Ntu Ⅰ: Kab Mob Raum Thiab Risk Of Dementia: Ib Txoj Kev Kawm Hauv Tebchaws Danish
Apr 10, 2023
Abstract
Lub hom phiaj
Tam sim no nws tseem tsis tau paub meej tias kab mob raum puas yog ib qho kev pheej hmoo rau dementia. Peb tshawb xyuas kev sib raug zoo ntawm kab mob raum thiab kev pheej hmoo ntawm kev dementia yav tom ntej.
Tsim thiab teeb tsa
Danish National Historical Register Cohort Study, raws li cov ntaub ntawv txij Lub Ib Hlis 1, 1995, txog rau Lub Kaum Ob Hlis 31, 2016.
Cov neeg koom nrog
Txhua tus neeg mob tau kuaj pom muaj kab mob raum thiab cov pej xeem sib koom ua ke tsis muaj kab mob raum (hnub nyoog, poj niam txiv neej, thiab xyoo kev kuaj mob raum sib npaug 1: 5).
Kev ntsuas thawj zaug thiab theem nrab
Tag nrho cov ua rau dementia thiab nws cov subtypes: Alzheimer's kab mob, vascular dementia, thiab lwm yam tshwj xeeb lossis tsis tau teev tseg dementias. Peb tau siv Cox regression tsom xam los xam cov 5-xyoo cumulative incidence (risk) thiab hazard ratios (HRs) rau qhov tshwm sim.
Cov txiaj ntsig
Cov pab pawg tshawb fawb suav nrog 82,690 tus neeg mob uas muaj kab mob raum thiab 413,405 tus neeg los ntawm cov pej xeem. Qhov 5- thiab 10- xyoo kev tuag yog ob zaug siab dua nyob rau hauv cov neeg mob raum kab mob ib yam li cov pej xeem. Lub xyoo 5-kev pheej hmoo ntawm tag nrho cov ua rau dementia yog 2.90 feem pua (95 feem pua ntawm kev ntseeg siab: 2.78 feem pua rau 3.08 feem pua ) hauv cov neeg mob raum thiab 2.98 feem pua (2.92 feem pua rau 3.04 feem pua ) hauv cov pej xeem. Piv nrog rau cov pej xeem, kho HRs rau tag nrho cov ua rau dementia nyob rau hauv cov neeg mob uas muaj kab mob raum yog 1.06 (1. tag nrho lub sijhawm kawm. Kev kwv yees pheej hmoo rau dementia subtypes sib txawv, nrog kev kwv yees qis dua rau Alzheimer's kab mob thiab kev kwv yees ntau dua rau vascular dementia.
Cov lus xaus
Cov neeg mob uas kuaj pom muaj kab mob raum muaj qhov tshwm sim me ntsis ntawm dementia, feem ntau tshwm sim los ntawm vascular dementia. Tsis tas li ntawd, cov neeg mob lub raum yuav tsis raug kuaj pom tias muaj dementia vim muaj kev tuag siab thiab lwm yam kev mob tseem ceeb.
Ntsiab lus
Kab mob raum; dementia;Cistanche ntxiv.
Nyem qhov no mus yuavCistanche extractkom koj lub raum noj qab nyob zoo
Taw qhia
Dementia yog ib qho tshwm sim, muaj hnub nyoog muaj feem cuam tshuam txog kev puas siab puas ntsws uas tau kuaj pom thaum tau txais kev paub tsis meej yog qhov hnyav txaus los cuam tshuam rau kev sib raug zoo thiab / lossis kev ua haujlwm txawm hais tias qhov xwm txheej ntawm dementia tau poob qis me ntsis hauv 30 xyoo dhau los, qhov feem ntau ntawm dementia tau nce thoob ntiaj teb. , tej zaum yuav yog vim muaj kev cia siab ntau ntxiv Qhov no ua rau cov nqi tseem ceeb rau cov tib neeg thiab tsev neeg, nrog rau kev kho mob thiab zej zog.
