Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
The National Research Center for the Working Environment, Copenhagen, Denmark.
Aging Ment Health. 2021 Jun;25(6):1151-1160. doi: 10.1080/13607863.2020.1742656. Epub 2020 Apr 1.
Previous studies indicated that stress diagnoses increase the risk of dementia. However, previous results may be biased by confounding, reverse causation and misclassification. Therefore, the main aim of this study was to investigate the association between clinically diagnosed stress in midlife and later dementia risk, while addressing limitations of previous studies.
The study population was selected from all individuals in Denmark born 1935-1956. Individuals diagnosed with stress in midlife (aged 37-58 years) were matched (1:5) with individuals without stress diagnoses based on sex and birthdate ( = 103,484). Data were retrieved from national registers. Cox regression models were adjusted for socio-demographic factors and different morbidities.
We found a 2.20 (95% CI: 1.93-2.50) times higher rate of dementia among individuals with any stress diagnosis registered in midlife compared with no stress diagnosis. Hazard rate ratios of dementia were 1.73 (95% CI: 1.13-2.65) among individuals with acute stress reactions, 2.37 (95% CI: 2.05-2.74) among individuals with adjustment disorders, and 2.20 (95% CI: 1.73-2.80) among individuals with unspecified stress reactions. Individuals with PTSD and other stress reactions had non-significantly elevated rates of dementia. Adjustment for confounding only slightly attenuated the association, and reverse causation did not appear to bias the results substantially.
Our results support the hypothesis that severe stress in midlife is an important risk factor for dementia. This finding emphasizes the importance of identifying and treating severe stress in midlife to reduce potential detrimental consequences for brain health in later life.
先前的研究表明，压力诊断会增加痴呆的风险。然而，先前的结果可能受到混杂因素、反向因果关系和分类错误的影响。因此，本研究的主要目的是调查中年时临床诊断的压力与以后痴呆风险之间的关联，同时解决先前研究的局限性。
研究人群选自丹麦所有 1935-1956 年出生的个体。在中年（37-58 岁）被诊断患有压力的个体与没有压力诊断的个体根据性别和出生日期进行匹配（n=103484）。数据来自国家登记册。Cox 回归模型调整了社会人口因素和不同的疾病。
我们发现，与没有压力诊断的个体相比，中年有任何压力诊断的个体痴呆的发生率高 2.20 倍（95%CI：1.93-2.50）。有急性应激反应的个体痴呆的危险率比为 1.73（95%CI：1.13-2.65），有适应障碍的个体为 2.37（95%CI：2.05-2.74），有未指定的应激反应的个体为 2.20（95%CI：1.73-2.80）。有创伤后应激障碍和其他应激反应的个体痴呆发生率略有升高，但无统计学意义。仅调整混杂因素略微减弱了关联，反向因果关系似乎没有对结果产生实质性影响。
我们的结果支持这样一种假设，即中年时期的严重压力是痴呆的一个重要危险因素。这一发现强调了在中年时期识别和治疗严重压力的重要性，以减少对以后生活中大脑健康的潜在不利影响。
