From the Usher Institute of Population Health Sciences and Informatics (C.S.), Muir Maxwell Epilepsy Centre (S.D., G.K.M., R.F.M.C.), Centre for Clinical Brain Sciences, and Centre for Clinical Brain Sciences (T.W.), University of Edinburgh; Department of Clinical Neurosciences (S.D., T.W.), Western General Hospital; and Royal Hospital for Sick Children (R.F.M.C.), Edinburgh, UK.
Neurology. 2020 Sep 22;95(12):e1686-e1693. doi: 10.1212/WNL.0000000000010358. Epub 2020 Jul 17.
To determine the association of epilepsy with incident dementia by conducting a nationwide, retrospective data-linkage, cohort study to examine whether the association varies according to dementia subtypes and to investigate whether risk factors modify the association.
We used linked health data from hospitalization, mortality records, and primary care consultations to follow up 563,151 Welsh residents from their 60th birthday to estimate dementia rate and associated risk factors. Dementia, epilepsy, and covariates (medication, smoking, comorbid conditions) were classified with the use of previously validated code lists. We studied rate of dementia and dementia subtypes in people with epilepsy (PWE) and without epilepsy using (stratified) Kaplan-Meier plots and flexible parametric survival models.
PWE had a 2.5 (95% confidence interval [CI] 2.3-2.6) times higher hazard of incident dementia, a 1.6 (95% CI 1.4-1.8) times higher hazard of incident Alzheimer disease (AD), and a 3.1 (95% CI 2.8-3.4) times higher hazard of incident Vascular dementia (VaD). A history of stroke modified the increased incidence in PWE. PWE who were first diagnosed at ≤25 years of age had a dementia rate similar to that of those diagnosed later in life. PWE who had ever been prescribed sodium valproate compared to those who had not were at higher risk of dementia (hazard ratio [HR] 1.6, 99% CI 1.4-1.9) and VaD (HR 1.7, 99% CI 1.4-2.1) but not AD (HR 1.2, 99% CI 0.9-1.5).
PWE compared to those without epilepsy have an increased dementia risk.
通过进行全国性回顾性数据链接队列研究，确定癫痫与痴呆发病的相关性，以检验这种相关性是否因痴呆亚型而有所不同，并探讨风险因素是否会改变这种相关性。
我们利用来自住院、死亡记录和初级保健咨询的链接健康数据，对 563151 名威尔士居民进行随访，随访时间从他们 60 岁生日开始，以估计痴呆的发病率和相关的风险因素。使用经过验证的代码列表对痴呆、癫痫和协变量（药物、吸烟、合并症）进行分类。我们使用（分层）Kaplan-Meier 图和灵活参数生存模型研究了癫痫患者（PWE）和非癫痫患者的痴呆发病率和痴呆亚型。
PWE 发生痴呆的风险是对照组的 2.5 倍（95%置信区间[CI]2.3-2.6），发生阿尔茨海默病（AD）的风险是对照组的 1.6 倍（95%CI1.4-1.8），发生血管性痴呆（VaD）的风险是对照组的 3.1 倍（95%CI2.8-3.4）。中风史改变了 PWE 发病率的增加。首次诊断年龄≤25 岁的 PWE 痴呆发生率与较晚诊断的患者相似。与未接受丙戊酸钠治疗的 PWE 相比，曾接受丙戊酸钠治疗的 PWE 患痴呆（危险比[HR]1.6，99%CI1.4-1.9）和 VaD（HR1.7，99%CI1.4-2.1）的风险更高，但患 AD（HR1.2，99%CI0.9-1.5）的风险则没有增加。
与无癫痫的患者相比，PWE 患痴呆的风险增加。
