An ironic tragedy: are spouses of persons with dementia at higher risk for dementia than spouses of persons without dementia?
An ironic tragedy: are spouses of persons with dementia at higher risk for dementia than spouses of persons without dementia?
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具有讽刺意味的悲剧：痴呆症患者的配偶患痴呆症的风险是否比非痴呆症患者的配偶更高？
DOI：
10.1111/j.1532-5415.2010.02843.x
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发表时间：
2010
影响因子：
6.3
通讯作者：
Vitaliano,PeterP
中科院分区：
文献类型：
--
作者：
Vitaliano,PeterP
这一期的Jags包括Norton等人(2010)1的一篇论文，该论文报告称，即使在控制了痴呆症的重要风险因素后，痴呆症患者的配偶患痴呆症的风险也比非痴呆者的配偶高600%。作者解释了他们的挑衅性发现，使用了三个以前用来理解痴呆症患者的配偶比非痴呆症患者的配偶更高的健康问题风险的论点。这些包括分类交配、共同的生活方式和照顾。然而，没有提供护理者的数据来支持他们的论点(例如，护理时间、护理时间、护理者痛苦、健康习惯和健康问题)；而且这项研究并不是为了检验护理者是痴呆症的危险因素的假设。尽管有这些限制，许多痴呆症患者的配偶可能是照顾者；尽管不可能进行调解分析来解释这项研究的结果，但文献包括了几个照顾者结果，这些结果可以被假设为观察到痴呆症患者配偶患痴呆症风险更高的原因。数千篇文章报告了照顾者比非照顾者更大的心理和/或身体健康问题2，3；然而，直到2003年，才对照顾者和非照顾者的认知进行比较。Norton等人的研究成果。1提供了这项研究的大部分内容来支持他们的发现。重要的是，其中两篇文章观察到照顾者相对于人口统计学上相似的非照顾者的认知能力下降更大，这些差异是由痴呆症的显著变量调节的。照顾者与非照顾者相比，两年来词汇量下降更大的原因是照顾者比非照顾者在肥胖、空腹胰岛素和空腹血糖方面的综合得分更高；照顾者比非照顾者在两年内处理速度下降快4.5%是由照顾者比非照顾者更高的抑郁情绪所调节的。这些样本中的照顾者在自我评估身体功能方面的下降速度也比非照顾者快85%，在控制了研究开始时和重要协变量的功能后。这是由研究开始时的处理速度、研究开始时的处理速度下降到一年后、研究开始时的心理困扰、C-反应蛋白(CRP)以及从研究开始到两年后的CRP增加所调节的。4.
This issue of JAGs includes a paper by Norton et al.(2010) 1 that reports a 600% greater risk of dementia in spouses of persons with dementia relative to spouses of persons without dementia even after controlling for important risk factors for dementia. The authors explain their provocative finding using three arguments previously employed to understand the higher risks of health problems seen in spouses of persons with dementia relative to spouses of persons without dementia. These include assortative mating, a shared life-style, and caregiving. 2 However, no caregiver data are presented to support their argument (eg, hours of care, length of care, caregiver distress, health habits and health problems); and this study was not designed to test the hypothesis that caregiving is a risk factor for dementia. Despite these limitations, many of the spouses of persons with dementia were probably caregivers; and, although it is not possible to conduct mediation analyses to interpret this study’s result, the literature includes several caregiver outcomes that may be postulated as reasons for the observed higher dementia risk in spouses of persons with dementia.Thousands of articles have reported greater psychological and/or physical health problems in caregivers relative to non-caregivers2, 3; however, it was not until 2003 that cognition was compared in caregivers versus non-caregivers. Norton et al. 1 present much of this research to support their finding. Importantly, two of these articles observed greater cognitive decline in caregivers relative to demographically-similar non-caregivers and these differences were mediated by variables salient to dementia. Greater two year decline in vocabulary in caregivers versus non-caregivers was mediated by caregivers having greater composite scores for obesity, fasting insulin, and fasting glucose than non-caregivers; and, a 4.5 faster two-year decline in processing speed in caregivers versus non-caregivers was mediated by higher depressed mood in caregivers than non-caregivers. Caregivers in these samples also declined 85% faster on self-rated physical functioning than did non-caregivers after controlling for functioning at study entry and important covariates. This was mediated by processing speed at study entry, processing speed decline from study entry to one year later, psychological distress at study entry, C-Reactive Protein (CRP) and increases in CRP from study entry to two years later. 4