创伤性脊髓损伤与阿尔茨海默病及相关痴呆症的风险:纵向病例和对照队列研究。

IF 2.1 4区 医学 Q3 CLINICAL NEUROLOGY Spinal cord Pub Date : 2024-06-27 DOI:10.1038/s41393-024-01009-1
Paul Lin, Neil Kamdar, Gianna M. Rodriguez, Christine Cigolle, Denise Tate, Elham Mahmoudi
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摘要

研究设计:回顾性病例/对照纵向队列研究 目的:创伤性脊髓损伤(TSCI)与阿尔茨海默病和相关痴呆症(ADRD)有关:创伤性脊髓损伤(TSCI)与阿尔茨海默病及相关痴呆症(ADRD)有关。我们研究了创伤性脊髓损伤后患阿尔茨海默病和相关痴呆症的危险比,并假设与没有创伤性脊髓损伤的匹配对照组相比,有创伤性脊髓损伤的成年人患阿尔茨海默病和相关痴呆症的危险更大:利用 2010-2020 年美国全国私人行政索赔数据,我们确定了 45 岁及以上可能(可能和极可能)发生 TSCI 的成年人(n = 657)。我们的对照组包括未患 TSCI 的一对十匹配人群(n = 6553):我们采用了 Cox 生存模型,并根据年龄、性别、患有某些慢性疾病的年数、接触六类处方药的情况以及居住地的社区特征进行了调整。结果:我们的完全调整模型不包含任何交互作用:我们的完全调整模型(无交互作用)显示,TSCI事件增加了ADRD的风险(HR = 1.30; 95% CI, 1.01-1.67)。年龄在 45-64 岁之间的 TSCI 患者罹患 ADRD 的风险较高(HR = 5.14;95% CI,2.27-11.67),而 65 岁之后则无明显风险(HR = 1.20;95% CI,0.92-1.55)。我们的敏感性分析证实,与匹配的对照组相比,45-64 岁发生 TSCI 后 ADRD 的危险比更高:结论:TSCI 与较高的 ADRD 危险相关。这项研究表明,有必要更新 TSCI 后认知筛查的临床指南,以应对认知能力下降的高风险,并阐明 TSCI 与 ADRD 之间的因果关系。
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Incident traumatic spinal cord injury and risk of Alzheimer’s disease and related dementia: longitudinal case and control cohort study
Retrospective case/control longitudinal cohort study Prevalent traumatic spinal cord injury (TSCI) is associated with Alzheimer’s disease and related dementia (ADRD). We examined the hazard ratio for ADRD after incident TSCI and hypothesized that ADRD hazard is greater among adults with incident TSCI compared with their matched control of adults without TSCI. Using 2010–2020 U.S. national private administrative claims data, we identified adults aged 45 years and older with probable (likely and highly likely) incident TSCI (n = 657). Our controls included one-to-ten matched cohort of people without TSCI (n = 6553). We applied Cox survival models and adjusted them for age, sex, years of living with certain chronic conditions, exposure to six classes of prescribed medications, and neighborhood characteristics of place of residence. Hazard ratios were used to compare the results within a 4-year follow-up. Our fully adjusted model without any interaction showed that incident TSCI increased the risk for ADRD (HR = 1.30; 95% CI, 1.01–1.67). People aged 45–64 with incident TSCI were at high risk for ADRD (HR = 5.14; 95% CI, 2.27–11.67) and no significant risk after age 65 (HR = 1.20; 95% CI, .92–1.55). Our sensitivity analyses confirmed a higher hazard ratio for ADRD after incident TSCI at 45–64 years of age compared with the matched controls. TSCI is associated with a higher hazard of ADRD. This study informs the need to update clinical guidelines for cognitive screening after TSCI to address the heightened risk of cognitive decline and to shed light on the causality between TSCI and ADRD.
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来源期刊
Spinal cord
Spinal cord 医学-临床神经学
CiteScore
4.50
自引率
9.10%
发文量
142
审稿时长
2 months
期刊介绍: Spinal Cord is a specialised, international journal that has been publishing spinal cord related manuscripts since 1963. It appears monthly, online and in print, and accepts contributions on spinal cord anatomy, physiology, management of injury and disease, and the quality of life and life circumstances of people with a spinal cord injury. Spinal Cord is multi-disciplinary and publishes contributions across the entire spectrum of research ranging from basic science to applied clinical research. It focuses on high quality original research, systematic reviews and narrative reviews. Spinal Cord''s sister journal Spinal Cord Series and Cases: Clinical Management in Spinal Cord Disorders publishes high quality case reports, small case series, pilot and retrospective studies perspectives, Pulse survey articles, Point-couterpoint articles, correspondences and book reviews. It specialises in material that addresses all aspects of life for persons with spinal cord injuries or disorders. For more information, please see the aims and scope of Spinal Cord Series and Cases.
期刊最新文献
Retraction Note: Prevalence of prescribed opioid claims among persons with nontraumatic spinal cord dysfunction in Ontario, Canada: a population-based retrospective cohort study. Patient flow problems affecting in-patient spinal cord injury rehabilitation in the Netherlands. The Sir Ludwig Guttmann lecture 2023: psychosocial factors and adjustment dynamics after spinal cord injury. Evaluation of a new model of care for bladder management in a statewide spinal cord service. Diagnostic evaluation and management of recurrent urinary tract infections in the spinal cord injury population - a retrospective evaluation at a tertiary care center.
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