ≥ 65 years from the longitudinal primary care Integrated Primary Care Information (IPCI) database. We determined in 6 age groups (from 65-70 to ≥ 90 years) the risk of hypertension, diabetes mellitus, dyslipidemia, stroke, myocardial infarction, heart failure, and atrial fibrillation for all-cause dementia using incidence rate ratios, Cox regression, and Fine and Gray regression models.
The mean age at inclusion of the total study sample was 72.4 years, 45.7% of the participants were male, and median follow-up was 3.6 years. During 1.4 million person-years of follow-up, 13,511 individuals were diagnosed with dementia. The risk for dementia decreased with increasing age for all risk factors and was no longer significant in individuals aged ≥ 90 years. Adjusting for mortality as a competing risk did not change the results.
We conclude that vascular disorders are no longer a risk factor for dementia at high age. Possible explanations include selective survival of individuals who are less susceptible to the negative consequences of vascular disorders and differences in follow-up time between individuals with and without a vascular disorder. Future research should focus on the identification of other risk factors than vascular disorders, for example, genetic or inflammatory processes, that can potentially explain the strong age-related increase in dementia risk.
越来越多的证据表明，血管疾病相关的痴呆风险是与年龄相关的。有必要进行大规模基于人群的痴呆发病研究，以进一步阐明这种影响。因此，本研究旨在确定在大型初级保健数据库中不同年龄组血管疾病与痴呆发病的相关性。
我们纳入了来自纵向初级保健综合初级保健信息（IPCI）数据库的 442428 名无痴呆且年龄≥65 岁的个体。我们在 6 个年龄组（65-70 岁至≥90 岁）中，使用发病率比、Cox 回归和 Fine 和 Gray 回归模型，确定高血压、糖尿病、血脂异常、中风、心肌梗死、心力衰竭和房颤对所有原因痴呆的风险。
总研究样本的平均年龄为 72.4 岁，45.7%的参与者为男性，中位随访时间为 3.6 年。在 140 万人年的随访期间，有 13511 人被诊断为痴呆。随着年龄的增长，所有危险因素发生痴呆的风险都降低，且在≥90 岁的个体中不再显著。将死亡率作为竞争风险进行调整并未改变结果。
我们得出结论，血管疾病不再是高龄人群发生痴呆的危险因素。可能的解释包括对血管疾病的负面后果不易感的个体的选择性生存，以及有和无血管疾病个体之间的随访时间差异。未来的研究应集中于确定除血管疾病以外的其他潜在危险因素，例如遗传或炎症过程，这些因素可能可以解释痴呆风险随年龄增长而增加的原因。
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