Department of Pathology, University of Sao Paulo Medical School, Sao Paulo, Brazil.
Physiopathology in Aging Lab/Brazilian Aging Brain Study Group - LIM22, University of Sao Paulo Medical School, Sao Paulo, Brazil.
J Alzheimers Dis. 2023;93(4):1307-1316. doi: 10.3233/JAD-220820.
Coronary atherosclerosis assessed in vivo was associated with cognitive impairment; however, conflicting findings have been reported in autopsy samples.
Our aims were to assess the association between atherosclerotic stenosis in the coronary arteries and cognitive impairment and to investigate the possibility of selection bias in an autopsy study.
Coronary arteries were collected, and the largest luminal stenosis was measured. Sociodemographic, clinical, and cognitive information were reported by a reliable next-of-kin. The association was tested using logistic and linear regressions adjusted for sociodemographic and clinical variables. We restricted the sample to individuals that were born in 1935 or earlier and stratified the analysis by cause of death to investigate the role of selection bias.
In 253 participants (mean age = 78.0±8.5 years old, 48% male), stenosis was not associated with cognitive impairment (OR = 0.85, 95% CI = 0.69; 1.06, p = 0.15). In individuals who were born before 1936 in the absence of cardiovascular disease as the cause of death, greater stenosis was associated with cognitive impairment (OR = 4.02, 95% CI = 1.39; 11.6, p = 0.01). On the other hand, this association was not present among those born in 1935 or earlier who died of cardiovascular diseases (OR = 0.83, 95% CI = 0.60; 1.16, p = 0.28).
We found that higher coronary stenosis was associated with cognitive impairment only in individuals born in 1935 or earlier and who had not died from cardiovascular diseases. Selection bias may be an important issue when investigating risk factors for chronic degenerative diseases in older individuals using autopsy samples.
体内评估的冠状动脉粥样硬化与认知障碍有关；然而，尸检样本的研究结果存在冲突。
本研究旨在评估冠状动脉粥样硬化狭窄与认知障碍之间的关系，并探讨尸检研究中可能存在的选择偏倚。
收集冠状动脉并测量最大管腔狭窄度。可靠的亲属报告社会人口学、临床和认知信息。使用逻辑回归和线性回归调整社会人口学和临床变量来检验相关性。我们将样本限制在出生于 1935 年或更早的个体，并按死亡原因进行分层分析，以研究选择偏倚的作用。
在 253 名参与者（平均年龄 78.0±8.5 岁，48%为男性）中，狭窄程度与认知障碍无关（OR=0.85，95%CI=0.69；1.06，p=0.15）。在没有心血管疾病作为死亡原因的情况下，出生于 1936 年之前的个体中，较大的狭窄程度与认知障碍相关（OR=4.02，95%CI=1.39；11.6，p=0.01）。另一方面，在出生于 1935 年或更早且死于心血管疾病的个体中，这种相关性并不存在（OR=0.83，95%CI=0.60；1.16，p=0.28）。
我们发现，只有在出生于 1935 年或更早且没有死于心血管疾病的个体中，较高的冠状动脉狭窄程度与认知障碍相关。在使用尸检样本研究老年个体慢性退行性疾病的危险因素时，选择偏倚可能是一个重要问题。
