From the Departments of Neurology (E.L.H., G.L.K., M.S.A., K.A.W., R.F.G.), Psychiatry (J.B.), Medicine (S.Y.), and Epidemiology (R.F.G.), Johns Hopkins School of Public Health, Baltimore, MD; Department of Epidemiology (A.K.-N.), University of North Carolina at Chapel Hill; Department of Epidemiology (A.K.-N.), University of Kentucky, Lexington; Department of Neurology (D.S.K.), Mayo Clinic, Rochester; and N. Bud Grossman Center for Memory Research and Care (K.A.V.), Department of Neurology, and Institute for Translational Neuroscience (K.A.V.), University of Minnesota, Minneapolis.
Neurology. 2020 Dec 15;95(24):e3248-e3256. doi: 10.1212/WNL.0000000000011080. Epub 2020 Oct 23.
To determine the risk of dementia after the development of late-onset epilepsy.
We used data from the Atherosclerosis Risk in Communities (ARIC) cohort study, which started in 1987 to 1989 with 15,792 mostly Black and White men and women from 4 US communities. We identified late-onset epilepsy (LOE; seizures starting at age 67 or later) from linked Medicare claims data. We used a Cox proportional hazards regression model to evaluate associations between LOE and dementia through 2017 as ascertained from neuropsychological testing, interviews, and hospital discharge surveillance, and we used multinomial logistic regression to assess the risk of dementia and mild cognitive impairment in the subset with full neuropsychological assessments available. We adjusted for demographics and vascular and Alzheimer disease risk factors.
Of 9,033 ARIC participants with sufficient Medicare coverage data (4,980 [55.1%] female, 1993 [22.1%] Black), 671 met the definition of LOE. Two hundred seventy-nine (41.6%) participants with and 1,408 (16.8%) without LOE developed dementia ( < 0.001). After a diagnosis of LOE, the adjusted hazard ratio for developing subsequent dementia was 3.05 (95% confidence interval 2.65-3.51). The median time to dementia ascertainment after the onset of LOE was 3.66 years (quartile 1-3, 1.28-8.28 years).
The risk of incident dementia is substantially elevated in individuals with LOE. Further work is needed to explore causes for the increased risk of dementia in this growing population.
确定迟发性癫痫发作后痴呆的风险。
我们使用了来自社区动脉粥样硬化风险（ARIC）队列研究的数据，该研究于 1987 年至 1989 年开始，共有来自美国 4 个社区的 15792 名主要为黑人和白人的男性和女性。我们从医疗保险索赔数据中确定了迟发性癫痫（LOE；发病年龄在 67 岁或以上）。我们使用 Cox 比例风险回归模型，通过 2017 年的神经心理学测试、访谈和医院出院监测来评估 LOE 与痴呆之间的关联，并使用多项逻辑回归来评估在有完整神经心理学评估的亚组中痴呆和轻度认知障碍的风险。我们调整了人口统计学和血管及阿尔茨海默病危险因素。
在具有足够医疗保险覆盖数据的 9033 名 ARIC 参与者中（4980 名女性[55.1%]，1993 名黑人[22.1%]），有 671 人符合 LOE 的定义。279 名（41.6%）有 LOE 和 1408 名（16.8%）无 LOE 的参与者发生了痴呆症（<0.001）。在 LOE 确诊后，随后发生痴呆的调整后的危险比为 3.05（95%置信区间 2.65-3.51）。LOE 发病后痴呆症确定的中位时间为 3.66 年（四分位间距 1-3，1.28-8.28 年）。
LOE 患者发生新发痴呆的风险显著升高。需要进一步研究来探索这一不断增长的人群中痴呆风险增加的原因。
