Thyroid function and the risk of dementia

医学 痴呆 甲状腺功能 亚临床感染 内科学 鹿特丹研究 危险系数 人口 风险因素 甲状腺功能测试 比例危险模型 优势比 前瞻性队列研究 队列 置信区间 甲状腺 疾病 环境卫生
作者
Layal Chaker,Frank J. Wolters,Daniël Bos,Tim I.M. Korevaar,Albert Hofman,Aad van der Lugt,Peter J. Koudstaal,Oscar H. Franco,Abbas Dehghan,Meike W. Vernooij,Robin P. Peeters,M. Arfan Ikram
出处
期刊:Neurology [Lippincott Williams & Wilkins]
卷期号:87 (16): 1688-1695 被引量:91
标识
DOI:10.1212/wnl.0000000000003227
摘要

To study the role of thyroid function in dementia, cognitive function, and subclinical vascular brain disease with MRI.Analyses were performed within the Rotterdam Study (baseline 1997), a prospective, population-based cohort. We evaluated the association of thyroid-stimulating hormone (TSH) and free thyroxine with incident dementia using Cox models adjusted for age, sex, cardiovascular risk factors, and education. Absolute risks were calculated accounting for death as a competing risk factor. Associations of thyroid function with cognitive test scores and subclinical vascular brain disease (white matter lesions, lacunes, and microbleeds) were assessed with linear or logistic regression. Additionally, we stratified by sex and restricted analyses to normal thyroid function.We included 9,446 participants with a mean age of 65 years. During follow-up (mean 8.0 years), 601 participants had developed dementia. Higher TSH was associated with lower dementia risk in both the full and normal ranges of thyroid function (hazard ratio [HR] 0.90, 95% confidence interval [CI] 0.83-0.98; and HR 0.76, 95% CI 0.64-0.91, respectively). This association was independent of cardiovascular risk factors. Dementia risk was higher in individuals with higher free thyroxine (HR 1.04, 95% CI 1.01-1.07). Absolute 10-year dementia risk decreased from 15% to 10% with higher TSH in older women. Higher TSH was associated with better global cognitive scores (p = 0.021). Thyroid function was not related to subclinical vascular brain disease as indicated by MRI.High and high-normal thyroid function is associated with increased dementia risk. Thyroid function is not related to vascular brain disease as assessed by MRI, suggesting a role for thyroid hormone in nonvascular pathways leading to dementia.
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