Neurológiai betegségek (pl. Alzheimer-kór, Huntington-kór, Parkinson-kór)
Dementia preventive interventions targeting multiple modifiable risk factors are a
promising approach. However, the impact of modifiable risk factors in the presence
of beta-amyloid or phosphorylated-tau (p-tau) pathology is unclear.The objective of
the study was to examine the role of modifiable risk factors (vascular factors, depression,
and smoking) in the progression to mild cognitive impairment (MCI) or dementia among
434 cognitively unimpaired (CU) and 611 individuals with MCI from the Alzheimer's
Disease Neuroimaging Initiative (ADNI) database. Vascular risk factors were summarized
with the Cardiovascular Risk Factors, Aging, and Dementia (CAIDE) score, dichotomized
into higher versus lower risk. Depression and smoking (yes/no) were categorised according
to medical history or current symptoms. Analyses were stratified by beta-amyloid negative
(A-) and positive (A +), p-tau negative (T-) and positive (T +), or beta-amyloid and
p-tau negative (A-T-) and positive (A + T +) biomarker status. Cox proportional hazard
models were adjusted for age, sex, education, baseline MMSE score, baseline hippocampal
volume and ApoE4 carrier status.Higher CAIDE score was associated with increased risk
of progression to all-cause dementia in most MCI subgroups: adjusted hazard ratios
(aHR) [95% CI] were 3.1 [1.43; 6.53] in the A- subgroup, 1.7 [1.20-2.27] in T + ,
2.6 [1.06-6.59] in A-T-, and 1.6 [1.15-2.22] in the A + T + subgroup. Smoking (yes/no)
was associated with increased dementia aHR in the A + MCI subgroup: 1.6 [1.07-2.34].
Depression increased dementia aHR in the T + MCI subgroup: 1.5 [1.06-2.02]. No significant
associations were found in the CU biomarker subgroups.Addressing modifiable risk factors
carries an important potential for reducing the risk of dementia even after the onset
of Alzheimer's pathology. Knowledge of biomarker status can further optimize prevention
strategies.
