Cognitive and social activities and long-term dementia risk: the prospective UK Million Women Study.
Cognitive and social activities and long-term dementia risk: the prospective UK Million Women Study.
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DOI：
10.1016/s2468-2667(20)30284-x
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发表时间：
2021-03
期刊：
影响因子：
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通讯作者：
Beral V
中科院分区：
文献类型：
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作者：
Floud S;Balkwill A;Sweetland S;Brown A;Reus EM;Hofman A;Blacker D;Kivimaki M;Green J;Peto R;Reeves GK;Beral V
尽管痴呆症与不参与认知和社会活动有关，但这种联系可能只反映了痴呆症的后果，而不是不参与对随后的痴呆症发病率的任何直接影响。由于痴呆症的发展缓慢，对任何此类直接影响的公正评估必须将不参与此类活动与多年后的痴呆症发现率联系起来。具有长期后续行动的前瞻性研究可以通过分别分析第一个和第二个后续行动十年来帮助实现这一目标。我们报告了对一项为期20年的大型研究的分析。英国百万女性研究是一项基于人群的前瞻性研究，邀请130万女性在1998年的中位数年(IQR 1997-1999)接受国民健康服务(NHS)乳腺癌筛查。在2001年的中位数(IQR 2001-2003年)，妇女被问及参加成人教育、艺术、手工艺或音乐团体和志愿工作的情况，而在2006年的中位数(IQR 2006-2006)，她们被问及阅读问题。所有参与者都通过电子链接跟踪NHS的住院记录，并提到痴呆症，第一次提到痴呆症是主要结果。比较没有参加某项活动与参加某项活动的情况，我们在获得有关该活动的信息后，使用COX回归评估0-4年、5-9年和10年或更长时间内完全调整后的痴呆症风险比(RR)。2001年，平均年龄为60岁(SD 5)的851名 307名妇女提供了关于参加成人教育、艺术、手工艺或音乐团体以及志愿工作的信息。10年后，仅有95 91例(1%)失访，789例 339例(93%)存活，无痴呆记录。平均随访16年(SD3)，其中31例(4%) 至少入院一次并提及痴呆，其中25例(3%)在随访开始后10年或以上首次提及痴呆入院( 636)。只有在参与记录后的头十年，没有参与认知或社会活动才与较高的痴呆症检测相对风险有关。在第二个十年里，几乎没有什么联系。没有参加成人教育(RR 1·04，99%CI 0·98-1·09)，没有参加艺术、工艺或音乐团体(RR 1·04，0·99-1·09)，没有参加志愿工作(RR 0·96，0·92-1·00)，或这三项中的任何一项(RR 0·99，0·95-1·03)，都是如此。2006年，655名 118名妇女提供了阅读方面的信息。不阅读与任何阅读相比，与痴呆症有类似的关联，同样是自阅读被记录以来随着时间的推移而强烈衰减，但需要更长的随访时间才能可靠地评估这一点。生活必须向前看，但只有向后看才能理解。早在痴呆症被诊断出来之前，各种精神和体力活动就会逐渐减少，但这主要是因为它的逐渐发作会导致缺乏活动，而不是因为缺乏活动会导致痴呆症。英国医学研究理事会，英国癌症研究中心。
Although dementia is associated with non-participation in cognitive and social activities, this association might merely reflect the consequences of dementia, rather than any direct effect of non-participation on the subsequent incidence of dementia. Because of the slowness with which dementia can develop, unbiased assessment of any such direct effects must relate non-participation in such activities to dementia detection rates many years later. Prospective studies with long-term follow-up can help achieve this by analysing separately the first and second decade of follow-up. We report such analyses of a large, 20-year study. The UK Million Women Study is a population-based prospective study of 1·3 million women invited for National Health Service (NHS) breast cancer screening in median year 1998 (IQR 1997–1999). In median year 2001 (IQR 2001–2003), women were asked about participation in adult education, groups for art, craft, or music, and voluntary work, and in median year 2006 (IQR 2006–2006), they were asked about reading. All participants were followed up through electronic linkage to NHS records of hospital admission with mention of dementia, the first mention of which was the main outcome. Comparing non-participation with participation in a particular activity, we used Cox regression to assess fully adjusted dementia risk ratios (RRs) during 0–4, 5–9, and 10 or more years, after information on that activity was obtained. In 2001, 851 307 women with a mean age of 60 years (SD 5) provided information on participation in adult education, groups for art, craft, or music, and voluntary work. After 10 years, only 9591 (1%) had been lost to follow-up and 789 339 (93%) remained alive with no recorded dementia. Follow-up was for a mean of 16 years (SD 3), during which 31 187 (4%) had at least one hospital admission with mention of dementia, including 25 636 (3%) with a hospital admission with dementia mentioned for the first time 10 years or more after follow-up began. Non-participation in cognitive or social activities was associated with higher relative risks of dementia detection only during the first decade after participation was recorded. During the second decade, there was little association. This was true for non-participation in adult education (RR 1·04, 99% CI 0·98–1·09), in groups for art, craft, or music (RR 1·04, 0·99–1·09), in voluntary work (RR 0·96, 0·92–1·00), or in any of these three (RR 0·99, 0·95–1·03). In 2006, 655 118 women provided information on reading. For non-reading versus any reading, there were similar associations with dementia, again with strong attenuation over time since reading was recorded, but longer follow-up is needed to assess this reliably. Life has to be lived forwards, but can be understood only backwards. Long before dementia is diagnosed, there is a progressive reduction in various mental and physical activities, but this is chiefly because its gradual onset causes inactivity and not because inactivity causes dementia. UK Medical Research Council, Cancer Research UK.