瑞典斯德哥尔摩市社区人群老年痴呆和阿尔茨海默病的危险因素队列研究

目的探讨老年痴呆和阿尔茨海默病（AD）的危险因素。方法在6年问（1991-1996年）对斯德哥尔摩市一个社区非痴呆老年人群（n=1301，年龄≥75岁）进行两次随访检查，并按照美国老年精神病协会制订的DSM—Ⅲ—R标准诊断随访期间痴呆和AD新发病例。研究对象在基线调查时对有关因素暴露情况系经问卷调查、临床检查和查阅住院病例登记资料库等方法确定。采用Cox比例风险模型对资料进行统计分析。结果随访期间共有350例被诊断为痴呆，包括260例AD患者。多因素分析结果显示，痴呆和AD发病的危险因素有年龄大、文化程度低、认知功能损害、体力活动障碍、低舒张压、糖尿病、缺血性心脏病和携带APOEa4基因。脑卒中和心房纤维颤动亦能增加痴呆的危险性，而服用抗高血压药物则可降低痴呆和AD发病的危险性。结论某些人口统计学因素、认知和体力功能障碍、血管性疾病及遗传易感性是老年痴呆和AD的重要危险因素；使用抗高血压药物及控制高血压相关的血管性疾病可能会降低痴呆发病的危险性。

Risk factors for dementia and Alzheimer's disease-findings from a community-based cohort study in Stockholm, Sweden

OBJECTIVE: It is known that dementia is a multi-factorial disorder, but the etiological factors other than aging remain to be explored, hence we sought to investigate the risk factors of dementia and Alzheimer's disease (AD). METHODS: We followed a community-based dementia-free cohort (n = 1301) aged 75 years and over in Stockholm, Sweden. Baseline data were obtained through a structured interview and extensive clinical examination, or by reviewing the inpatient register database. We used the DSM-III-R criteria to define dementia and AD cases. RESULTS: Over six years of a follow-up program,350 subjects were diagnosed as dementia, including 260 Alzheimer cases. Multiple Cox regression analysis suggested that older age,low education (< 8 years), cognitive impairment, functional disability (ADL > or = 1), low diastolic pressure (< 70 mm Hg), diabetes mellitus, coronary heart disease, and APOEepsilon4 allele were significantly or marginally associated with subsequent development of dementia and AD. Dementia was related also to stroke and atrial fibrillation. Antihypertensive drug use was associated with a lower risk of AD and dementia. CONCLUSIONS: Our study revealed that some sociodemographic features, cognitive and physical dysfunctions, vascular disorders, and genetic susceptibility were major risk factors for dementia and AD. Use of antihypertensive drugs might protect against the dementing disorders in a very old population.