Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA
Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA.
BMJ Open. 2022 Apr 4;12(4):e059317. doi: 10.1136/bmjopen-2021-059317.
Preventing Alzheimer's dementia (AD) fundamentally equates to delaying onset. Thus, we quantified associations of modifiable, psychosocial risk factors to years of delayed onset of dementia.
Two prospective cohorts (n=2860) with negative and positive psychosocial factors measured at baseline (depressive symptoms, neuroticism, cognitive activity).
Religious Orders Study of older priests, nuns and brothers across the USA, initiated in 1994; Rush Memory and Aging Project, of older persons in Chicago area, initiated in 1997.
We conducted annual neurological and neuropsychological assessments to identify AD (n=785 incident cases). We compared age at diagnosis of AD across psychosocial risk factor groups, controlling for confounders, using accelerated failure time models.
We found strong relations of three or more depressive symptoms with age at AD diagnosis; estimated mean age at diagnosis was 86.9 years with significant symptoms versus 92.1 years with no symptoms (p=0.001). In addition, neuroticism was inversely related to age at AD diagnosis; estimated mean age at diagnosis was 88.8 years for the highest neuroticism tertile and 93.1 years in the lowest tertile (p<0.001). Participants with higher cognitive activity (such as reading books) had later AD diagnosis; estimated mean age at diagnosis was 89.2 years for the lowest cognitive activity group and 92.6 years for the highest activity group (p<0.001).
Higher depressive symptoms were associated with 5-year acceleration in AD; higher neuroticism with 4-year acceleration and higher cognitive activity with a 3.5-year delay. To translate findings, prior health services research in the USA indicates delaying dementia 5 years could add 3 years of life and reduce individual costs of care >$60 000. These results provide a rigorous, easily translatable metric for communicating and evaluating the potential public health impact of psychosocial and experiential interventions.
预防阿尔茨海默病（AD）本质上等同于延迟发病。因此，我们量化了可改变的心理社会风险因素与痴呆发病延迟年限的关联。
两个前瞻性队列（n=2860），在基线时测量了消极和积极的心理社会因素（抑郁症状、神经质、认知活动）。
美国各地的宗教秩序研究，涉及老年牧师、修女和兄弟，始于 1994 年；芝加哥地区的 Rush 记忆与衰老项目，始于 1997 年。
我们每年进行神经学和神经心理学评估，以确定 AD（n=785 例新发病例）。我们比较了不同心理社会风险因素组 AD 诊断时的年龄，控制了混杂因素，使用加速失效时间模型。
我们发现，有三个或更多抑郁症状与 AD 诊断年龄有很强的关系；有症状的患者平均诊断年龄为 86.9 岁，无症状的患者为 92.1 岁（p=0.001）。此外，神经质与 AD 诊断年龄呈负相关；神经质最高的 tertile 组平均诊断年龄为 88.8 岁，最低 tertile 组为 93.1 岁（p<0.001）。认知活动较高（如读书）的参与者 AD 诊断较晚；认知活动最低组的平均诊断年龄为 89.2 岁，最高组为 92.6 岁（p<0.001）。
较高的抑郁症状与 AD 发病加速 5 年相关；较高的神经质与发病加速 4 年相关，较高的认知活动与发病延迟 3.5 年相关。为了转化研究结果，美国之前的卫生服务研究表明，痴呆症延迟 5 年可以增加 3 年的寿命，并降低个体护理费用超过 60000 美元。这些结果为沟通和评估心理社会和经验干预对公共卫生的潜在影响提供了一个严格、易于转化的指标。
