School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Sydney, Australia.
J Am Geriatr Soc. 2021 Dec;69(12):3568-3575. doi: 10.1111/jgs.17435. Epub 2021 Sep 17.
This study examined the risk of mortality in older adults with newly detected cognitive impairment or dementia.
Data from the Australian cohort of the ASPirin in Reducing Events in the Elderly (ASPREE) trial were examined. The ASPREE clinical trial compared daily low-dose aspirin to a placebo and involved 16,703 individuals aged 70 years and over, who were without major cognitive impairment, physical disability, or cardiovascular disease at recruitment. During the trial, evidence of cognitive impairment, based on cognitive testing and medical record information, triggered dementia adjudication of participants using DSM-IV criteria. Cox proportional hazard models were used to compare mortality rates across the dementia, trigger-only, and no-trigger groups.
Over a median 4.7-year follow-up period, 806 participants triggered dementia adjudication, with 485 (60.2%) judged to have dementia. Following recruitment, mortality risks were 32.9, 33.6, and 10.8 events per 1000 person-years in the dementia, trigger-no-dementia, and no-trigger groups, respectively. In the fully adjusted model, mortality risks remained higher in the dementia and trigger-no-dementia groups, with hazard ratios of 1.7 (95% CI: 1.3-2.1) and 1.9 (95% CI: 1.5-2.6), respectively. There was no discernible difference between the dementia and trigger-no-dementia groups in mortality rates following recruitment, or following a dementia trigger. These two groups were more likely to die from sepsis, respiratory disease, and dementia, but less likely to die from cancer than the no-trigger group, χ = 161.5, p < 0.001.
ASPREE participants who triggered for a dementia evaluation experienced a substantially higher mortality rate than those who remained cognitively intact. The increase was indistinguishable among persons who met DSM-IV criteria for dementia vs. those who triggered for a dementia evaluation but failed to meet DSM-IV criteria. Future work should investigate whether earlier detection of cognitive decline can be used to identify and prevent early mortality.
本研究旨在探讨新诊断出认知障碍或痴呆的老年人的死亡率风险。
本研究对澳大利亚人群 ASPREE 试验（阿司匹林减少老年人事件试验）的数据进行了分析。ASPREE 临床试验比较了每日低剂量阿司匹林与安慰剂，共纳入了 16703 名年龄在 70 岁及以上、入组时无严重认知障碍、身体残疾或心血管疾病的个体。在试验期间，基于认知测试和医疗记录信息，发现认知障碍的证据会触发参与者根据 DSM-IV 标准进行痴呆症裁决。使用 Cox 比例风险模型比较痴呆症、仅触发和无触发组的死亡率。
在中位 4.7 年的随访期间，806 名参与者触发了痴呆症裁决，其中 485 名（60.2%）被判定患有痴呆症。招募后，痴呆症、触发但无痴呆症和无触发组的死亡率分别为每 1000 人年 32.9、33.6 和 10.8 例。在完全调整的模型中，痴呆症和触发但无痴呆症组的死亡率仍然较高，风险比分别为 1.7（95%CI：1.3-2.1）和 1.9（95%CI：1.5-2.6）。在招募后或痴呆症触发后，痴呆症和触发但无痴呆症组的死亡率没有明显差异。与无触发组相比，这两组更有可能死于败血症、呼吸道疾病和痴呆症，但死于癌症的可能性较小，χ²=161.5，p<0.001。
触发痴呆评估的 ASPREE 参与者的死亡率明显高于认知完整的参与者。在符合 DSM-IV 痴呆症标准的人与触发痴呆评估但不符合 DSM-IV 标准的人之间，这种增加是无法区分的。未来的工作应该研究是否可以更早地发现认知能力下降，以识别和预防早期死亡。
