老年人癫痫、血管危险因素与认知衰退：心血管健康研究。
Epilepsy, Vascular Risk Factors, and Cognitive Decline in Older Adults: The Cardiovascular Health Study.
机构信息
From the Department of Neurology (H.C., M.S.V.E., A.K.B.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology (M.S.V.E., A.K.B.), Mailman School of Public Health, Columbia University, New York; Department of Neurology (W.T.L.), University of Washington, Seattle; and Department of Public Health (R.H., E.J.H., E.L.T.), Brigham Young University, Provo, UT.
出版信息
Neurology. 2022 Nov 22;99(21):e2346-e2358. doi: 10.1212/WNL.0000000000201187. Epub 2022 Sep 2.
BACKGROUND AND OBJECTIVES
Recent studies have shown that global cognitive ability tends to decline faster over time in older adults (≥65 years) with epilepsy compared with older adults without epilepsy. Scarce data exist about the role of vascular risk factors (VRFs) on cognitive course in epilepsy. We assessed whether the associations of individual VRFs with cognitive trajectory differed depending on the presence of prevalent epilepsy.
METHODS
The Cardiovascular Health Study is a population-based longitudinal cohort study of 5,888 US adults aged ≥65 years. Cognitive function was assessed annually with modified Mini-Mental State Examination (3MS; global cognitive ability) and Digit Symbol Substitution Test (DSST; information processing speed). We used linear mixed models to estimate the individual and joint associations of epilepsy and VRFs with cognitive decline by modeling epilepsy × VRF interactions one by one, each adjusted for all other VRFs considered, including demographics, health behaviors, clinical characteristics, and comorbid diagnoses. From these models, we estimated excess mean cognitive decline due to interaction of epilepsy with each VRF.
RESULTS
We observed excess mean decline in global cognitive ability (3MS) due to interactions of epilepsy with hypertension (6.6 points greater mean 8-year decline than expected if no interaction; 95% CI 1.3-12.0) and with abstaining from alcohol (5.8 points greater than expected; 95% CI 0.3-11.3). We also observed excess mean decline in information processing speed (DSST) due to interactions of epilepsy with prior stroke (18.1 points greater mean 9-year decline than expected; 95% CI 7.6-28.5), with abstaining from alcohol (6.1 points greater than expected; 95% CI 2.5-9.8), and with higher triglyceride levels (2.4 points greater than expected per SD; 95% CI 0.4-4.3).
DISCUSSION
Associations of some VRFs with cognitive decline in older adults are stronger in the presence of epilepsy, suggesting a need for greater attention to vascular protection for preserving brain health in older adults with epilepsy.
背景和目的
最近的研究表明，与无癫痫的老年人相比，患有癫痫的老年人（≥65 岁）的整体认知能力随时间的推移下降得更快。关于血管危险因素（VRF）在癫痫中的认知过程中的作用的数据很少。我们评估了个体 VRF 与认知轨迹的关联是否因是否存在常见的癫痫而有所不同。
方法
心血管健康研究是一项针对 5888 名美国≥65 岁老年人的基于人群的纵向队列研究。每年使用改良的 Mini-Mental State Examination（3MS；整体认知能力）和数字符号替代测试（DSST；信息处理速度）评估认知功能。我们使用线性混合模型来估计癫痫和 VRF 与认知下降的个体和联合关联，通过逐个建模癫痫×VRF 相互作用，每个模型都调整了所有其他考虑的 VRF，包括人口统计学、健康行为、临床特征和合并诊断。从这些模型中，我们估计了由于癫痫与每个 VRF 的相互作用而导致的认知下降的平均额外差异。
结果
我们观察到由于癫痫与高血压（8 年平均下降差异为 6.6 点，高于无相互作用时的预期；95%CI 1.3-12.0）和戒酒（5.8 点高于预期；95%CI 0.3-11.3）之间的相互作用而导致整体认知能力（3MS）的平均下降差异较大。我们还观察到由于癫痫与既往中风（9 年平均下降差异为 18.1 点，高于预期；95%CI 7.6-28.5）、戒酒（6.1 点高于预期；95%CI 2.5-9.8）和高甘油三酯水平（每标准差增加 2.4 点，高于预期；95%CI 0.4-4.3）之间的相互作用而导致信息处理速度（DSST）的平均下降差异较大。
讨论
在老年人中，一些 VRF 与认知能力下降的关联在存在癫痫时更强，这表明需要更加关注血管保护，以保护患有癫痫的老年人的大脑健康。
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