虚弱与卒中和痴呆共病进展轨迹之间的关联：来自观察和遗传分析的见解

IF 3.5 3区医学 Q2 GERIATRICS & GERONTOLOGY

Archives of gerontology and geriatrics Pub Date : 2025-04-21 DOI:10.1016/j.archger.2025.105862

Dongze Chen , Yali Zhang , Zhiqiang Ji , Yi Zhou , Zhisheng Liang

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引用次数: 0

摘要

背景：虚弱与脑卒中-痴呆共病的发展轨迹之间的关系尚不明确。本研究旨在确定虚弱与卒中-痴呆合并症的进展轨迹之间是否存在关联，包括从入组到卒中/痴呆的转变，进展到卒中-痴呆合并症，最终到死亡率。方法本前瞻性研究基于英国生物银行队列进行。使用虚弱指数（FI）评估虚弱程度，并将其分为强壮（FI≤0.10），虚弱(0.10 <；FI≤0.25)，或脆弱(FI >；0.25)。我们使用多状态模型和单样本孟德尔随机化（MR）来研究虚弱与卒中-痴呆共病进展轨迹之间的关系。采用人口归因分数（PAF）分析来评估虚弱的归因风险及其组成部分。结果最终分析纳入459924名参与者。与健康组相比，体弱组从入组过渡到卒中的风险显著升高[HR(95% CI): 2.32(2.19-2.45)]，从入组过渡到痴呆[2.56(2.31-2.83)]，从入组过渡到死亡[2.32(2.23-2.42)]，从卒中过渡到卒中-痴呆共病[1.59(1.23-2.05)]，从痴呆过渡到卒中-痴呆共病[1.79(1.29-2.48)]，从卒中过渡到死亡[1.25(1.11-1.40)]。核磁共振分析显示，基因预测的FI与卒中-痴呆合并症的高风险有因果关系。PAF分析表明，高血压、糖尿病、肺部疾病和视力障碍是进展为卒中-痴呆合并症的重要因素。结论虚弱状态增加脑卒中后痴呆的风险，为临床管理和公共卫生策略提供重要见解。

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Association between frailty and the progression trajectories of stroke and dementia comorbidity: insights from observational and genetic analyses

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Association between frailty and the progression trajectories of stroke and dementia comorbidity: insights from observational and genetic analyses

Background

The relationship between frailty and the progression trajectories of stroke-dementia comorbidity remains inconclusive. This study aimed to determine whether there are associations between frailty and the progression trajectories of stroke-dementia comorbidity, including the transitions from enrollment to incident stroke/dementia, progression to stroke-dementia comorbidity, and ultimately to mortality.

Methods

This prospective study was conducted based on the UK Biobank cohort. Frailty was assessed using the frailty index (FI) and categorized as robust (FI ≤ 0.10), prefrail (0.10 < FI ≤ 0.25), or frail (FI > 0.25). We used multi-state models and one-sample Mendelian randomization (MR) to investigate the relationships between frailty and the progression trajectories of stroke-dementia comorbidity. Population attributable fraction (PAF) analyses were conducted to assess the attributable risks of frailty and its components.

Results

The final analysis included 459,924 participants. In comparison to the robust, the frail group significantly elevated the risk of transitioning from enrollment to stroke [HR(95 %CI): 2.32(2.19–2.45)], from enrollment to dementia [2.56(2.31–2.83)], from enrollment to mortality [2.32(2.23–2.42)], from stroke to stroke-dementia comorbidity [1.59(1.23–2.05)], from dementia to stroke-dementia comorbidity [1.79(1.29–2.48)], and from stroke to mortality [1.25(1.11–1.40)]. MR analyses revealed that genetically predicted FI was causally associated with higher risks of stroke-dementia comorbidity. PAF analyses indicated that hypertension, diabetes, lung disease, and visual impairment were significant contributors to the risk of progression to stroke-dementia comorbidity.

Conclusion

Our findings revealed that frailty status increases the risk of post-stroke dementia, offering important insights for the clinical management and public health strategies.

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来源期刊

Archives of gerontology and geriatrics 医学-老年医学

CiteScore

7.30

自引率

5.00%

发文量

198

审稿时长

16 days

期刊介绍： Archives of Gerontology and Geriatrics provides a medium for the publication of papers from the fields of experimental gerontology and clinical and social geriatrics. The principal aim of the journal is to facilitate the exchange of information between specialists in these three fields of gerontological research. Experimental papers dealing with the basic mechanisms of aging at molecular, cellular, tissue or organ levels will be published. Clinical papers will be accepted if they provide sufficiently new information or are of fundamental importance for the knowledge of human aging. Purely descriptive clinical papers will be accepted only if the results permit further interpretation. Papers dealing with anti-aging pharmacological preparations in humans are welcome. Papers on the social aspects of geriatrics will be accepted if they are of general interest regarding the epidemiology of aging and the efficiency and working methods of the social organizations for the health care of the elderly.