From the Framingham Heart Study (M.S., A.S.B., J.J.H., S.S.); Department of Neurology (M.S., A.S.B., J.J.H., S.S.), Boston University School of Medicine; Department of Biostatistics (A.S.B., J.J.H.), Boston University School of Public Health, MA; Department of Neurology (T.J.P.), Yale University School of Medicine, New Haven, CT; Department of Neurology (O.D., D.F.), NYU Grossman School of Medicine, New York, NY; and University of Texas Health Sciences Center (S.S.), San Antonio. Dr. Himali is currently affiliated with the Department of Population Health Sciences, University of Texas Health Science Center, San Antonio.
Neurology. 2020 Dec 15;95(24):e3241-e3247. doi: 10.1212/WNL.0000000000011077. Epub 2020 Oct 23.
To assess the risk of incident epilepsy among participants with prevalent dementia and the risk of incident dementia among participants with prevalent epilepsy in the Framingham Heart Study (FHS).
We analyzed prospectively collected data in the Original and Offspring FHS cohorts. To determine the risk of developing epilepsy among participants with dementia and the risk of developing dementia among participants with epilepsy, we used separate, nested, case-control designs and matched each case to 3 age-, sex- and FHS cohort-matched controls. We used Cox proportional hazards regression analysis, adjusting for sex and age. In secondary analysis, we investigated the role of education level and ε4 allele status in modifying the association between epilepsy and dementia.
A total of 4,906 participants had information on epilepsy and dementia and dementia follow-up after age 65. Among 660 participants with dementia and 1,980 dementia-free controls, there were 58 incident epilepsy cases during follow-up. Analysis comparing epilepsy risk among dementia cases vs controls yielded a hazard ratio (HR) of 1.82 (95% confidence interval 1.05-3.16, = 0.034). Among 43 participants with epilepsy and 129 epilepsy-free controls, there were 51 incident dementia cases. Analysis comparing dementia risk among epilepsy cases vs controls yielded a HR of 1.99 (1.11-3.57, = 0.021). In this group, among participants with any post-high school education, prevalent epilepsy was associated with a nearly 5-fold risk for developing dementia (HR 4.67 [1.82-12.01], = 0.001) compared to controls of the same educational attainment.
There is a bi-directional association between epilepsy and dementia. with either condition carrying a nearly 2-fold risk of developing the other when compared to controls.
在弗雷明汉心脏研究（Framingham Heart Study，FHS）中，评估有显性痴呆的参与者新发癫痫的风险，以及有显性癫痫的参与者新发痴呆的风险。
我们分析了原始和后代 FHS 队列中前瞻性收集的数据。为了确定有痴呆的参与者中发生癫痫的风险，以及有癫痫的参与者中发生痴呆的风险，我们使用了单独的、嵌套的病例对照设计，将每个病例与 3 名年龄、性别和 FHS 队列相匹配的对照相匹配。我们使用 Cox 比例风险回归分析，调整了性别和年龄。在二次分析中，我们研究了教育水平和 ε4 等位基因状态在修饰癫痫与痴呆之间的关联中的作用。
共有 4906 名参与者有关于癫痫和痴呆以及 65 岁后痴呆随访的信息。在 660 名有痴呆的参与者和 1980 名无痴呆的对照者中，有 58 例在随访期间发生了新发癫痫。比较痴呆病例与对照者的癫痫风险的分析得出了一个危险比（HR）为 1.82（95%置信区间 1.05-3.16， = 0.034）。在 43 名有癫痫的参与者和 129 名无癫痫的对照者中，有 51 例新发痴呆。比较癫痫病例与对照者的痴呆风险的分析得出了一个 HR 为 1.99（1.11-3.57， = 0.021）。在这一组中，与具有相同教育程度的对照者相比，任何高中后教育的有显性癫痫者发生痴呆的风险几乎增加了 5 倍（HR 4.67 [1.82-12.01]， = 0.001）。
癫痫与痴呆之间存在双向关联。与对照者相比，任何一种情况发生另一种情况的风险都增加了近 2 倍。
