Risk Factors and Preventive Interventions for Alzheimer Disease State of the Science
Risk Factors and Preventive Interventions for Alzheimer Disease State of the Science
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DOI：
10.1001/archneurol.2011.100
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发表时间：
2011-09-01
影响因子：
--
通讯作者：
Williams, John W., Jr.
中科院分区：
文献类型：
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作者：
Daviglus, Martha L.;Plassman, Brenda L.;Williams, John W., Jr.
背景：大量研究调查了阿尔茨海默病（AD）的危险因素。然而，在最近的美国国立卫生研究院科学状况会议上，一个独立小组发现，没有足够的证据支持任何可改变因素与认知能力下降或AD风险之间的联系。目的：介绍导致小组得出结论的选定因素和AD风险的关键发现。数据来源：一份证据报告是由医疗保健研究和质量机构委托编写的。它包括从1984年到2009年10月27日在MEDLINE和Cochrane系统评论数据库中的英文出版物。审议了专家发言和公众讨论。研究选择：证据报告的研究纳入标准是来自发达国家普通人群的年龄在50岁及以上的受试者；队列研究的最小样本量为300，随机对照试验的最小样本量为50；接触和结果评估之间至少2年；以及使用广为接受的阿尔茨海默病诊断标准。资料提取：对纳入研究的合格性进行评估，并对资料进行摘要。每个因素的总体证据质量被总结为低、中、高。数据综合：糖尿病、中年高脂血症和当前吸烟与AD风险增加相关，地中海型饮食、叶酸摄入、低或中度酒精摄入、认知活动和体育锻炼与风险降低相关。所有这些关联的证据质量都很低。结论：目前，没有足够的证据来得出任何可改变因素与AD风险之间的确切结论。
Background: Numerous studies have investigated risk factors for Alzheimer disease (AD). However, at a recent National Institutes of Health State-of-the-Science Conference, an independent panel found insufficient evidence to support the association of any modifiable factor with risk of cognitive decline or AD.Objective: To present key findings for selected factors and AD risk that led the panel to their conclusion.Data Sources: An evidence report was commissioned by the Agency for Healthcare Research and Quality. It included English-language publications in MEDLINE and the Cochrane Database of Systematic Reviews from 1984 through October 27, 2009. Expert presentations and public discussions were considered.Study Selection: Study inclusion criteria for the evidence report were participants aged 50 years and older from general populations in developed countries; minimum sample sizes of 300 for cohort studies and 50 for randomized controlled trials; at least 2 years between exposure and outcome assessment; and use of well-accepted diagnostic criteria for AD.Data Extraction: Included studies were evaluated for eligibility and data were abstracted. Quality of overall evidence for each factor was summarized as low, moderate, or high.Data Synthesis: Diabetes mellitus, hyperlipidemia in midlife, and current tobacco use were associated with increased risk of AD, and Mediterranean-type diet, folic acid intake, low or moderate alcohol intake, cognitive activities, and physical activity were associated with decreased risk. The quality of evidence was low for all of these associations.Conclusion: Currently, insufficient evidence exists to draw firm conclusions on the association of any modifiable factors with risk of AD.