Kab mob raum yog lwm yam kab mob uas muaj qhov siab (ze li 10 feem pua) thiab muaj kev pheej hmoo ntau ntxiv, ib feem yog vim cov neeg laus laus zuj zus thiab muaj kev kub ntxhov thiab ntshav qab zib ntau ntxiv.
Kab mob raum thiab dementia muaj feem cuam tshuam xws li kev laus, kub siab, ntshav qab zib, hyperlipidemia, thiab pathophysiology ntawm cov hlab ntsha me. Ib qho kev sib txuas ntawm cov kab mob hauv lub raum thiab kev dementia tuaj yeem yog qhov cuam tshuam rau lub raum thiab lub paj hlwb rau vascular raug mob raum kab mob cuam tshuam nrog oxidative kev nyuaj siab, mob ntev, thiab hloov coagulation, thiab tseem tuaj yeem cuam tshuam rau lub hlwb lossis cerebral vasculature indirect lossis ncaj qha los ntawm metabolic. cuam tshuam thiab uremic toxins.
Kev tshawb fawb txog pej xeem yav dhau los hauv Taiwan pom qhov phom sij piv (HR) ntawm 1.41 rau txhua qhov ua rau dementia hauv cov neeg mob uas kuaj pom muaj kab mob raum (N=37049) piv rau cov pej xeem (N=74098. Tsis tas li ntawd, cov kev tshawb pom no yuav tsis siv rau cov neeg nyob sab Europe thiab txoj kev tshawb fawb Taiwanese tsis tau tshuaj xyuas qhov sib txawv ntawm cov kab mob dementia subtypes. Tsis tas li ntawd, hauv cov kev tshawb fawb yav dhau los txhais cov kab mob raum xws li cov proteinuria tsis tu ncua lossis kwv yees glomerular filtration rate (eGFR) qis dua 60 mL / min / 1.73 m2. Peb tau tshawb xyuas txhua qhov ua rau dementia thiab dementia subtypes (Alzheimer's disease, vascular dementia, thiab lwm yam dementias) hauv kev tshawb fawb hauv tebchaws.
Cov txheej txheem
Peb tau ua raws li Cov Lus Qhia rau Txhim Kho Kev Tshaj Tawm Txog Kev Tshawb Fawb Txog Kev Tshawb Fawb Txog Kev Tshawb Fawb Txog Kev Tshawb Fawb Txog Kab Mob Epidemiologic.
Herbal Cistanche
Kawm pawg
Thaum lub sijhawm kawm txij Lub Ib Hlis 1, 1995, txog rau Lub Kaum Ob Hlis 31, 2016, peb tau ua ib qho kev tshawb fawb thoob tebchaws suav nrog txhua tus neeg mob hauv tsev kho mob Danish kuaj mob raum thiab cov neeg sib tw sib piv cov pej xeem tsis muaj kab mob raum.
Daim ntawv qhia kev khiav dej num ntawm pawg neeg tshawb fawb tau pom nyob rau hauv daim duab 1. Lub sijhawm kawm, peb tau txheeb xyuas 122,670 tus neeg mob uas tau kuaj pom thawj zaug ntawm cov kab mob raum. Tom ntej no, peb tsis suav cov neeg mob uas tuag (N=32196) lossis tsis nyob hauv Denmark (N=465) hauv ib xyoos tom qab kuaj mob raum. Cov txheej txheem cais tawm ntxiv yog kev kuaj mob ntawm dementia (N=1909) thiab cov tsos mob prodromal ntawm dementia, piv txwv li kev puas hlwb me me thiab amnesic syndrome (N=303) ua ntej kuaj mob raum. Tsis tas li ntawd, peb tsis suav nrog cov neeg mob uas tau kuaj pom tias muaj dementia (N=1300) thiab cov tsos mob prodromal dementia (N=156) hauv ib xyoos ntawm kev kuaj mob raum, raws li kev kuaj mob dementia lub sijhawm no tsis zoo li. los ua ib tug tshwm sim ntawm lub raum kab mob. Thaum kawg, peb txwv cov pab pawg rau cov neeg laus hnub nyoog 18 xyoo thiab laus dua. Qhov seem 82,690 tus neeg mob suav nrog peb lub raum kab mob. Rau txhua tus neeg mob hauv cov kab mob hauv lub raum, 5 tus neeg los ntawm cov pej xeem uas tsis muaj kab mob raum kuaj ua ntej hnub ntsuas tau raug xaiv thiab sib tw raws lub hnub nyoog (xyoo yug), poj niam txiv neej, thiab xyoo daim ntawv qhia hnub ntawm hnub ntsuas. (piv txwv li, hnub kuaj mob raum). Kev sib koom ua ke tau ua raws li tus neeg sib tw los hloov cov pej xeem sib piv cov pab pawg suav nrog 413,405 cov neeg mob uas tsis muaj dementia, me ntsis kev paub tsis meej, amnesic syndrome, lossis kab mob raum ua ntej kev kawm nkag.
