Association of Hospitalization, Critical Illness, and Infection with Brain Structure in Older Adults.
Association of Hospitalization, Critical Illness, and Infection with Brain Structure in Older Adults.
复制标题
DOI：
10.1111/jgs.15470
复制
发表时间：
2018-10
影响因子：
6.3
通讯作者：
Brown CH 4th
中科院分区：
文献类型：
--
作者：
Walker KA;Gottesman RF;Wu A;Knopman DS;Mosley TH Jr;Alonso A;Kucharska-Newton A;Brown CH 4th
住院、危重病和感染都与认知能力下降和痴呆症有关。然而，这些医院事件与老年人潜在脑异常的相关程度尚不清楚。在社区动脉粥样硬化风险研究（ARIC）中，我们研究了住院治疗，危重病和感染与老年人大脑结构异常之间的关系。在24年的监测期内，对当地医院和年度参与者联系进行了积极监测，以收集所有ARIC参与者的住院信息（包括ICD-9代码）。随后，一部分参与者接受了3 T脑MRI，以量化总脑体积和局部脑体积、白色高信号（WMH）体积和白色微结构完整性（通过扩散张量成像[DTI]测量的各向异性分数[FA]和平均扩散率[MD]）。在纳入的1，689名参与者中（MRI年龄：76岁），72%住院，4%患有危重病，14%在监测期间发生重大感染。使用协变量调整回归，与未住院相比，住院与WMH体积增加0.12标准差（SD）（95% CI：0.00，0.24）和白色微结构完整性较差（FA降低0.17 SD [CI：-0.27，-0.06]和MD增加0.16 SD [CI：0.07，0.25]）相关。住院次数、脑体积较小和白色完整性较低之间存在剂量依赖性关系（p趋势≤0.048）。在住院的参与者中，危重病与较小的阿尔茨海默病特征区域（-1.64 cm 3，CI：-3.16，-0.12）相关;严重感染与较小的阿尔茨海默病特征区域（-1.28 cm 3，CI：-2.21，-0.35）和较大的心室容积（3.79 cm 3，CI：0.81，6.77）相关。尽管全因住院主要与较低的白色物质完整性相关，但危重病和重大感染与较小的脑体积相关，特别是在与阿尔茨海默病有关的区域内。
Hospitalization, critical illness, and infection have each been linked to cognitive decline and dementia. However, the degree to which these hospital events are associated with underlying brain abnormalities in older adults is less clear. Within the Atherosclerosis Risk in Communities Study (ARIC), we examined the association of hospitalization, critical illness, and infection occurring during middle- and late-life with structural brain abnormalities in older adults. Active surveillance of local hospitals and annual participant contact were used to gather hospitalization information (including ICD-9 codes) on all ARIC participants over a 24-year surveillance period. Subsequently, a subset of participants underwent a 3T brain MRI to quantify total and regional brain volumes, white matter hyperintensity (WMH) volume, and white matter microstructural integrity (fractional anisotropy [FA] and mean diffusivity [MD] as measured by diffusion tensor imaging [DTI]). Of the 1,689 participants included (age at MRI: 76), 72% were hospitalized, 4% had a critical illness, and 14% had a major infection during the surveillance period. Using covariate-adjusted regression, hospitalization, compared to no hospitalization, was associated with 0.12 standard deviation (SD) greater WMH volume (95% CI: 0.00, 0.24) and poorer white matter microstructural integrity (0.17 SD lower FA [CI: −0.27, −0.06] and 0.16 SD greater MD [CI: 0.07, 0.25]). There was a dose-dependent relationship between number of hospitalizations, smaller brain volumes, and lower white matter integrity (p-trends ≤0.048). Among hospitalized participants, critical illness was associated with a smaller Alzheimer’s disease Signature Region (−1.64 cm3, CI: −3.16, −0.12); major infection was associated with both a smaller Alzheimer’s disease Signature Region (−1.28 cm3, CI: −2.21, −0.35) and a larger ventricular volume (3.79 cm3, CI: 0.81, 6.77). Whereas all-cause hospitalization was primarily associated with lower white matter integrity, critical illness and major infection were associated with smaller brain volume, particularly within regions implicated in Alzheimer’s disease.
登录
查看更多内容
DOI：
10.1056/nejmoa1301372
发表时间：
2013-10-03
期刊：
The New England journal of medicine
影响因子：
--
作者：
Pandharipande PP;Girard TD;Jackson JC;Morandi A;Thompson JL;Pun BT;Brummel NE;Hughes CG;Vasilevskis EE;Shintani AK;Moons KG;Geevarghese SK;Canonico A;Hopkins RO;Bernard GR;Dittus RS;Ely EW;BRAIN-ICU Study Investigators
通讯作者：
BRAIN-ICU Study Investigators
DOI：
10.1007/s10552-013-0285-y
发表时间：
2013-12
期刊：
Cancer causes & control : CCC
影响因子：
--
作者：
Prizment AE;Folsom AR;Dreyfus J;Anderson KE;Visvanathan K;Joshu CE;Platz EA;Pankow JS
通讯作者：
Pankow JS
影响因子：
9.9
作者：
Dickerson, B. C.;Stoub, T. R.;deToledo-Morrell, L.
通讯作者：
deToledo-Morrell, L.
影响因子：
6.4
作者：
CANNON, JG;TOMPKINS, RG;DINARELLO, CA
通讯作者：
DINARELLO, CA
影响因子：
2.2
作者：
Qiao Y;Feng H;Zhao T;Yan H;Zhang H;Zhao X
通讯作者：
Zhao X