Circadian Rest-Activity Rhythms, Delirium Risk, and Progression to Dementia.
Circadian Rest-Activity Rhythms, Delirium Risk, and Progression to Dementia.
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DOI：
10.1002/ana.26617
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发表时间：
2023-06
影响因子：
11.2
通讯作者：
Hu, Kun
中科院分区：
文献类型：
--
作者：
Gao, Lei;Li, Peng;Gaykova, Nicole;Zheng, Xi;Gao, Chenlu;Lane, Jacqueline M.;Saxena, Richa;Scheer, Frank A. J. L.;Rutter, Martin K.;Akeju, Oluwaseun;Hu, Kun
谵妄是一种复杂的神经认知综合征，被怀疑与痴呆有双向联系。昼夜节律紊乱可能与痴呆发病有关，但这些紊乱是否与谵妄风险和发展为全因痴呆有关尚不清楚。我们分析了53,417名中年或老年英国生物银行参与者在中位5年随访期间的连续活动记录数据。采用四种测量方法来表征24小时每日休息-活动节律（RARs）：归一化幅度、代表峰值活动时间的顶相、日间稳定性和节律碎片化的日内变异性（IV）。Cox比例风险模型检验了RARs是否预测谵妄（n = 551）和痴呆进展（n = 61）。在调整了年龄、性别、教育程度、认知表现、睡眠持续时间/障碍和合共病等因素后，被抑制的24小时振幅、最低（Q1）与最高（Q4）四分位数（风险比[HR]Q1 vs Q4 = 1.94, 95%可信区间[CI] = 1.53-2.46, p < 0.001）和更碎片化（更高IV: HRQ4 vs Q1 = 1.49, 95% CI = 1.18-1.88, p < 0.001）节律预示着更高的谵妄风险。在无痴呆的患者中，每小时的顶相延迟与谵妄风险相关（HR = 1.13, 95% CI = 1.04-1.23, p = 0.003）。24小时振幅抑制与谵妄发展为新发痴呆的风险增加相关（HR = 1.31, 95% CI = 1.03-1.67，每降低1个标准差p = 0.03）。每日24小时RAR抑制、碎片化和潜在的顶相延迟与谵妄风险相关。在节律抑制的谵妄病例中，随后发展为痴呆的可能性更大。在谵妄之前和痴呆进展之前存在RAR障碍表明，这些障碍可能预示着更高的风险，并参与疾病的早期发病机制。
Delirium is a complex neurocognitive syndrome suspected to be bidirectionally linked to dementia. Circadian rhythm disturbances likely contribute to dementia pathogenesis, but whether these disturbances are related to delirium risk and progression to all-cause dementia is unknown. We analyzed continuous actigraphy data from 53,417 middle-aged or older UK Biobank participants during a median 5 years of follow-up. Four measures were used to characterize the 24-hour daily rest–activity rhythms (RARs): normalized amplitude, acrophase representing the peak activity time, interdaily stability, and intradaily variability (IV) for fragmentation of the rhythm. Cox proportional hazards models examined whether RARs predicted incident delirium (n = 551) and progression to dementia (n = 61). Suppressed 24-hour amplitude, lowest (Q1) versus highest (Q4) quartile (hazard ratio [HR]Q1 vs Q4 = 1.94, 95% confidence interval [CI] = 1.53–2.46, p < 0.001), and more fragmented (higher IV: HRQ4 vs Q1 = 1.49, 95% CI = 1.18–1.88, p < 0.001) rhythms predicted higher delirium risk, after adjusting for age, sex, education, cognitive performance, sleep duration/disturbances, and comorbidities. In those free from dementia, each hour of delayed acrophase was associated with delirium risk (HR = 1.13, 95% CI = 1.04–1.23, p = 0.003). Suppressed 24-hour amplitude was associated with increased risk of progression from delirium to new onset dementia (HR = 1.31, 95% CI = 1.03–1.67, p = 0.03 for each 1-standard deviation decrease). Twenty-four-hour daily RAR suppression, fragmentation, and potentially delayed acrophase were associated with delirium risk. Subsequent progression to dementia was more likely in delirium cases with suppressed rhythms. The presence of RAR disturbances before delirium and prior to progression to dementia suggests that these disturbances may predict higher risk and be involved in early disease pathogenesis.
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影响因子：
11.7
作者：
Gao, Lei;Gaba, Arlen;Li, Peng;Saxena, Richa;Scheer, Frank A. J. L.;Akeju, Oluwaseun;Rutter, Martin K.;Hu, Kun
通讯作者：
Hu, Kun
DOI：
10.1136/jnnp-2022-328903
发表时间：
2022-05-23
期刊：
Journal of neurology, neurosurgery, and psychiatry
影响因子：
--
作者：
通讯作者：
--
影响因子：
6.7
作者：
Aya, Antoine G. M.;Pouchain, Pierre-Henri;Cuvillon, Philippe
通讯作者：
Cuvillon, Philippe
影响因子：
25.8
作者：
Davis DH;Muniz-Terrera G;Keage HA;Stephan BC;Fleming J;Ince PG;Matthews FE;Cunningham C;Ely EW;MacLullich AM;Brayne C;Epidemiological Clinicopathological Studies in Europe (EClipSE) Collaborative Members
通讯作者：
Epidemiological Clinicopathological Studies in Europe (EClipSE) Collaborative Members
影响因子：
1.6
作者：
Angeles-Castellanos, Manuel;Ramirez-Gonzalez, Fatima;Escobar, Carolina
通讯作者：
Escobar, Carolina