Midlife risk factors for subtypes of dementia: A nested case-control study in Taiwan
Midlife risk factors for subtypes of dementia: A nested case-control study in Taiwan
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DOI：
10.1097/jgp.0b013e318050c98f
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发表时间：
2007-09-01
影响因子：
7.2
通讯作者：
Chen, Chien-Jen
中科院分区：
文献类型：
--
作者：
Chiang, Chun-Ju;Yip, Ping-Keung;Chen, Chien-Jen
目的：确定晚年新出现的痴呆亚型的中年危险因素。方法：采用巢式病例对照研究方法，从1982年至1992年入组的40636名男性和女性中选取157例痴呆病例和628例对照病例。其中4例对照病例在年龄、入组时间（6个月内）、性别和居住乡镇上进行频数匹配。中年危险因素包括血管危险因素（体重指数[BMI]、总胆固醇、总甘油三酯、血糖、脑血管意外[CVA]史、糖尿病史和高血压史）、吸烟和饮酒。痴呆症评估是通过2000年至2002年国家健康保险数据库的计算机化数据链接确定的，并由神经科医生或精神科医生进行临床确认。使用条件逻辑回归分析来估计每个风险因素的匹配比值比 (OR) 及其 95% 置信区间 (CI)。结果：BMI（kg/m(2)）与痴呆之间观察到J形关系。 BMI = 25.5 时，与参考组 BMI 20.5-22.9 相比，发展为痴呆的多变量调整 OR ( 95% CI) 分别为 1.84 ( 1.02-3.33)、1.87 ( 1.08-3.23) 和 2.44 ( 1.39-4.28) ( OR = 1.0）。在阿尔茨海默病 (AD) 和血管性痴呆 (VaD) 中也观察到了类似的结果。肥胖（BMI >= 25.5）与 AD 和 VaD 之间的关联在吸烟者中具有统计学显着性，但在不吸烟者中则不显着。此外，CVA 病史是 VaD 的重要危险因素，但不是 AD 的重要危险因素。结论：体重过轻、体重过重以及中年时发生脑血管意外可能会增加晚年患痴呆症的风险。
Objective: To identify the midlife risk factors for subtypes of dementia newly developed later in life. Methods: A nested case-control study was conducted on 157 demented cases and 628 comparison cases selected from 40,636 men and women who were enrolled from 1982 to 1992. Four comparison cases were frequency-matched on age, time at enrollment ( within 6 months), gender, and residential township. Midlife risk factors included vascular risk factors ( body mass index [ BMI], total cholesterol, total triglycerides, blood glucose, cerebrovascular accident [ CVA] history, diabetes mellitus history, and hypertension history), cigarette smoking, and alcohol consumption. Dementia assessments were ascertained through the computerized data linkage from National Health Insurance Database from 2000 to 2002 and clinically confirmed by neurologists or psychiatrists. Conditional logistic regression analysis was used to estimate the matched odds ratio ( OR) and its 95% confidence intervals ( CI) for each risk factor. Results: A J-shaped relationship was observed between BMI ( kg/m(2)) and dementia. The multivariate-adjusted ORs ( 95% CI) of developing dementia were 1.84 ( 1.02-3.33), 1.87 ( 1.08-3.23) and 2.44 ( 1.39-4.28), respectively, for BMIs of = 25.5 compared with a BMI of 20.5-22.9 as the referent group ( OR = 1.0). Similar findings were observed for Alzheimer disease ( AD) and vascular dementia ( VaD). The association between obesity ( BMI >= 25.5) and both AD and VaD was statistically significant among cigarette smokers but not among nonsmokers. Additionally, history of CVA was a significant risk factor for VaD, but not for AD. Conclusion: Being underweight, being overweight, and a cerebrovascular accident in midlife may increase the risk of dementia in late life.