创伤性脊髓损伤与早发性和晚发性阿尔茨海默病及相关痴呆的风险：大型纵向研究。
Traumatic Spinal Cord Injury and Risk of Early and Late Onset Alzheimer's Disease and Related Dementia: Large Longitudinal Study.
机构信息
Department of Family Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI; Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, MI.
Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, MI.
出版信息
Arch Phys Med Rehabil. 2021 Jun;102(6):1147-1154. doi: 10.1016/j.apmr.2020.12.019. Epub 2021 Jan 27.
OBJECTIVE
Traumatic spinal cord injury (TSCI) is a life altering event most often causing permanent physical disability. Little is known about the risk of developing Alzheimer disease and related dementia (ADRD) among middle-aged and older adults living with TSCI. Time to diagnosis of and adjusted hazard for ADRD was assessed.
DESIGN
Cohort study.
SETTING
Using 2007-2017 claims data from the Optum Clinformatics Data Mart, we identified adults (45+) with diagnosis of TSCI (n=7019). Adults without TSCI diagnosis were included as comparators (n=916,516). Using age, sex, race/ethnicity, cardiometabolic, psychological, and musculoskeletal chronic conditions, US Census division, and socioeconomic variables, we propensity score matched persons with and without TSCI (n=6083). Incidence estimates of ADRD were compared at 4 years of enrollment. Survival models were used to quantify unadjusted, fully adjusted, and propensity-matched unadjusted and adjusted hazard ratios (HRs) for incident ADRD.
PARTICIPANTS
Adults with and without TSCI (N=6083).
INTERVENTION
Not applicable.
MAIN OUTCOMES MEASURES
Diagnosis of ADRD.
RESULTS
Both middle-aged and older adults with TSCI had higher incident ADRD compared to those without TSCI (0.5% vs 0.2% and 11.7% vs 3.3% among 45-64 and 65+ y old unmatched cohorts, respectively) (0.5% vs 0.3% and 10.6% vs 6.2% among 45-64 and 65+ y old matched cohorts, respectively). Fully adjusted survival models indicated that adults with TSCI had a greater hazard for ADRD (among 45-64y old: unmatched HR: 3.19 [95% confidence interval, 95% CI, 2.30-4.44], matched HR: 1.93 [95% CI, 1.06-3.51]; among 65+ years old: unmatched HR: 1.90 [95% CI, 1.77-2.04], matched HR: 1.77 [1.55-2.02]).
CONCLUSIONS
Adults with TSCI are at a heightened risk for ADRD. Improved clinical screening and early interventions aiming to preserve cognitive function are of paramount importance for this patient cohort.
目的
外伤性脊髓损伤（TSCI）是一种改变生活的事件，通常导致永久性身体残疾。对于中年和老年人患有 TSCI 后发生阿尔茨海默病及相关痴呆症（ADRD）的风险知之甚少。评估了 ADRD 的诊断时间和调整后的发病风险。
设计
队列研究。
地点
我们使用 2007-2017 年来自 Optum Clinformatics Data Mart 的索赔数据，从该数据库中确定了患有 TSCI 的成年人（45+岁）（n=7019）。未诊断为 TSCI 的成年人被作为对照组纳入（n=916516）。我们使用年龄、性别、种族/民族、心血管代谢、心理和肌肉骨骼慢性疾病、美国人口普查区和社会经济变量，对患有和不患有 TSCI 的成年人进行了倾向评分匹配（n=6083）。在入组后 4 年比较 ADRD 的发生率估计值。使用生存模型来量化未调整、完全调整和倾向评分匹配的未调整和调整后的 ADRD 发病风险比（HR）。
参与者
患有和不患有 TSCI 的成年人（n=6083）。
干预措施
无。
主要观察指标
ADRD 的诊断。
结果
与没有 TSCI 的成年人相比，中年和老年 TSCI 患者的 ADRD 发病率更高（45-64 岁和 65 岁以上未匹配队列中分别为 0.5% vs 0.2%和 11.7% vs 3.3%，45-64 岁和 65 岁以上匹配队列中分别为 0.5% vs 0.3%和 10.6% vs 6.2%）。完全调整后的生存模型表明，患有 TSCI 的成年人发生 ADRD 的风险更高（45-64 岁时：未匹配 HR：3.19[95%置信区间，95%CI，2.30-4.44]，匹配 HR：1.93[95%CI，1.06-3.51]；65 岁以上时：未匹配 HR：1.90[95%CI，1.77-2.04]，匹配 HR：1.77[1.55-2.02]）。
结论
患有 TSCI 的成年人发生 ADRD 的风险更高。对于这一患者群体，提高临床筛查和旨在保护认知功能的早期干预措施非常重要。
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