Table_1_The relationship of history of psychiatric and substance use disorders on risk of dementia among racial and ethnic groups in the United States.DOCX

IntroductionDementia is characterized by significant declines in cognitive, physical, social, and behavioral functioning, and includes multiple subtypes that differ in etiology. There is limited evidence of the influence of psychiatric and substance use history on the risk of dementia subtypes among older underrepresented racial/ethnic minorities in the United States. Our study explored the role of psychiatric and substance use history on the risk of etiology-specific dementias: Alzheimer’s disease (AD) and vascular dementia (VaD), in the context of a racially and ethnically diverse sample based on national data.
MethodsWe conducted secondary data analyses based on the National Alzheimer’s Coordinating Center Uniform Data Set (N = 17,592) which is comprised a large, racially, and ethnically diverse cohort of adult research participants in the network of US Alzheimer Disease Research Centers (ADRCs). From 2005 to 2019, participants were assessed for history of five psychiatric and substance use disorders (depression, traumatic brain injury, other psychiatric disorders, alcohol use, and other substance use). Cox proportional hazard models were used to examine the influence of psychiatric and substance use history on the risk of AD and VaD subtypes, and the interactions between psychiatric and substance use history and race/ethnicity with adjustment for demographic and health-related factors.
ResultsIn addition to other substance use, having any one type of psychiatric and substance use history increased the risk of developing AD by 22–51% and VaD by 22–53%. The risk of other psychiatric disorders on AD and VaD risk varied by race/ethnicity. For non-Hispanic White people, history of other psychiatric disorders increased AD risk by 27%, and VaD risk by 116%. For African Americans, AD risk increased by 28% and VaD risk increased by 108% when other psychiatric disorder history was present.
ConclusionThe findings indicate that having psychiatric and substance use history increases the risk of developing AD and VaD in later life. Preventing the onset and recurrence of such disorders may prevent or delay the onset of AD and VaD dementia subtypes. Prevention efforts should pay particular attention to non-Hispanic White and African American older adults who have history of other psychiatric disorders.
Future research should address diagnostic shortcomings in the measurement of such disorders in ADRCs, especially with regard to diverse racial and ethnic groups.

引言
痴呆以认知、躯体、社交及行为功能显著减退为特征，包含多种病因学不同的亚型。目前针对美国代表性不足的老年少数种族/族裔群体，关于精神疾病与物质使用史对痴呆亚型发病风险影响的研究证据较为有限。本研究基于全国性数据，以种族与族裔多元化的样本为研究对象，探讨了精神疾病与物质使用史对病因特异性痴呆——阿尔茨海默病（Alzheimer’s disease, AD）与血管性痴呆（vascular dementia, VaD）——发病风险的作用。
方法
本研究采用二级数据分析方法，数据来源于国家阿尔茨海默病协调中心统一数据集（National Alzheimer’s Coordinating Center Uniform Data Set，样本量N=17592），该数据集涵盖了美国阿尔茨海默病研究中心（Alzheimer Disease Research Centers, ADRCs）网络内的大型成年研究参与者队列，其种族与族裔分布多元。2005年至2019年间，研究人员对参与者的5类精神疾病与物质使用障碍史进行了评估，包括抑郁、创伤性脑损伤、其他精神疾病、酒精使用及其他物质使用。本研究采用考克斯比例风险模型（Cox proportional hazard models），在校正人口学与健康相关因素的前提下，分析精神疾病与物质使用史对AD及VaD亚型发病风险的影响，以及精神疾病与物质使用史和种族/族裔之间的交互作用。
结果
除其他物质使用外，存在任意一类精神疾病与物质使用史，可使AD发病风险升高22%~51%，VaD发病风险升高22%~53%。其他精神疾病对AD及VaD发病风险的影响因种族/族裔而异。对于非西班牙裔白人而言，其他精神疾病史可使AD发病风险升高27%，VaD发病风险升高116%；对于非裔美国人而言，若存在其他精神疾病史，则AD发病风险升高28%，VaD发病风险升高108%。
结论
本研究结果显示，存在精神疾病与物质使用史会升高晚年罹患AD及VaD的风险。预防此类疾病的发作与复发，或可预防或延缓AD及VaD这两类痴呆亚型的发病。相关预防工作应重点关注存在其他精神疾病史的非西班牙裔白人与非裔美国老年群体。
未来研究
未来研究应针对ADRCs中此类疾病评估的诊断局限性展开探讨，尤其需关注种族与族裔多元化群体的相关评估问题。