Daim duab 1: Flow chart of the study. cov tib neeg hauv pawg neeg mob uas tsim kab mob raum thaum lub sij hawm 1995-2016 thiab cov pej xeem sib piv cov neeg sib piv.
Kev kuaj mob
Kev kuaj mob ntawm lub raum (kev raug mob), dementia (qhov tshwm sim), kev paub tsis meej me ntsis, amnesic syndrome, thiab covariates yog raws li kev kuaj mob tau los ntawm Danish National Patient Registry thiab / lossis Danish Central Research Registry of Psychiatry. Cov ntawv sau npe no suav nrog txhua lub tsev kho mob hauv Denmark thiab tau sau npe nkag hauv tsev kho mob txij li xyoo 1977 thiab 1969, raws li, thiab cov kws kho mob tshwj xeeb mus ntsib txij li xyoo 1995. Peb tau siv tag nrho cov kev kuaj mob thawj zaug thiab theem nrab rau txhua qhov kev mus ntsib tus neeg mob hauv tsev thiab sab nraud tab sis tsis suav nrog kev mus ntsib chav xwm txheej ceev (vim kev kuaj mob hauv cov xwm txheej zoo li no. tej zaum yuav tentative thiab yog li tsawg siv tau). Kev kuaj mob tau txiav txim siab raws li World Health Organization's International Classification of Diseases, Revision 8 (ICD-8), mus txog rau thaum xaus ntawm 1993, ua raws li Kev Kho 10 (ICD-10). Peb tau siv hnub uas tau mus pw hauv tsev kho mob lossis pib kho tus neeg mob sab nraud raws li hnub ntawm txhua qhov kev kuaj mob.
Kab mob raum
Hauv thawj qhov kev tshuaj xyuas, peb tau siv cov ntsiab lus nthuav dav ntawm cov kab mob raum uas suav nrog cov kab mob raum ntev nrog rau ntau yam kab mob raum tsis tu ncua, kev kho mob raum, thiab hloov lub raum. Qhov tseem ceeb, qhov kev ncua ntev ntawm cov kab mob raum tsis suav nrog mob hnyav thiab / lossis muaj feem cuam tshuam rau lub raum raug mob. Hauv kev tshuaj ntsuam rhiab heev, peb tsuas yog siv cov kab mob raum ntev (tsuas yog rau ICD-8 792 thiab ICD-10 N18) raws li qhov tshwm sim rau txhua qhov ua rau dementia. Lub raum Kab Mob Txhim Kho Zuag Qhia Tag Nrho (KDIGO) txhais tau hais tias lub raum mob tsis tu ncua (3 lub hlis) eGFR 60 mL / min / 1.73 m2 lossis lub raum tsis zoo, feem ntau txiav txim siab los ntawm qhov muaj proteinuria.
Dementia
Kev siv tau ntawm txhua qhov ua rau dementia tau siab, nrog rau qhov zoo kwv yees tus nqi ntawm 86 feem pua ntawm cov dementia subtypes sau npe hauv Denmark tau sib koom ua ke, thiab peb tsuas yog siv thawj coded dementia subtype: Alzheimer's disease, vascular dementia, thiab lwm yam. (tshwj xeeb los yog tsis meej) dementia, tom kawg ua rau feem ntau ntawm kev kuaj mob dementia. Vim hais tias kwv yees li ib feem peb ntawm lwm cov neeg mob dementia uas tsis tau qhia txog tej zaum yuav tshwm sim los ntawm Alzheimer's disease, 19 peb kuj suav nrog cov txiaj ntsig ua ke ntawm Alzheimer's kab mob thiab lwm yam dementias.
