Association Between High School Personality Phenotype and Dementia 54 Years Later in Results From a National US Sample
Association Between High School Personality Phenotype and Dementia 54 Years Later in Results From a National US Sample
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DOI：
10.1001/jamapsychiatry.2019.3120
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发表时间：
2020-02-01
期刊：
影响因子：
25.8
通讯作者：
Lapham, Susan
中科院分区：
文献类型：
--
作者：
Chapman, Benjamin P.;Huang, Alison;Lapham, Susan
在老年人的研究中，重要个性表型与随后的痴呆症相关。然而，神经病理变化往往比认知症状早很多年，并可能影响人格本身。因此，目前尚不清楚所谓的易患痴呆症的个性特征(高度神经质和低责任感)是真正的风险因素，还是仅仅反映了先前存在的疾病。目的研究青春期人格--临床前痴呆病理不太可能出现的时期--是否会增加晚年患痴呆症的风险，并检验这种关联是否可以由青春期的健康因素解释，或者在不同的社会经济地位(SES)之间存在差异。设计、设置和参与者在美国的队列研究。参与者是人才计划的成员，这是1960年全国高中生的样本。在2011至2013年间的任何一年中，都确定了接受与痴呆症相关的国际疾病分类第九版(ICD-9)诊断代码的个人。我们的分析日期为2018年3月至2019年5月。采用150个项目的人才人格问卷对10种人格特质进行测量。社会经济地位是通过基于父母教育水平、收入、职业和财产所有权的综合指标来衡量的。参与者还接受了人口统计因素以及身高和体重的调查。收集了主要结果和衡量标准的联邦医疗保险记录，根据美国联邦医疗保险和医疗补助服务中心基于ICD-9的算法对2011至2013年期间的痴呆症诊断进行了分类。Cox比例风险回归模型基于10个人格特征，测试与SES的交互作用，并调整人口统计混杂因素，估计患痴呆症的相对风险。结果82232名受试者中50.1%为女性，平均年龄为15.8岁(1.7岁)，随访时为69.5岁(1.2岁)。较低的痴呆症风险与较高的活力水平相关(1 SD的风险比为0.93；95%CI为0.90-0.97；P<；.001)。平静和成熟与后来的痴呆症显示出保护性的联系，这种联系随着SES的增加而增加。在SES的1 SD时，Calm的风险比为0.89(95%CI，0.84-0.95；P<；交互作用为.001)，成熟度的风险比为0.90(95%CI，0.85-0.96；交互作用的P=.001)。结论和相关性这项研究的发现表明，与晚年痴呆相关的青少年人格特征与在老年人研究中观察到的相似。此外，与冷静和成熟的青少年表型相关的痴呆症风险的降低在SES水平较高的情况下可能更大。到70岁时，人格表型可能是痴呆症的一个真正的独立风险因素，比它早近50年，并与青少年的社会经济状况相互作用。这项美国国家队列研究调查了青春期的个性-临床前痴呆病理不太可能存在的时期-是否会在以后的生活中增加痴呆症的风险，并测试相关性是否可以由青春期的健康因素解释，或者在不同的社会经济状况下存在差异。问题是不适应的人格特征是痴呆症的真正风险因素，还是仅仅是潜在的神经病理变化的早期表现？在一项对82 232名参与者进行的队列研究中，青春期的个性特征--一个痴呆症病理不太可能存在的时期--是近50年后美国全国队列中与痴呆症事件相关的一个因素。冷静和成熟的青少年患痴呆症的可能性较小，而且这种风险降低在社会经济地位较高的情况下明显更明显。这意味着这项研究的发现表明，几十年前的适应不良个性特征可能是70岁之前痴呆的独立风险因素。
Importance Personality phenotype has been associated with subsequent dementia in studies of older adults. However, neuropathologic changes often precede cognitive symptoms by many years and may affect personality itself. Therefore, it is unclear whether supposed dementia-prone personality profiles (high neuroticism and low conscientiousness) are true risk factors or merely reflections of preexisting disease. Objectives To examine whether personality during adolescence-a time when preclinical dementia pathology is unlikely to be present-confers risk of dementia in later life and to test whether associations could be accounted for by health factors in adolescence or differed across socioeconomic status (SES). Design, Setting, and Participants Cohort study in the United States. Participants were members of Project Talent, a national sample of high school students in 1960. Individuals were identified who received a dementia-associated International Classification of Diseases, Ninth Revision (ICD-9) diagnosis code during any year between 2011 and 2013. The dates of our analysis were March 2018 to May 2019. Exposures Ten personality traits were measured by the 150-item Project Talent Personality Inventory. Socioeconomic status was measured by a composite based on parental educational level, income, occupation, and property ownership. Participants were also surveyed on demographic factors and height and weight. Main Outcomes and Measures Medicare records were collected, with dementia diagnoses in the period of 2011 to 2013 classified according to the US Centers for Medicare & Medicaid Services ICD-9-based algorithm. Cox proportional hazards regression models estimated the relative risk of dementia based on the 10 personality traits, testing interactions with SES and adjusting for demographic confounders. Results The sample of 82232 participants was 50.1% female, with a mean (SD) age of 15.8 (1.7) years at baseline and 69.5 (1.2) years at follow-up. Lower risk of dementia was associated with higher levels of vigor (hazard ratio for 1 SD, 0.93; 95% CI, 0.90-0.97; P < .001). Calm and maturity showed protective associations with later dementia that increased with SES. At 1 SD of SES, calm showed a hazard ratio of 0.89 (95% CI, 0.84-0.95; P < .001 for the interaction) and maturity showed a hazard ratio of 0.90 (95% CI, 0.85-0.96; P = .001 for the interaction). Conclusions and Relevance This study's findings suggest that the adolescent personality traits associated with later-life dementia are similar to those observed in studies of older persons. Moreover, the reduction in dementia risk associated with a calm and mature adolescent phenotype may be greater at higher levels of SES. Personality phenotype may be a true independent risk factor for dementia by age 70 years, preceding it by almost 5 decades and interacting with adolescent socioeconomic conditions.This national US cohort study examines whether personality during adolescence-a time when preclinical dementia pathology is unlikely to be present-confers risk of dementia in later life and tests whether associations could be accounted for by health factors in adolescence or differed across socioeconomic status.Question Are maladaptive personality traits true risk factors for dementia or merely early expressions of underlying neuropathologic changes? Findings In a cohort study of 82 232 participants, personality traits in adolescence-a time when dementia pathology is unlikely to be present-were a factor associated with incident dementia almost 5 decades later in a national US cohort. Calm and mature adolescents were less likely to develop dementia, and this risk reduction was significantly more pronounced with higher socioeconomic status. Meaning This study's findings suggest that maladaptive personality traits decades earlier may be independent risk factors for dementia by age 70 years.