Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan.
Faculty of Medicine, National Yang-Ming University Schools of Medicine, Taipei, Taiwan.
J Am Geriatr Soc. 2020 Jan;68(1):129-136. doi: 10.1111/jgs.16181. Epub 2019 Oct 6.
To investigate the summative effects of vascular risk factors (VRFs) on the progression of Alzheimer disease (AD).
Longitudinal follow-up cohort study.
AD patients from two teaching hospitals in Taiwan with 3-year follow-ups.
A total of 330 AD patients with a mean age of 80.7 years, a mean Mini-Mental State Examination (MMSE) score 18.7, and a mean Clinical Dementia Rating Sum of Boxes (CDRSB) score of 6.9.
All patients completed a clinically functional assessment and a neuropsychological test battery at baseline and yearly follow-ups. The VRF burden was combined into a summative VRF index at baseline (ie, having one, two, or more VRFs); VRFs included coronary heart disease, cardiac arrhythmia, hypertension, cerebrovascular disease, diabetes mellitus, obesity, smoking, and physical inactivity. The generalized estimating equation (GEE) method was used to analyze the correlations between the VRFs and longitudinal MMSE and CDRSB changes.
The results of the GEE adjusted for age, years of education, sex, disease duration, baseline MMSE score, time, apolipoprotein E (APOE) ε4 carrier status, use of medications (acetylcholinesterase inhibitors or N-methyl-D-aspartate receptor antagonists), and hospitalization rates and showed that patients with more than three VRFs had more rapid cognitive decline than patients without VRFs (MMSE, P = .02; CDRSB, P = .001) as well as patients with three or fewer VRFs (MMSE, P = .009; CDRSB, P = .02). Subsequent analyses of APOE ε4 carriers with more than three VRFs also showed their more rapid cognitive decline compared with patients without VRFs (MMSE, P = .02; CDRSB, P = .001) and patients with three or fewer VRFs (MMSE, P = .009; CDRSB, P = .02), but no significant difference was found in APOE ε4 noncarriers.
Multiple VRFs have summative effects on the progression of AD, especially in APOE ε4 carriers. J Am Geriatr Soc 68:129-136, 2019.
研究血管危险因素 (VRF) 对阿尔茨海默病 (AD) 进展的综合影响。
纵向随访队列研究。
台湾两所教学医院的 AD 患者，随访 3 年。
共纳入 330 名 AD 患者，平均年龄 80.7 岁，平均简易精神状态检查 (MMSE) 评分 18.7，平均临床痴呆评定量表总评分 (CDRSB) 6.9。
所有患者均在基线及每年随访时进行临床功能评估和神经心理学测试。VRF 负担在基线时组合成一个综合 VRF 指数（即存在一个、两个或更多 VRF）；VRF 包括冠心病、心律失常、高血压、脑血管疾病、糖尿病、肥胖、吸烟和缺乏身体活动。使用广义估计方程 (GEE) 方法分析 VRF 与纵向 MMSE 和 CDRSB 变化之间的相关性。
在调整年龄、受教育年限、性别、疾病持续时间、基线 MMSE 评分、时间、载脂蛋白 E (APOE) ε4 携带状态、药物使用（乙酰胆碱酯酶抑制剂或 N-甲基-D-天冬氨酸受体拮抗剂）和住院率后，GEE 的结果显示，患有超过三个 VRF 的患者认知衰退速度比没有 VRF 的患者更快（MMSE，P=0.02；CDRSB，P=0.001），也比患有三个或更少 VRF 的患者更快（MMSE，P=0.009；CDRSB，P=0.02）。对患有超过三个 VRF 且携带 APOE ε4 的患者进行的后续分析也显示，与没有 VRF 的患者（MMSE，P=0.02；CDRSB，P=0.001）和患有三个或更少 VRF 的患者（MMSE，P=0.009；CDRSB，P=0.02）相比，他们的认知衰退速度更快，但在非 APOE ε4 携带者中未发现显著差异。
多种 VRF 对 AD 的进展具有综合影响，尤其是在 APOE ε4 携带者中。
美国老年医学会杂志 68：129-136，2019 年。
