Chu Che-Sheng, Cheng Shu-Li, Bai Ya-Mei, Su Tung-Ping, Tsai Shih-Jen, Chen Tzeng-Ji, Yang Fu-Chi, Chen Mu-Hong, Liang Chih-Sung
Department of Psychiatry (CSC), Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan; Center for Geriatrics and Gerontology (CSC), Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan; Noninvasive Neuromodulation Consortium for Mental Disorders (CSC), Society of Psychophysiology, Taipei, Taiwan; Graduate Institute of Medicine, College of Medicine (CSC), Kaohsiung Medical University, Kaohsiung, Taiwan.
Department of Nursing (SLC), Mackay Medical College, Taipei, Taiwan.
Am J Geriatr Psychiatry. 2025 Feb;33(2):156-166. doi: 10.1016/j.jagp.2024.07.013. Epub 2024 Jul 26.
The association between specific types of malignancies and the subsequent risk of dementia remains unknown.
A retrospective population-based cohort study based on data from Taiwan National Health Insurance Research Database.
We recruited 32,250 patients who survived malignancies and 322,500 controls between 1998 and 2011 and followed them up until the end of 2013.
Diagnoses of dementia (including Alzheimer's disease (AD), vascular dementia (VaD), and unspecified dementia) was made during the follow-up period. Cox regression analyses were performed after adjusting for potential confounders. A sensitivity analysis was conducted to exclude patients with prodromal dementia.
Cancer survivors were more likely to develop AD (hazard ratio [HR]: 1.68, 95% confidence interval [CI]: 1.38-2.06), unspecified dementia (HR: 1.19, 95% CI: 1.07-1.32), and any dementia (HR: 1.26, 95% CI: 1.16-1.37) compared with controls after adjusting for potential confounders. Importantly, cancers of the digestive and genitourinary organs seem to be associated with AD, unspecified dementia, and any dementia, whereas only malignant neoplasms of the brain are more likely to develop into VaD. Sensitivity analyses after exclusion of the first three or five years of observation and after exclusion of case enrollment before 2009 or 2007 showed consistent findings.
Cancer survivors are at higher risk of subsequent dementia. Different types of cancer survivors may contribute to variable risks of specific dementias. Further studies are necessary to investigate the underlying mechanisms in cancer survivors and patients with dementia.
特定类型恶性肿瘤与后续患痴呆症风险之间的关联尚不清楚。
基于台湾国民健康保险研究数据库的数据进行的一项回顾性人群队列研究。
我们招募了1998年至2011年间32250名恶性肿瘤存活患者和322500名对照，并对他们进行随访直至2013年底。
在随访期间对痴呆症（包括阿尔茨海默病（AD）、血管性痴呆（VaD）和未特定的痴呆症）进行诊断。在调整潜在混杂因素后进行Cox回归分析。进行敏感性分析以排除前驱性痴呆患者。
在调整潜在混杂因素后，癌症存活者比对照更有可能患AD（风险比[HR]：1.68，95%置信区间[CI]：1.38 - 2.06）、未特定的痴呆症（HR：1.19，95% CI：1.07 - 1.32）和任何痴呆症（HR：1.26，95% CI：1.16 - 1.37）。重要的是，消化器官和泌尿生殖器官癌症似乎与AD、未特定的痴呆症和任何痴呆症相关，而只有脑恶性肿瘤更有可能发展为VaD。在排除观察的前三年或五年以及排除2009年或2007年之前的病例入组后进行的敏感性分析显示结果一致。
癌症存活者后续患痴呆症的风险更高。不同类型的癌症存活者可能导致特定痴呆症的风险各异。有必要进一步研究以探究癌症存活者和痴呆症患者的潜在机制。
