The Role of Dementia Diagnostic Delay in the Inverse Cancer-Dementia Association.
The Role of Dementia Diagnostic Delay in the Inverse Cancer-Dementia Association.
复制标题
痴呆诊断延迟在癌症-痴呆反向关联中的作用。
DOI：
10.1093/gerona/glab341
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发表时间：
2022
期刊：
影响因子：
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通讯作者：
Mayeda,ElizabethRose
中科院分区：
文献类型：
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作者：
Hayes-Larson,Eleanor;Shaw,Crystal;Ackley,SarahF;Zimmerman,ScottC;Glymour,MMaria;Graff,RebeccaE;Witte,JohnS;Kobayashi,LindsayC;Mayeda,ElizabethRose
背景癌症与痴呆症呈负相关。使用模拟，我们研究了这种负相关是否可以解释痴呆症的诊断时间，包括死亡前痴呆症的诊断和鉴别诊断模式的癌症history.MethodsWe使用多状态马尔可夫模拟模型生成队列65岁，无癌症和痴呆症的基线;在30年内每月对癌症（所有癌症、乳腺癌、前列腺癌和肺癌）、痴呆、痴呆诊断和死亡进行随访。模型没有说明癌症对痴呆症的真正影响，并使用了根据美国人口和队列数据校准的年龄特异性转换率。我们改变了痴呆发作和诊断之间的平均时间间隔，包括癌症史的非鉴别和鉴别延迟，并检查了观察到的癌症对痴呆诊断的影响的发病率比（IRR）。（IRR = 0.98-1.02）和肺癌模型中的显著偏倚（IRR = 0.78）。对于所有癌症类型的差异性痴呆诊断延迟模型，有癌症史的患者与无癌症史的患者相比，痴呆诊断率降低≥20%（额外延迟4.5个月）的模拟场景产生的结果与文献估计一致。较长的痴呆症诊断延迟，在那些癌症和痴呆症的死亡率较高，产生了更多的bias.ConclusionsDelays痴呆症诊断可能发挥作用，在逆癌症-痴呆症的关系，特别是对于更致命的癌症，但中度差异延迟在那些癌症需要充分解释的文献报道的IRR。
BackgroundCancer is inversely associated with dementia. Using simulations, we examined whether this inverse association may be explained by dementia diagnosis timing, including death before dementia diagnosis and differential diagnosis patterns by cancer history.MethodsWe used multistate Markov simulation models to generate cohorts 65 years of age and free of cancer and dementia at baseline; follow-up for incident cancer (all cancers, breast, prostate, and lung cancer), dementia, dementia diagnosis among those with dementia, and death occurred monthly over 30 years. Models specified no true effect of cancer on dementia, and used age-specific transition rates calibrated to U.S. population and cohort data. We varied the average lapse between dementia onset and diagnosis, including nondifferential and differential delays by cancer history, and examined observed incidence rate ratios (IRRs) for the effect of cancer on dementia diagnosis.ResultsNondifferential dementia diagnosis delay introduced minimal bias (IRRs = 0.98–1.02) for all cancer, breast, and prostate models and substantial bias (IRR = 0.78) in lung cancer models. For the differential dementia diagnosis delay model of all cancer types combined, simulation scenarios with ≥20% lower dementia diagnosis rate (additional 4.5-month delay) in those with cancer history versus without yielded results consistent with literature estimates. Longer dementia diagnosis delays in those with cancer and higher mortality in those with cancer and dementia yielded more bias.ConclusionsDelays in dementia diagnosis may play a role in the inverse cancer–dementia relationship, especially for more fatal cancers, but moderate differential delays in those with cancer were needed to fully explain the literature-reported IRRs.