Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, 100191, China.
Institute for Global Health and Development, Peking University, Beijing, China.
BMC Med. 2024 Sep 27;22(1):423. doi: 10.1186/s12916-024-03642-2.
Previous studies only considered the impact of a single physical or psychological disorder on dementia. Our study investigated the association of physical and psychological multimorbidity with dementia among older adults using two multinational prospective cohorts to supplement the limited joint evidence.
We utilized the Health and Retirement Study (HRS 2012 to 2018) in the United States (US) and the Survey of Health, Ageing and Retirement in Europe (SHARE 2012 to 2018). Physical disorder was defined as any one of seven self-reported physician-diagnosed conditions. Psychological disorder was assessed using the 8-item Center for Epidemiologic Research Depression (CES-D) scale or the EURO-D. Dementia was determined through a combination of self-reported physician diagnosis of dementia or Alzheimer's disease, or the 27-point HRS cognitive scale. Competing risk models were utilized to estimate the hazard ratios (HRs) and 95% confidence intervals (95% CI). DerSimonian-Laird random-effects meta-analyses were conducted to obtain pooled estimates.
The prevalence of physical and psychological multimorbidity was 17.29% (1027/5939) in continental Europe and 15.52% (1326/8543) in the US. The incidence of dementia was 6.21 per 1000 person-years in continental Europe and 8.27 per 1000 person-years in the US, respectively. It was highest among participants with physical and psychological multimorbidity in continental Europe (10.46 per 1000 person-years) and the US (14.82 per 1000 person-years), compared with the other three groups. In the univariate model, participants who reported physical and psychological multimorbidity had a higher risk of dementia compared with those who reported no physical and psychological disorders in continental Europe (HR = 2.59; 95% CI: 1.55, 4.33) and the US (HR = 4.11; 95% CI: 2.44, 6.94). After adjusting all covariates, the risk of dementia among participants who reported physical and psychological multimorbidity increased by 86% in continental Europe (aHR = 1.86; 95% CI: 1.08, 3.21) and by 176% in the US (aHR = 2.76; 95% CI: 1.61, 4.72), respectively. After pooling the outcomes, the risk of dementia among participants who reported physical and psychological multimorbidity increased by 115% (aHR = 2.15; 95% CI: 1.27, 3.03).
Physical and psychological multimorbidity was prevalent among older adults in the US and continental Europe. Given the consistent associations with dementia, it is imperative to increase awareness of the links and recognize the limitations of single-disorder care. Specific attention should be given to providing care coordination.
之前的研究仅考虑了单一身体或心理障碍对痴呆症的影响。我们的研究使用两个跨国前瞻性队列来补充有限的联合证据，调查了老年人身体和心理多种疾病与痴呆症之间的关联。
我们使用了美国的健康与退休研究（HRS 2012 至 2018 年）和欧洲健康、衰老和退休调查（SHARE 2012 至 2018 年）。身体障碍定义为任何一种七种经医生诊断的疾病。心理障碍使用 8 项流行病学研究抑郁量表（CES-D）或 EURO-D 进行评估。痴呆症通过结合自我报告的痴呆症或阿尔茨海默病的医生诊断，或 HRS 认知量表的 27 分来确定。竞争风险模型用于估计风险比（HR）和 95%置信区间（95%CI）。DerSimonian-Laird 随机效应荟萃分析用于获得汇总估计值。
在欧洲大陆，身体和心理多种疾病的患病率为 17.29%（5939 例中的 1027 例），在美国为 15.52%（8543 例中的 1326 例）。欧洲大陆的痴呆症发病率为每 1000 人年 6.21 例，美国为每 1000 人年 8.27 例。在欧洲大陆和美国，身体和心理多种疾病的参与者中发病率最高（分别为每 1000 人年 10.46 例和每 1000 人年 14.82 例），与其他三组相比。在单变量模型中，与没有身体和心理障碍的参与者相比，报告身体和心理多种疾病的参与者患痴呆症的风险更高，在欧洲大陆（HR=2.59；95%CI：1.55，4.33）和美国（HR=4.11；95%CI：2.44，6.94）。在调整所有协变量后，欧洲大陆报告身体和心理多种疾病的参与者患痴呆症的风险增加了 86%（aHR=1.86；95%CI：1.08，3.21），美国增加了 176%（aHR=2.76；95%CI：1.61，4.72）。汇总结果后，报告身体和心理多种疾病的参与者患痴呆症的风险增加了 115%（aHR=2.15；95%CI：1.27，3.03）。
身体和心理多种疾病在美欧老年人群中很普遍。鉴于与痴呆症的一致关联，必须提高对这些关联的认识，并认识到单一疾病护理的局限性。应特别注意提供护理协调。