Covariates
Peb suav nrog cov kab mob plawv (CVD), CVD muaj feem cuam tshuam, (ib yam dab tsi) mob qog noj ntshav, thiab kev noj qab haus huv kev noj qab haus huv uas muaj peev xwm ua rau muaj kev tsis sib haum xeeb vim lawv koom nrog cov kab mob raum thiab dementia. Tag nrho covariates raug soj ntsuam ua ntej nkag mus kawm. CVD covariates yog angina pectoris, myocardial infarction, mob stroke, peripheral arterial kab mob, venous thromboembolism, plawv tsis ua hauj lwm, kab mob plawv, thiab atrial fibrillation. Covariates txuam nrog CVD muaj feem cuam tshuam yog hypercholesterolemia, ntshav siab, rog rog, ntshav qab zib mellitus, thiab mob ntsws obstructive pulmonary disease (kev haus luam yeeb.) CVD cov xwm txheej muaj kev pheej hmoo yog raws li kev kuaj mob los ntawm Danish National Patient Registry, ntxiv rau cov ntawv sau rau lipid-txo thiab tiv thaiv. -cov tshuaj hypertensive los ntawm Danish National Prescription Registry, uas muaj cov ncauj lus kom ntxaws tus neeg mob ntawm tag nrho cov tshuaj kho mob sab nraud txij li xyoo 1995.
Covariates txuam nrog kev noj qab haus huv yog kev kawm siab tshaj plaws, tag nrho cov nyiaj tau los ntawm tus kheej, thiab kev ua haujlwm, uas tau txais los ntawm Labor Market Research Comprehensive Database tsim nyob rau hauv 1981. Kev kawm tau yog categorized li qis (elementary tsev kawm ntawv nkaus xwb), nruab nrab (high school thiab / lossis kev kawm qib siab hauv tsev kawm qib siab), thiab siab (bachelor's, master's, lossis siab dua). Tag nrho cov nyiaj tau los ntawm tus kheej yog categorized los ntawm quartiles. Cov xwm txheej ua haujlwm tau muab faib ua haujlwm, so haujlwm, thiab poob haujlwm. Peb tau siv cov xwm txheej ua haujlwm 12-24 lub hlis ua ntej nkag mus rau hauv txoj kev tshawb fawb vim tias kev ua haujlwm nyob rau hauv lub xyoo ua ntej kuaj pom tus kab mob raum tuaj yeem kwv yees qhov ua haujlwm siab tshaj plaws.
