Schofield P W, Tang M, Marder K, Bell K, Dooneief G, Chun M, Sano M, Stern Y, Mayeux R
Gertrude H Sergievsky Center, Columbia University, New York City 10032, USA.
J Neurol Neurosurg Psychiatry. 1997 Feb;62(2):119-24. doi: 10.1136/jnnp.62.2.119.
To evaluate a history of remote head injury as a risk factor for subsequent dementia due to Alzheimer's disease.
271 participants of a community based longitudinal study of aging in north Manhattan without evidence of significant cognitive impairment were interrogated for a history of head injury on two occasions at entry into the study. The examining physician sought a history of head injury with loss of conciousness. Independently, a risk factor interviewer inquired about a history of head injury with loss of consiousness or amnesia, the duration of any loss of consiousness, and the date of the head injury. Patients were followed up with standardised annual evaluations for up to five years to determine the first occurrence of dementia.
Over the course of the study incident dementia due to probable or possible Alzheimer's disease was diagnosed in 39 patients. Cox proportional hazards modelling showed that a history of head injury with loss of consiousness reported to the physician was associated with earlier onset of dementia due to Alzheimer's disease (relative risk (RR) = 4.1, 95% confidence interval (95% CI) 1.3-12.7). head injury with loss of consiousness or amnesia reported to the risk factor interviewer was not significantly associated with earlier onset of Alzheimer's disease overall (RR 2.0, 95% CI 0.7-6.2), but those who reported loss of consiousness exceeding five minutes were at significantly increased risk (RR 11.2, 95% CI 2.3-59.8). Incident Alzheimer's disease was significantly associated with head injury which occurred within the preceding 30 years (RR 5.4, 95% CI 1.5-19.5).
The results of this cohort study are consistent with the findings of several case-control studies suggesting that head injury may be a risk factor for Alzheimer's disease.
评估既往头部外伤史作为后续患阿尔茨海默病所致痴呆症的危险因素。
对曼哈顿北部一项基于社区的老龄化纵向研究中的271名参与者进行了调查，这些参与者在进入研究时没有明显认知障碍的证据，在研究开始时两次询问他们的头部外伤史。检查医生询问有无头部外伤伴意识丧失的病史。独立地，一名危险因素访谈员询问有无头部外伤伴意识丧失或失忆、任何意识丧失的持续时间以及头部外伤的日期。对患者进行长达五年的标准化年度评估随访，以确定痴呆症的首次发生情况。
在研究过程中，39名患者被诊断为可能或疑似阿尔茨海默病所致的新发痴呆症。Cox比例风险模型显示，向医生报告的有头部外伤伴意识丧失的病史与阿尔茨海默病所致痴呆症的较早发病相关（相对风险（RR）=4.1，95%置信区间（95%CI）1.3 - 12.7）。向危险因素访谈员报告的有头部外伤伴意识丧失或失忆的情况总体上与阿尔茨海默病的较早发病无显著关联（RR 2.0，95%CI 0.7 - 6.2），但那些报告意识丧失超过五分钟的人风险显著增加（RR 11.2，95%CI 2.3 - 59.8）。新发阿尔茨海默病与前30年内发生的头部外伤显著相关（RR 5.4，95%CI 1.5 - 19.5）。
这项队列研究的结果与几项病例对照研究的结果一致，表明头部外伤可能是阿尔茨海默病的一个危险因素。
