Association between dementia and infectious disease - Evidence from a case-control study
Association between dementia and infectious disease - Evidence from a case-control study
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DOI：
10.1097/01.wad.0000165511.52746.1f
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发表时间：
2005-04-01
影响因子：
2.1
通讯作者：
Holmes, C
中科院分区：
文献类型：
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作者：
Dunn, N;Mullee, M;Holmes, C
炎症在痴呆的病因学中起着一定的作用。这是主要发病机制还是继发反应尚不清楚。我们假设，由于全身性感染可以引起大脑中炎症介质的合成增强，这些疾病可能会促进痴呆症的发病。我们进行了巢式病例对照研究，使用全科医学研究数据库。病例为偶发性痴呆患者，对照组无此类诊断。诊断前四年的感染事件使用诊断代码或抗感染药物的处方代码进行计数。我们考虑了年龄、性别、吸烟、糖尿病和就诊频率作为潜在的混杂因素，共有9954例有效病例和9374例有效对照。与对照组相比，病例平均年龄更大，更可能是女性，吸烟和患有糖尿病。在84岁以上的感染患者中，痴呆的诊断风险增加（与0或1例相比，2例或2例以上感染的OR = 1.4，95% CI 1.2至1.7）。吸烟和糖尿病也显示出显着增加痴呆症的诊断风险。我们已经证明了感染发作和老年痴呆症诊断可能性增加之间的正相关。吸烟和糖尿病与老年痴呆症的发病有关。这项研究的证据可能代表了因果关系，因为有一个可信的生物学解释。
Inflammation plays a part in the etiology of dementia. Whether this is the primary pathogenesis, or a secondary reaction is unclear. We postulate that since systemic infection can provoke the enhanced synthesis of inflammatory mediators in the brain, such diseases may promote the onset of dementia.We carried out a nested case-control study using the General Practice Research Database. Cases were patients with incident dementia, and controls without such a diagnosis. Infectious episodes in the four years preceding diagnosis were counted using diagnostic codes, or prescription codes for anti-infective drugs. We considered age, sex, smoking, diabetes mellitus, and frequency of consultation as potential confounders.There were 9954 valid cases, and 9374 valid controls. Cases were on average older, more likely to be female, to smoke and to have diabetes, than the controls. There was an increased risk of diagnosis of dementia in those patients older than 84 with infections (OR for 2 or more infections compared with 0 or 1 = 1.4, 95% CI 1.2 to 1.7). Smoking and diabetes mellitus were also shown to markedly increase the risk of diagnosis of dementia.We have shown a positive association between episodes of infection and increased likelihood of diagnosis of dementia in the very elderly. Smoking and diabetes mellitus are associated with onset of dementia in the elderly. The evidence from this study may represent cause and effect, since there is a credible biologic explanation.