Cov txiaj ntsig Cistanche
Kev txheeb cais
Peb piv cov xwm txheej ntawm kev tuag (kev pheej hmoo) thiab tag nrho cov ua rau dementia (siv rau hauv kev sib tw kev pheej hmoo ntawm kev tuag) hauv cov kab mob raum thiab cov pawg sib piv. HRs rau tag nrho-ua rau dementia thiab dementia subtypes thiab lawv qhov sib thooj 95 feem pua CIs tau suav nrog Cox regression tsom xam siv lub sijhawm kawm raws li lub sijhawm teev. Qhov kev pheej hmoo ntawm kev pheej hmoo sib npaug tau kuaj pom los ntawm cov ntaub ntawv log-log, thiab tsis muaj kev ua txhaum cai. Nyob rau hauv tus qauv Cox tsis hloov kho, hnub nyoog, poj niam txiv neej, thiab daim ntawv qhia hnub xyoo ntawm qhov ntsuas hnub tau raug tswj xyuas, vim cov no yog cov qauv sib xws. Txawm li cas los xij, txhawm rau suav rau txoj kev sib txuam, cov kev sib tw tsis tuaj yeem khaws cia tag nrho vim yog kev xaiv tsis zoo hauv kev xaiv, yog li kev hloov kho Cox tus qauv suav nrog hnub nyoog, poj niam txiv neej, thiab xyoo daim ntawv qhia hnub ntawm hnub ntsuas, nrog rau lwm yam muaj peev xwm confounders. Cov neeg koom nrog qhov tseem ceeb uas ploj lawm (1 feem pua ntawm tag nrho cov nyiaj tau los ntawm tus kheej thiab 11 feem pua ntawm kev ua haujlwm thiab qib kev kawm) raug tshem tawm los ntawm kev tshuaj ntsuam xyuas. 1 xyoo txij li hnub ntsuas mus txog rau lub Kaum Ob Hlis 31, 2016 kuaj mob dementia lossis kuaj xyuas, kev nkag tebchaws, lossis kev tuag, qhov twg los ua ntej. Lub sijhawm soj ntsuam yam tsawg kawg yog 1 xyoo thiab qhov siab tshaj plaws yog 22 xyoo. Vim tias txhua qhov kev kuaj mob thiab lub neej thiab kev nkag tebchaws tau sau npe rau hauv National Registry, peb tsis muaj kev rov qab los. Peb tau ua qhov kev ntsuam xyuas ua ntej stratified rau hnub nyoog (18-49, 50-59, 60-74, 75-84, thiab 85 xyoo), poj niam txiv neej, hnub tim daim ntawv qhia hnub xyoo (1995-2003 lossis 2004-2016), kab mob plawv, kab mob plawv, kab mob plawv, kab mob kev noj qab haus huv, thiab lub sijhawm rov qab los (1-5, 1-10, thiab 1-22 xyoo).
Thaum kawg, txhawm rau txheeb xyuas seb puas muaj tag nrho cov kev pheej hmoo dementia cuam tshuam nrog rau mob raum hnyav, peb stratified kab mob raum raws li qhov muaj lossis tsis muaj lub raum tsis ua haujlwm. Txhua qhov kev ntsuam xyuas tau ua tiav siv SAS V.9.4 (SAS Institute).
Standardized Cistanche
REFERENCES
1. Arvanitakis Z, Shah RC, Bennett DA. Kev kuaj mob thiab kev tswj hwm ntawm dementia: kev tshuaj xyuas. JAMA 2019; 322: 1589–99.
2. Knopman DS. Lub enigma ntawm kev txo qis dementia tshwm sim. JAMA Netw Qhib 2020; 3:e2011199.
3. Ntiaj teb Alzheimer Report 2015: lub ntiaj teb no cuam tshuam ntawm dementia: kev tsom xam ntawm prevalence, tshwm sim, nqi, thiab tiam sis. nkauj tawm tshiab 2020, 2015.
4. Kev sib koom tes ntawm GBD Chronic Kidney Disease. Ntiaj teb no, lub regional, thiab lub teb chaws lub nra ntawm lub raum mob, 1990-2017: ib tug systematic tsom xam rau lub ntiaj teb no lub nra ntawm txoj kev tshawb no kab mob 2017. Lancet 2020; 395: 709–33.
5. Barnes DE, Yaffe K. Lub phiaj xwm ua rau muaj kev pheej hmoo txo qis ntawm Alzheimer's kab mob ntau dua. Lancet Neurol 2011; 10:819–28.
6. Ikram MA, Vernooij MW, Hofman A, et al. Lub raum ua haujlwm muaj feem xyuam rau cov kab mob cerebral me hlab ntsha. Stroke 2008; 39:55–61.
7. Bugnicourt JM, Godefroy O, Chillon JM, et al. Kev paub tsis meej thiab dementia hauv CKD: qhov tsis saib xyuas lub raum-hlwb axis. J Am Soc Nephrol 2013; 24:353–63.
8. Cheng KC, Chen YL, Lai SW, et al. Cov neeg mob uas muaj kab mob raum ntev yog qhov muaj feem pheej hmoo ntawm dementia: kev tshawb fawb pej xeem raws li hauv Taiwan. BMC Nephrol 2012; 13:129.
