Department of Neurology, Center for Brain and Mind Health, Yale University School of Medicine, New Haven, Connecticut, USA.
National Institute of Neurological Disorders and Stroke, Bethesda, Maryland, USA.
Alzheimers Dement. 2024 Oct;20(10):6810-6819. doi: 10.1002/alz.14126. Epub 2024 Sep 4.
Dementia often involves comorbid Alzheimer's and vascular pathology, but their combined impact warrants additional study.
We analyzed the Systolic Blood Pressure Intervention Trial and categorized white matter hyperintensity (WMH) volume into highest versus lowest/mid tertile and the amyloid beta (Aβ)42/40 ratio into lowest versus mid/highest ratio tertile. Using these binary variables, we created four exposure categories: (1) combined low risk, (2) Aβ risk, (3) WMH risk, and (4) combined high risk.
In the cohort of 467 participants (mean age 69.7 ± 7.1, 41.8% female, 31.9% nonwhite or Hispanic) during 4.8 years of follow-up and across the four exposure categories the rates of cognitive impairment were 5.3%, 7.8%, 11.8%, and 22.6%. Compared to the combined low-risk category, the adjusted hazard ratio for cognitive impairment was 4.12 (95% confidence interval, 1.71 to 9.94) in the combined high-risk category.
This study emphasizes the potential impact of therapeutic approaches to dementia prevention that target both vascular and amyloid pathology.
White matter hyperintensity (WMH) and plasma amyloid (Aβ42/40) are additive risk factors for the development of cognitive impairment in the SPRINT MIND trial. Individuals in the high-risk categories of both WMH and Aβ42/40 had a near fivefold increase in risk of cognitive impairment during 4.8 years of follow-up on average. These findings suggest that treatment strategies targeting both vascular health and amyloid burden warrant further research.
痴呆症常伴有阿尔茨海默病和血管病理学的共病，但它们的综合影响需要进一步研究。
我们分析了收缩压干预试验，并将脑白质高信号（WMH）体积分为最高与最低/中三分位，将淀粉样蛋白β（Aβ）42/40 比值分为最低与中/最高三分位。使用这些二分变量，我们创建了四个暴露类别：（1）联合低风险，（2）Aβ 风险，（3）WMH 风险，和（4）联合高风险。
在 467 名参与者的队列中（平均年龄 69.7±7.1，41.8%为女性，31.9%为非白种人或西班牙裔），在 4.8 年的随访期间和四个暴露类别中，认知障碍的发生率分别为 5.3%、7.8%、11.8%和 22.6%。与联合低风险类别相比，在联合高风险类别中，认知障碍的调整后危险比为 4.12（95%置信区间，1.71 至 9.94）。
这项研究强调了针对血管和淀粉样蛋白病理学的痴呆症预防治疗方法的潜在影响。
脑白质高信号（WMH）和血浆淀粉样蛋白（Aβ42/40）是 SPRINT MIND 试验中认知障碍发展的附加危险因素。在平均 4.8 年的随访期间，WMH 和 Aβ42/40 两个高风险类别的个体认知障碍的风险增加近五倍。这些发现表明，针对血管健康和淀粉样蛋白负担的治疗策略值得进一步研究。
