背景:心血管代谢疾病(CMD),包括2型糖尿病,心脏病,中风与痴呆症的高风险有关。我们研究了高水平的认知储备(CR)是否可以减轻与CMD相关的痴呆风险和脑部病变的增加。
方法:在英国生物银行内,216,178名年龄≥60岁的无痴呆参与者接受了长达15年的随访。从医疗记录中确定基线CMD和痴呆事件,药物使用,和病史。潜在类别分析用于生成CR指标(低,中度,和高)基于教育,职业素养,向别人倾诉,社会接触,休闲活动,看电视的时间。一个子样本(n=13,663)在随访期间接受了脑部MRI扫描。灰质总量(GMV)海马(HV),并确定了白质高信号(WMHV),以及白质区域的平均扩散率(MD)和分数各向异性(FA)。
结果:在基线时,43,402名(20.1%)参与者至少有一个CMD。平均随访11.7年,6,600(3.1%)患有痴呆症。CMD的存在与痴呆风险增加57%相关(HR1.57[95%CI1.48,1.67])。在联合效应分析中,患有CMD和中高CR和低CR的痴呆症患者的HR分别为1.78[1.66,1.91]和2.13[1.97,2.30]),分别(参考:无CMD,中高CR)。痴呆风险降低17%(HR0.83[0.77,0.91],与低CR相比,具有CMD和中高的人群中p<0.001)。在脑部核磁共振成像上,CMD与较小的GMV(β-0.18[-0.22,-0.13])和HV(β-0.13[-0.18,-0.08])以及明显较大的WMHV(β0.06[0.02,0.11])和MD(β0.08[0.02,0.13])相关。与低CR相比,CMD和中高的人的GMV和HV明显更大,但是WMHV没有区别,MD,或FA。
结论:在CMD患者中,具有较高水平的CR与较低的痴呆风险以及较大的灰质和海马体积相关.结果强调了精神和社会活跃的生活是一个可改变的因素,可以支持CMD患者的认知和大脑健康。
BACKGROUND: Cardiometabolic diseases (CMDs) including type 2 diabetes, heart disease, and stroke have been linked to a higher risk of dementia. We examined whether high levels of cognitive reserve (CR) can attenuate the increased dementia risk and brain pathologies associated with CMDs.
METHODS: Within the UK Biobank, 216,178 dementia-free participants aged ≥ 60 were followed for up to 15 years. Baseline CMDs and incident dementia were ascertained from medical records, medication use, and medical history. Latent class analysis was used to generate an indicator of CR (low, moderate, and high) based on education, occupational attainment, confiding in others, social contact, leisure activities, and television watching time. A subsample (n = 13,663) underwent brain MRI scans during follow-up. Volumes of total gray matter (GMV), hippocampus (HV), and white matter hyperintensities (WMHV) were ascertained, as well as mean diffusivity (MD) and fractional anisotropy (FA) in white matter tracts.
RESULTS: At baseline, 43,402 (20.1%) participants had at least one CMD. Over a mean follow-up of 11.7 years, 6,600 (3.1%) developed dementia. The presence of CMDs was associated with 57% increased risk of dementia (HR 1.57 [95% CI 1.48, 1.67]). In joint effect analysis, the HRs of dementia for people with CMDs and moderate-to-high CR and low CR were 1.78 [1.66, 1.91] and 2.13 [1.97, 2.30]), respectively (reference: CMD-free, moderate-to-high CR). Dementia risk was 17% lower (HR 0.83 [0.77, 0.91], p < 0.001) among people with CMDs and moderate-to-high compared to low CR. On brain MRI, CMDs were associated with smaller GMV (β -0.18 [-0.22, -0.13]) and HV (β -0.13 [-0.18, -0.08]) as well as significantly larger WMHV (β 0.06 [0.02, 0.11]) and MD (β 0.08 [0.02, 0.13]). People with CMDs and moderate-to-high compared to low CR had significantly larger GMV and HV, but no differences in WMHV, MD, or FA.
CONCLUSIONS: Among people with CMDs, having a higher level of CR was associated with lower dementia risk and larger gray matter and hippocampal volumes. The results highlight a mentally and socially active life as a modifiable factor that may support cognitive and brain health among people with CMDs.