Santabárbara Javier, Villagrasa Beatriz, Lopez-Anton Raúl, De la Cámara Concepción, Gracia-García Patricia, Lobo Antonio
Department of Preventive Medicine and Public Health, Universidad de Zaragoza, 50009 Zaragoza, Spain.
Instituto de Investigación Sanitaria de Aragón (IIS Aragón), 50009 Zaragoza, Spain.
Brain Sci. 2020 Apr 30;10(5):265. doi: 10.3390/brainsci10050265.
To assess the association between anxiety and risk of vascular dementia (VaD), as well as potential sex differences, in a community-based cohort. A random sample of 4057 dementia-free community participants aged 55 or older, from the longitudinal, community-based Zaragoza Dementia and Depression Project (ZARADEMP) study were followed for 4.5 years. Geriatric Mental State B (GMS)-Automated Geriatric Examination for Computer Assisted Taxonomy (AGECAT) was used for the assessment and diagnosis of anxiety, and a panel of research psychiatrists diagnosed the incident cases of VaD according to DSM-IV (). Multivariate survival analysis with competing risk regression model was performed. In men, the incidence rate of VaD was significantly higher among anxiety subjects compared with non-anxiety subjects (incidence rate ratio (IRR) (95% confidence interval (CI)): 3.24 (1.13-9.35); = 0.029), and no difference was observed in women (IRR (95%CI): 0.68 (0.19-2.23); = 0.168). In the multivariate model, for men, cases of anxiety had 2.6-fold higher risk of VaD (subdistribution hazard ratio (SHR): 2.61; 95%CI: 0.88-7.74) when all potential confounding factors were controlled, with no statistical significance ( = 0.084), but a clinically relevant effect (Cohen's d: 0.74). No association was found in women. In men, but not in women, risk of VaD was higher among individuals with anxiety, with a clinically relevant effect. Potential anxiety-related preventive interventions for VaD might be tailored to men and women separately.
在一个基于社区的队列中，评估焦虑与血管性痴呆（VaD）风险之间的关联以及潜在的性别差异。从基于社区的纵向萨拉戈萨痴呆与抑郁项目（ZARADEMP）研究中随机抽取了4057名55岁及以上无痴呆的社区参与者，随访4.5年。使用老年精神状态B（GMS）-计算机辅助分类自动老年检查（AGECAT）评估和诊断焦虑，一组研究精神科医生根据《精神疾病诊断与统计手册》第四版（DSM-IV）诊断VaD的发病病例。采用竞争风险回归模型进行多变量生存分析。在男性中，焦虑受试者的VaD发病率显著高于非焦虑受试者（发病率比（IRR）（95%置信区间（CI））：3.24（1.13 - 9.35）；P = 0.029），而在女性中未观察到差异（IRR（95%CI）：0.68（0.19 - 2.23）；P = 0.168）。在多变量模型中，对于男性，当控制所有潜在混杂因素时，焦虑病例患VaD的风险高2.6倍（亚分布风险比（SHR）：2.61；95%CI：0.88 - 7.74），无统计学意义（P = 0.084），但有临床相关效应（科恩d值：0.74）。在女性中未发现关联。在男性而非女性中，焦虑个体患VaD的风险更高，且有临床相关效应。针对VaD的潜在焦虑相关预防干预措施可能需要分别针对男性和女性制定。
