重度饮酒是导致痴呆症最重要的危险因素 | 柳叶刀子刊
2018/02/27
春节长假期间,探索君曾推送过一篇有关“低剂量酒精对大脑有益”的报道。不过,最新发表在《柳叶刀》子刊上的一项大型研究则需要大家高度警惕了。因为该研究表明,重度饮酒和酒精使用障碍,是导致痴呆症最重要的危险因素。


图片来源:The Lancet Public Health(DOI: https://doi.org/10.1016/S2468-2667(18)30022-7)

2月20日,发表在The Lancet Public Health杂志上,题为“Contribution of alcohol use disorders to the burden of dementia in France 2008–13: a nationwide retrospective cohort study”的这篇论文中,科学家们进行了一项全国性的观察研究,以调查酒精使用障碍(Alcohol use disorders)的影响。

研究包括了被诊断患有精神和行为障碍或慢性疾病的人,其疾病都是由酒精的慢性有害使用引起的。分析结果显示,57000例早发性痴呆(65岁之前)中,大多数(57%)与慢性重度饮酒有关。此外,早发性痴呆有明显的性别差异。虽然大多数痴呆患者是女性,但几乎三分之二(64.9%)的早发性痴呆患者是男性。


图片来源:网络

参与该研究的Jürgen Rehm博士说:“我们的研究结果表明,重度饮酒和酒精使用障碍是导致痴呆症最重要的危险因素,其中,对65岁前就开始的痴呆尤为重要。酒精使用障碍也与导致痴呆发病的所有其他独立危险因素有关,如吸烟、高血压、糖尿病、抑郁和听力损失等。”

Rehm博士还指出,平均而言,酒精使用障碍会使预期寿命(life expectancy)缩短超过20年,而痴呆症是导致这些人死亡的主要原因之一。不过,值得庆幸的是,酒精诱导的大脑损伤和痴呆是可以预防的。

作者们表示,世界卫生组织对慢性重度饮酒的定义为男性平均每天饮用超过60克纯酒精女性平均每天饮用超过40克纯酒精。鉴于这项研究中发现的强相关性,他们建议,对重度饮酒实施筛查和干预;对酒精使用障碍进行治疗,以减少因酒精引起的痴呆症负担。

论文的共同作者Bruce Pollock博士强调:“作为一名老年精神病医生,我经常能看到酒精使用障碍对痴呆症的影响,不幸的是,在这些病例中,酒精治疗干预可能太晚,因此无法改善认知能力。我认为,对问题饮酒(problem drinking)的筛查、干预,以及对酒精使用障碍的治疗需要开始得更早。

参考资料:

Largest study of its kind finds alcohol use biggest risk factor for dementia

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  • Contribution of alcohol use disorders to the burden of dementia in France 2008–13: a nationwide retrospective cohort study

    Background Dementia is a prevalent condition, affecting 5–7% of people aged 60 years and older, and a leading cause of disability in people aged 60 years and older globally. We aimed to examine the association between alcohol use disorders and dementia risk, with an emphasis on early-onset dementia (<65 years). Methods We analysed a nationwide retrospective cohort of all adult (≥20 years) patients admitted to hospital in metropolitan France between 2008 and 2013. The primary exposure was alcohol use disorders and the main outcome was dementia, both defined by International Classification of Diseases, tenth revision discharge diagnosis codes. Characteristics of early-onset dementia were studied among prevalent cases in 2008–13. Associations of alcohol use disorders and other risk factors with dementia onset were analysed in multivariate Cox models among patients admitted to hospital in 2011–13 with no record of dementia in 2008–10. Findings Of 31 624 156 adults discharged from French hospitals between 2008 and 2013, 1 109 343 were diagnosed with dementia and were included in the analyses. Of the 57 353 (5·2%) cases of early-onset dementia, most were either alcohol-related by definition (22 338 [38·9%]) or had an additional diagnosis of alcohol use disorders (10 115 [17·6%]). Alcohol use disorders were the strongest modifiable risk factor for dementia onset, with an adjusted hazard ratio of 3·34 (95% CI 3·28–3·41) for women and 3·36 (3·31–3·41) for men. Alcohol use disorders remained associated with dementia onset for both sexes (adjusted hazard ratios >1·7) in sensitivity analyses on dementia case definition (including Alzheimer's disease) or older study populations. Also, alcohol use disorders were significantly associated with all other risk factors for dementia onset (all p<0·0001). Interpretation Alcohol use disorders were a major risk factor for onset of all types of dementia, and especially early-onset dementia. Thus, screening for heavy drinking should be part of regular medical care, with intervention or treatment being offered when necessary. Additionally, other alcohol policies should be considered to reduce heavy drinking in the general population.

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