Department of Neurology and Institute of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, Shanghai, China.
Department of Neurology, Qingdao Municipal Hospital Group, Qingdao University, Qingdao, China.
J Affect Disord. 2022 Oct 1;314:160-167. doi: 10.1016/j.jad.2022.07.008. Epub 2022 Jul 19.
Dementia and cognitive impairment can be attributed to genetic and modifiable factors. Considerable evidence emerged in modifiable factors and urgently requires standardized evaluation. We conducted an umbrella review to evaluate the strength and validity of the existing evidence.
We searched PubMed, Embase, CINAHL and Cochrane Database of Systematic Reviews to identify relevant systematic reviews and meta-analyses of prospective studies regarding the associations of dementia and cognitive impairment with modifiable factors. For each association, we analyzed the summary effect size, 95 % confidence interval, 95 % prediction interval, heterogeneity, small study effect and excess significance bias. Mendelian randomization studies were descriptively reviewed further exploring the causality of the associations.
In total, 12,015 articles were identified, of which 118 eligible studies yielded 243 unique associations. Convincing evidence was found for associations of dementia and cognitive impairment with early-life education, midlife to late-life plasma glucose, BMI, atrial fibrillation, benzodiazepine use, and gait speed. Suggestive to highly suggestive evidence was found for that of midlife to late-life blood pressure, homocysteine, cerebrovascular diseases, hearing impairment, respiratory illness, anemia, smoking, alcohol consumption, diet, sleep, physical activity and social engagement. Among convincing evidence, Mendelian randomization studies verified causal relationships of education and plasma glucose with Alzheimer's disease.
Low quality of the studies included.
Modifiable risk factors identified in this study, especially those with high-level evidence, should be considered in dementia prevention. Our results support a valuable rationale for future experimental designs to establish further evidence for the associations in larger populations.
痴呆和认知障碍可归因于遗传和可改变的因素。大量证据表明，可改变的因素具有重要意义，迫切需要进行标准化评估。我们进行了一项伞式综述，以评估现有证据的强度和有效性。
我们检索了 PubMed、Embase、CINAHL 和 Cochrane 系统评价数据库，以确定与痴呆和认知障碍与可改变因素相关的前瞻性研究的系统评价和荟萃分析。对于每种关联，我们分析了汇总效应大小、95%置信区间、95%预测区间、异质性、小样本效应和过度显著性偏差。进一步进行了孟德尔随机化研究，以探讨关联的因果关系。
共检索到 12015 篇文章，其中 118 篇符合条件的研究产生了 243 个独特的关联。有确凿证据表明痴呆和认知障碍与早年教育、中年至晚年血浆葡萄糖、BMI、房颤、苯二氮䓬类药物使用和步态速度有关。有提示到高度提示性证据表明中年至晚年血压、同型半胱氨酸、脑血管疾病、听力障碍、呼吸道疾病、贫血、吸烟、饮酒、饮食、睡眠、身体活动和社会参与有关。在有确凿证据的关联中，孟德尔随机化研究验证了教育和血浆葡萄糖与阿尔茨海默病的因果关系。
纳入研究的质量较低。
本研究确定的可改变风险因素，尤其是那些具有高水平证据的因素，应在痴呆预防中加以考虑。我们的结果为在更大人群中进一步确定这些关联的证据提供了有价值的理由，支持未来的实验设计。
