中年和晚年可改变痴呆风险因素的聚类及其与新发痴呆的关联：一项纳入246,968名成人的前瞻性队列研究

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中文摘要

背景： 可改变的痴呆风险因素很少单独出现，但其共存和聚类特征仍研究不足，这限制了对高风险个体的识别以及针对性策略的制定。目的：识别中年（45-65岁）和晚年（>65岁）十种可改变风险因素的聚类，并检验其与新发痴呆的关联。方法：数据来自2012年荷兰公共卫生监测调查（中年：n = 121,120；晚年：n = 125,848），痴呆随访至2023年。使用十种可改变风险因素：肥胖、高血压、糖尿病、听力损失、视力损失、缺乏体力活动、过量饮酒、吸烟、孤独感和抑郁，通过潜在类别分析推导聚类。采用Cox比例风险模型检验晚年聚类与新发痴呆之间的关联。结果：在中年（平均年龄55.7 ± 6.2岁）中，识别出四个风险因素聚类：心脏代谢、物质使用、心理社会和较低风险。在晚年（平均年龄73.9 ± 6.4岁）中，识别出四个聚类：心脏代谢、物质使用、心理社会和缺乏体力活动、较低风险。在调整社会人口学因素后，心理社会和缺乏体力活动聚类与最高的痴呆风险相关（风险比（HR）1.23；95% CI 1.16-1.32），其次是物质使用聚类（HR 1.16；95% CI 1.09-1.24）和心脏代谢聚类（HR 1.12；95% CI 1.07-1.18）。结论：在中年和晚年均识别出不同的风险因素聚类；心理社会和缺乏体力活动聚类具有最高的痴呆风险。这些发现强调，在设计针对性干预措施以降低全生命周期痴呆风险时，应考虑风险因素聚类。

英文摘要

BackgroundModifiable dementia risk factors rarely occur in isolation, yet their co-occurrence and clustering remain poorly characterized, limiting identification of high-risk individuals and development of targeted strategies.ObjectiveTo identify clusters of ten modifiable risk factors in mid-life (45-65 years) and late-life (>65 years), and to examine their association with incident dementia.MethodsData were drawn from the 2012 Dutch Public Health Monitor Survey (mid-life: n = 121,120; late-life: n = 125,848), with dementia follow-up through 2023. Ten modifiable risk factors: obesity, hypertension, diabetes, hearing loss, visual loss, physical inactivity, excessive alcohol consumption, smoking, loneliness, and depression, were used to derive clusters using latent class analysis. Cox proportional hazards models examined the association between late-life clusters and incident dementia.ResultsIn mid-life (mean age, 55.7 ± 6.2 years), four risk factor clusters were identified: cardiometabolic, substance use, psychosocial, and lower risk. In late-life (mean age, 73.9 ± 6.4 years), four clusters were identified: cardiometabolic, substance use, psychosocial and physically inactive, and lower risk. After adjustment for sociodemographic factors, the psychosocial and physically inactive cluster was associated with the highest hazard of dementia (hazard ratio (HR), 1.23; 95% CI, 1.16-1.32), followed by the substance use (HR, 1.16; 95% CI, 1.09-1.24) and the cardiometabolic cluster (HR, 1.12; 95% CI, 1.07-1.18).ConclusionsDistinct risk factor clusters were identified at both mid-life and late-life; the psychosocial and physically inactive cluster carried the highest risk of dementia. These findings underscore the importance of considering risk factor clustering when designing targeted interventions to reduce dementia risk across the life course.