TY - JOUR T1 -妊娠高血压疾病与晚年认知的关系JF - Neurology JO - Neurology DO - 10.1212/WNL.0000000000207134首页Sp - 10.1212/ wnl.0000000000207134AU - Michelle M. Mielke AU - Ryan D. Frank AU - Luke R . christensen AU - Julie A. Fields AU - Walter A. Rocca AU - Vesna D. Garovic Y1 - 2023/03/01背景与目的妊娠期高血压首页疾病(HDP)的研究，包括妊娠期或慢性高血压(GH/CH)和先兆子痫/子痫(PE/E);提示与早期生活和中年认知有关，但由于自我报告或诊断代码的使用、排除未生育妇女以及缺乏对晚年认知的测量而受到限制。我们检查了任何HDP、GH/CH、PE/E和nulliparity对晚年认知的影响。研究对象包括2239名女性(中位年龄73岁)，她们参加了梅奥诊所老年研究，并有妊娠信息的医疗记录。每15个月进行9项认知测试。整体认知和特定领域的z得分(记忆、执行/注意力、视觉空间、语言)是结果。线性混合效应模型评估了怀孕史(所有正常血压、任何HPD、HPD亚型[GH/CH, PE/E]或未生育)与年龄和教育调整后的认知能力下降之间的相关性。附加模型调整了载脂蛋白e、吸烟、高血压、血脂异常、身体质量指数(BMI)、糖尿病、中风和心脏病。 Interactions between pregnancy history and age or education on cognitive performance were examined.Results Of the 2,239 women, 1,854 (82.8%) had at least one pregnancy (1,607 all normotensive, 100 GH/CH, 147 PE/E); 385 (17.2%) were nulliparous. Cognitive performance did not cross-sectionally differ for women with a history of any HDP, GH/CH, or PE/E versus women with a history of all normotensive pregnancies; women who were nulliparous had lower global and domain-specific cognition (all p<0.05) in age- and education-adjusted models. There was an interaction (p=0.015) between nulliparity and education such that the lower cognitive performance was most pronounced among nulliparous women with ≤12 years of education (beta = -0.42, p<0.001) versus 12+ years (b = -0.11, p=0.049). Longitudinally, women with any HDP had greater declines in global cognition and attention/executive z-scores compared to women with all normotensive pregnancies. When stratified by HDP type, only women with PE/E had greater declines in global cognition (beta = -0.04, p<0.001), language (beta = -0.03, p=0.001), and attention (beta = -0.04, p<0.001) z-scores. Adjustment for vascular risk factors, BMI, smoking, and APOE did not attenuate results.Discussion Women with a history of HDP, especially PE/E, are at greater risk of cognitive decline in later life. ER -