美国老年女性酒精使用障碍退伍军人痴呆风险增加。

Increased risk of dementia in older female US veterans with alcohol use disorder.

机构信息

Department of Psychiatry, University of California, San Francisco, CA, USA.

Northern California Institute for Research and Education, San Francisco, CA, USA.

出版信息

Addiction. 2021 Aug;116(8):2049-2055. doi: 10.1111/add.15416. Epub 2021 Feb 3.

DOI:10.1111/add.15416

PMID:33449402

Abstract

AIM

To determine whether alcohol use disorder (AUD) is associated with increased dementia risk among older women veterans.

DESIGN

Cohort study.

SETTING

United States.

PARTICIPANTS

Women veterans with AUD aged ≥ 55 years (n = 2207), receiving care from Veterans Health Administration medical centers from October 2004 to September 2015 with one or more follow-up visit and an age-matched sample of women veterans without AUD (n = 2207). Women at baseline with prevalent dementia or AUD in remission were excluded.

MEASUREMENTS

AUD, substance use disorder (SUD), smoking, psychiatric (depression, anxiety, post-traumatic stress disorder, anxiety) and medical comorbidities (diabetes, hypertension, stroke, chronic obstructive pulmonary disorder, traumatic brain disorder) and dementia determined by the International Classification of Diseases, 9th revision, Clinical Modification codes. Cox proportional hazards models were used to determine the association between AUD and dementia risk during follow-up. Sensitivity analyses were performed by excluding women (n = 349) with comorbid SUD and by excluding women (n = 1568) currently smoking.

FINDINGS

Veteran women had a mean [standard deviation (SD)] age of 65.0 (5.6) years at baseline. During follow-up (median 4 years, interquartile range: 2-6) 3.7% of women (n = 82) with AUD developed dementia compared with 1.1% (n = 24) without AUD (P < 0.001). After adjustment for demographics, medical and psychiatric conditions and accounting for different Veteran's Integrated Service Networks, the adjusted hazard ratio (aHR) for dementia was 3.12 (95% CI = 1.90-5.12) for women with AUD compared with women without AUD. After removing women with SUD (aHR = 3.53, 95% CI = 2.13-5.85) and women currently smoking (aHR = 3.80, 95% CI = 2.11-6.84), results were similar.

CONCLUSIONS

Alcohol use disorder among female US veterans aged more than 55 years appears to be associated with a more than threefold increase of dementia.

摘要

目的

确定酒精使用障碍（AUD）是否与老年女性退伍军人的痴呆风险增加有关。

设计

队列研究。

地点

美国。

参与者

年龄≥55 岁的患有 AUD 的女性退伍军人（n=2207），她们在 2004 年 10 月至 2015 年 9 月期间接受退伍军人健康管理局医疗中心的治疗，且有一次或多次随访，以及年龄匹配的无 AUD 的女性退伍军人样本（n=2207）。在基线时患有常见痴呆症或 AUD 缓解的女性被排除在外。

测量

AUD、物质使用障碍（SUD）、吸烟、精神疾病（抑郁、焦虑、创伤后应激障碍、焦虑）和医疗合并症（糖尿病、高血压、中风、慢性阻塞性肺疾病、创伤性脑疾病）和痴呆症，根据国际疾病分类，第九版，临床修正版代码确定。使用 Cox 比例风险模型来确定在随访期间 AUD 与痴呆风险之间的关联。通过排除患有共病 SUD 的女性（n=349）和排除目前吸烟的女性（n=1568）进行敏感性分析。

结果

退伍军人女性的平均（标准差）年龄为 65.0（5.6）岁。在随访期间（中位数为 4 年，四分位间距：2-6），患有 AUD 的女性中有 3.7%（n=82）发生痴呆症，而无 AUD 的女性中为 1.1%（n=24）（P<0.001）。在调整人口统计学、医疗和精神疾病状况并考虑不同退伍军人综合服务网络后，患有 AUD 的女性发生痴呆症的调整后风险比（aHR）为 3.12（95%CI=1.90-5.12），而无 AUD 的女性为 3.12（95%CI=1.90-5.12）。在排除患有 SUD 的女性（aHR=3.53，95%CI=2.13-5.85）和目前吸烟的女性（aHR=3.80，95%CI=2.11-6.84）后，结果相似。