Pathological correlates of dementia in a longitudinal, population-based sample of aging
Pathological correlates of dementia in a longitudinal, population-based sample of aging
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DOI：
10.1002/ana.21208
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发表时间：
2007-10-01
影响因子：
11.2
通讯作者：
Montine, Thomas J.
中科院分区：
文献类型：
--
作者：
Sonnen, Joshua A.;Larson, Eric B.;Montine, Thomas J.
目的：之前发表的基于社区或人群的尸检脑老化和痴呆研究仅限于单一性别、单一种族、罗马天主教神职人员或集中病理评估。我们的目标是确定与典型美国人群中的痴呆症相关的独立病理相关性。方法：我们评估了成人思想变化研究的尸检数据，该研究是一项正在进行的纵向、基于人群的脑衰老和痴呆症研究。分析基于从约 3,400 名 65 岁或以上的人收集的数据，这些人在加入华盛顿州金县团体健康合作社时认知能力完好。通过加权多变量分析对来自该队列的其他连续尸检（n = 221；死亡人数的 20%）进行评估和分析，以考虑潜在的参与偏差。结果：调整年龄、性别、教育程度和 APOE 后，痴呆症的独立相关性（相对风险，95% 置信区间；总体 p 值）包括 Braak 分期（V/VI 与 0/I/II：5.89， 1.62-17.60； p < 0.05）、标准化切片中脑微梗死的数量（> 2 与无：4.80、1.91-10.26；p < 0.001）和新皮质路易体（有与无：5.08、1.37-18.96；P < 0.05）。这三个过程的调整后人群归因风险估计为：布拉克阶段为 45%，微梗塞为 33%，新皮质路易体为 10%。 解释：我们的结果强调了阿尔茨海默病和路易体疾病的治疗必要性，并提供证据支持立即使用针对脑微梗塞的策略作为部分缓解的方法。 预防或延缓痴呆症的发作。
Objective: Previously published community- or population-based studies of brain aging and dementia with autopsy were restricted to a single sex, a single ethnic group, Roman Catholic clergy, or focused pathological assessments. Our goal was to determine the independent pathological correlates associated with dementia in a typical US population.Methods: We evaluated autopsy data from the Adult Changes in Thought study, an ongoing longitudinal, population-based study of brain aging and dementia. Analyses were based on data collected from about 3,400 people 65 years or older who were cognitively intact at the time of enrollment in the Group Health Cooperative in King County, Washington. Alt consecutive autopsies (n = 221; 20% of deaths) from this cohort were evaluated and analyzed by weighted multivariate analysis to account for potential participation bias.Results: After adjusting for age, sex, education, and APOE, independent correlates of dementia (relative risk, 95% confidence interval; overall p value) included Braak stage (V/VI vs 0/I/II: 5.89, 1.62-17.60; p < 0.05), number of cerebral microinfarcts in standardized sections (> 2 vs none: 4.80, 1.91-10.26; p < 0.001), and neocortical Lewy bodies (any vs none: 5.08, 1.37-18.96; P < 0.05). Estimates of adjusted population attributable risk for these three processes were 45% for Braak stage, 33% for microinfarcts, and 10% for neocortical Lewy bodies.Interpretation: Our results underscore the therapeutic imperative for Alzheimer's and Lewy body diseases, and provide evidence to support the immediate use of strategies that target cerebral microinfarcts as a means to partially prevent or delay the onset of dementia.