神经病理损伤与体重指数之间的关联独立于认知能力。
The Association Between Neuropathological Lesions and Body Mass Index Is Independent of Cognitive Abilities.
作者信息
Ururahy Raul Dos Reis, do Val Marina Scott, Ciciliati Aline Maria Macagnan, Leite Renata Elaine Paraizo, Paes Vitor Ribeiro, Rodrigues Roberta Diehl, Grinberg Lea Tenenholz, Pasqualucci Carlos Augusto, Jacob Filho Wilson, Suemoto Claudia Kimie
机构信息
Division of Geriatrics - Laboratório de Investigação Médica no Envelhecimento (LIM 66), University of São Paulo Medical School, São Paulo, Brazil.
Escola Politécnica of the University of São Paulo, São Paulo, Brazil.
出版信息
J Alzheimers Dis. 2024;101(3):773-785. doi: 10.3233/JAD-231366.
BACKGROUND
The association of moderate and severe dementia with low body mass index (BMI) is well described, but weight decline seems to also occur in individuals with preclinical neuropathologies. Considering that up to one-fifth of individuals with normal cognition meet the criteria for a dementia-related neuropathological diagnosis, autopsy studies are key to detecting preclinical neurodegenerative and cerebrovascular diseases that could be underlying weight changes.
OBJECTIVE
We investigated the association between dementia-related brain lesions and BMI and evaluated whether the cognitive function was a mediator of this association.
METHODS
In 1,170 participants, sociodemographic data, clinical history, and cognitive post-mortem evaluation were assessed with an informant. Neuropathological evaluation was performed in all cases. Linear regression models were used to investigate the association between neuropathological lesions (exposure variable) and BMI (outcome) adjusted for demographic, clinical, and cognitive variables in the whole sample, and in only those with normal cognition. Corrections for multiple comparisons were performed. In addition, a mediation analysis was performed to investigate the direct and indirect effects of cognitive abilities on the association between neuropathology and BMI.
RESULTS
Individuals with lower BMI had a higher burden of neuropathological lesions and poorer cognitive abilities. Only neurofibrillary tangles (NFT) and neuropathological comorbidity were associated with low BMI, while other neurodegenerative and cerebrovascular lesions were not. NFT were indirectly associated with BMI through cognitive abilities, and also directly, even in participants with normal cognition.
CONCLUSIONS
Neurofibrillary tangles were directly associated with low BMI even in individuals with preclinical Alzheimer's disease.
背景
中度和重度痴呆与低体重指数（BMI）之间的关联已有充分描述，但体重下降似乎也发生在具有临床前神经病理学特征的个体中。鉴于高达五分之一认知正常的个体符合与痴呆相关的神经病理学诊断标准，尸检研究对于检测可能是体重变化潜在原因的临床前神经退行性疾病和脑血管疾病至关重要。
目的
我们研究了与痴呆相关的脑损伤与BMI之间的关联，并评估认知功能是否为这种关联的中介因素。
方法
对1170名参与者，通过 informant 评估社会人口统计学数据、临床病史和认知尸检评估。对所有病例进行神经病理学评估。使用线性回归模型研究神经病理学损伤（暴露变量）与BMI（结果变量）之间的关联，并在整个样本以及仅认知正常的个体中对人口统计学、临床和认知变量进行调整。进行多重比较校正。此外，进行中介分析以研究认知能力对神经病理学与BMI之间关联的直接和间接影响。
结果
BMI较低的个体神经病理学损伤负担较高且认知能力较差。只有神经原纤维缠结（NFT）和神经病理学合并症与低BMI相关，而其他神经退行性和脑血管损伤则不然。NFT通过认知能力与BMI间接相关，并且即使在认知正常的参与者中也直接相关。
结论
即使在临床前阿尔茨海默病患者中，神经原纤维缠结也与低BMI直接相关。
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