慢性鼻-鼻窦炎与痴呆患者认知功能障碍的进展

Chronic rhinosinusitis and progression of cognitive impairment in dementia.

作者信息

Jung H-J, Lee J-Y, Choi Y-S, Choi H-G, Wee J-H

机构信息

Department of Otorhinolaryngology-Head and Neck Surgery, Chungbuk National University College of Medicine, Chungbuk National University Hospital, Cheongju, South Korea.

Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea.

出版信息

Eur Ann Otorhinolaryngol Head Neck Dis. 2021 May;138(3):147-151. doi: 10.1016/j.anorl.2020.05.017. Epub 2020 Oct 8.

DOI:10.1016/j.anorl.2020.05.017

PMID:33041243

Abstract

AIM

The relationship between chronic inflammatory disease and cognitive decline is still unclear, but there is increasing evidence to support the role of systemic inflammation. The aim of this study was to investigate if chronic rhinosinusitis (CRS) in dementia or mild cognitive impairment (MCI) is associated with the progression of cognitive decline.

MATERIAL AND METHODS

We retrospectively reviewed the data of patients who complained of memory impairment, and underwent brain magnetic resonance imaging (MRI) from January 2006 to April 2019. According to the Mini-Mental State Examination (MMSE) score, subjects (n=661) were divided into three groups: dementia (≤17), MCI (18-23), and normal (≥24). CRS was defined as a total score of greater than or equal to 4 according to the Lund-Mackay scoring system using brain MRI. Multiple logistic regression analyses estimated adjusted odds ratio (aOR) for the association between CRS and dementia or MCI. Among the subjects with follow-up MMSE (n=286), a repeated-measures ANOVA was used to assess the difference of changes in MMSE scores between the groups with and without CRS.

RESULTS

According to the initial MMSE score, there were 221 subjects with dementia, 195 with MCI, and 245 with normal results. CRS was not significantly associated with dementia (aOR=1.519, CI=0.909-2.538, P=0.111), while being suggestively associated with MCI (aOR=1.740, CI=1.041-2.906, P=0.034). The MMSE scores at follow-up decreased further in subjects with CRS than in those without CRS (P=0.009). Especially, in the initial dementia group, there was a significant between-group difference in the MMSE score from baseline to follow-up (13.6±4.3 to 11.1±6.3 in CRS group vs. 13.5±3.3 to 14.4±5.4 in no CRS group, P=0.002).

CONCLUSION

The result of the present study implies a potential association between CRS and progression of cognitive decline. Physicians should be aware of this possibility in patients with clinically diagnosed CRS.

摘要

目的

慢性炎症性疾病与认知功能衰退之间的关系仍不明确，但越来越多的证据支持全身炎症所起的作用。本研究的目的是调查痴呆或轻度认知障碍（MCI）中的慢性鼻窦炎（CRS）是否与认知功能衰退的进展相关。

材料与方法

我们回顾性分析了2006年1月至2019年4月期间主诉记忆障碍并接受脑磁共振成像（MRI）检查的患者数据。根据简易精神状态检查表（MMSE）评分，将受试者（n = 661）分为三组：痴呆（≤17分）、MCI（18 - 23分）和正常（≥24分）。根据使用脑MRI的Lund - Mackay评分系统，CRS被定义为总分大于或等于4分。多项逻辑回归分析估计了CRS与痴呆或MCI之间关联的调整优势比（aOR）。在有随访MMSE数据的受试者（n = 286）中，采用重复测量方差分析来评估有CRS组和无CRS组之间MMSE评分变化的差异。

结果

根据初始MMSE评分，有221名痴呆受试者、195名MCI受试者和245名结果正常的受试者。CRS与痴呆无显著关联（aOR = 1.519，CI = 0.909 - 2.538，P = 0.111），而与MCI有提示性关联（aOR = 1.740，CI = 1.041 - 2.906，P = 0.034）。随访时，有CRS的受试者的MMSE评分比无CRS的受试者下降得更多（P = 0.009）。特别是，在初始痴呆组中，从基线到随访的MMSE评分存在显著的组间差异（CRS组从13.6±4.3降至11.1±6.3，无CRS组从13.5±3.3升至14.4±5.4，P = 0.002）。