9. Deckers K, Camerino I, van Boxtel MPJ, et al. Kev pheej hmoo dementia hauv lub raum tsis ua haujlwm: kev tshuaj xyuas thiab kev tshuaj ntsuam meta ntawm cov kev tshawb fawb yav tom ntej. Neurology 2017; 88: 198–208.
10. Gabin JM, Romundstad S, Saltvedt I, et al. Kev nce qib albuminuria, kab mob raum ntev, thiab qhov tshwm sim dementia: txoj kev tshawb nrhiav HUNT. BMC Nephrol 2019; 20:261.
11. Takae K, Hata J, Ohara T, et al. Albuminuria ua rau muaj kev pheej hmoo rau ob qho tib si Alzheimer's kab mob thiab vascular dementia hauv zej zog cov neeg laus Nyij Pooj: txoj kev tshawb fawb Hisayama. J Am Heart Assoc 2018;7.
12. Paterson EN, Williams MA, Passmore P, thiab al. Qhov kwv yees glomerular pom tus nqi tsis cuam tshuam nrog Alzheimer's kab mob hauv Northern Ireland pawg. J Alzheimers Dis 2017; 60:1379–85.
13. Berger I, Wu S, Masson P, et al. Kev paub txog kab mob raum ntev: kev tshuaj xyuas thiab kev tshuaj ntsuam meta. BMC Med 2016; 14:206.
14. Heide-Jørgensen U, Adelborg K, Kahlert J, et al. Cov tswv yim piv txwv rau xaiv cov pej xeem sib piv cov pab pawg. Clin Epidemiol 2018; 10:1325–37.
15. Mors O, Perto GP, Mortensen PB. Lub Danish psychiatric central tshawb fawb sau npe. Scand J Public Health 2011; 39:54–7.
16. Schmidt M, Schmidt SAJ, Sandegaard JL, et al. Daim ntawv teev npe neeg mob hauv tebchaws Danish: kev tshuaj xyuas cov ntsiab lus, cov ntaub ntawv zoo, thiab kev tshawb fawb muaj peev xwm. Clin Epidemiol 2015; 7:449–90.
17. Schmidt M, Schmidt SAJ, Adelborg K, et al. Danish kev saib xyuas kev noj qab haus huv thiab kev tshawb fawb txog kabmob kis: los ntawm kev tiv tauj kev kho mob mus rau cov ntaub ntawv khaws cia. Clin Epidemiol 2019; 11:563–91.
18. Levey AS, de Jong PE, Coresh J, et al. Lub ntsiab lus, kev faib tawm, thiab kev kwv yees ntawm tus kab mob raum mob ntev: daim ntawv tshaj tawm ntawm KDIGO controversies. Raum Int 2011; 80:17–28.
19. Phung TKT, Andersen BB, Høgh P, et al. Kev siv tau ntawm kev kuaj mob dementia hauv Danish Tsev Kho Mob sau npe. Dement Geriatr Cogn Disord 2007; 24:220–8.
20. Webster AC, Nagler EV, Morton RL, et al. Mob raum mob. Lancet 2017; 389: 1238–52.
21. Pottegård A, Schmidt SAJ, Wallach-Kildemoes H, et al. Cov ntaub ntawv peev txheej profile: Danish lub teb chaws sau npe tshuaj. Int J Epidemiol 2017; 46: 798–798f.
22. Petersson F, Baadsgaard M, Thygesen LC. Danish sau npe ntawm tus kheej kev ua lag luam koom nrog. Scand J Public Health 2011; 39:95–8.
Alisa D Kjaergaard: koj puas xav tau ntau tus thwjtim?1,2. Benjamin R Johannesen2. Henrik T Sørensen2,3. Victor W Henderson2,4. Christian F Christiansen2
1. Steno Diabetes Center Aarhus, Aarhus University Tsev Kho Mob, Aarhus, Denmark
2. Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
3. Excellence Research Center, Stanford University, Stanford, California, USA
4. Departments of Epidemiology and Population Health and of Neurology and Neurological Sciences, Stanford University, Stanford, California, USA
