Migraine and the risk of all‐cause dementia, Alzheimer's disease, and vascular dementia: A prospective cohort study in community‐dwelling older adults
来源：中检健康
编辑：中检健康
时间：2019-09-16
Abstract
Objectives
Dementia is the most common neurological disease in older adults; headaches, including migraines, are the most common neurological disorder across all ages. The objective of this study was to explore the relationship between migraines and dementia, including Alzheimer's disease (AD) and vascular dementia (VaD).
Methods
Analyses were based on 679 community‐dwelling participants 65+ years from the Manitoba Study of Health and Aging, a population‐based, prospective cohort study. Participants screened as cognitively intact at baseline had complete data on migraine history and all covariates at baseline and were assessed for cognitive outcomes (all‐cause dementia, AD, and VaD) 5 years later. The association of exposure (lifetime history of migraines), confounding (age, gender, education, and depression), and intervening variables (hypertension, myocardial infarction, other heart conditions, stroke, and diabetes) with all‐cause dementia and dementia subtypes (AD and VaD) was assessed using multiple logistic regression models.
Results
A history of migraines was significantly associated with both all‐cause dementia (odds ratio [OR]=2.97; 95% confidence interval [CI]=1.25‐6.61) and AD (OR=4.22; 95% CI=1.59‐10.42), even after adjustment for confounding and intervening variables. Migraines were not significantly associated with VaD either before (OR=1.83; 95% CI=0.39‐8.52) or after (OR=1.52; 95% CI=0.20‐7.23) such adjustment.
Conclusions
Migraines were a significant risk factor for AD and all‐cause dementia. Despite the vascular mechanisms involved in migraine physiology, migraines were not significantly associated with VaD in this study. Recognition of the long‐term detrimental consequences of migraines for AD and dementia has implications for migraine management, as well as for our understanding of AD etiology.
Key points
Evidence of an association between migraines and dementia is unclear and may vary by dementia subtype, headache/migraine measure, gender, comorbidities, and clinical vs. community‐based sample.
A history of migraines was a significant risk factor for Alzheimer's disease and for all‐cause dementia, even after adjustment for confounding and intervening variables in a community‐dwelling population of older adults.
A history of migraines was not significantly associated with vascular dementia.
INTRODUCTION
As the global population ages, the prevalence of age‐related conditions, such as dementia, will continue to rise.1 Although dementia is the most common neurological disease in older adults, headaches are the most common neurological disorder across all ages, affecting almost half of the global population of adults.2 Migraines are the most debilitating form of headaches, affecting 20% of women and 8% of men.3 Both neurological disorders—dementia and migraines—cause significant impacts on individuals and their families, as well as on society more broadly. The relationship between migraines and dementia, including Alzheimer's disease (AD) and vascular dementia (VaD), has not yet been clearly established and has the potential to inform prevention and treatment as well as further understanding of the etiology of these disorders.
Cognitive consequences of migraines have been more thoroughly studied for cognition in general than for cognitive states such as dementia. Although one systematic review concluded that migraines were associated with mild cognitive changes across several domains,4 particularly in patient populations, other reviews5, 6 focusing on stronger cohort study designs have concluded that current evidence does not support an association between migraines and cognitive decline. However, evidence is less clear on the impact of migraines on dementia. A recent meta‐analysis7 of the limited number of cohort studies available noted substantial heterogeneity in these studies. Overall, it concluded that migraines did not increase the risk of dementia, although it did find an association with the broader category of headache disorders. An earlier meta‐analysis of four case‐control studies found a marginally significant inverse relationship between migraines and AD.8 In contrast, results from individual studies have suggested that migraines significantly increase the risk of dementia, but that the effect may be restricted to specific subgroups (eg, women9) or subtypes of dementia (eg, VaD10), or that headache disorders broadly11 or nonmigrainous headaches12, 13 may be risk factors rather than migraines specifically. Evidence of a significant association between migraines and dementia has been primarily based on patient populations, which are susceptible to selection biases.
The purpose of this study was to determine if migraines are a risk factor for dementia and its subtypes, AD and VaD, in a population‐based prospective cohort study of community‐dwelling older adults. The impact of possible intervening variables—hypertension, myocardial infarction, other heart conditions, stroke, and diabetes—was also investigated.
Rebecca E. Morton Philip D. St. John Suzanne L. Tyas
First published: 04 September 2019 https://doi.org/10.1002/gps.5180
Objectives
Dementia is the most common neurological disease in older adults; headaches, including migraines, are the most common neurological disorder across all ages. The objective of this study was to explore the relationship between migraines and dementia, including Alzheimer's disease (AD) and vascular dementia (VaD).
Methods
Analyses were based on 679 community‐dwelling participants 65+ years from the Manitoba Study of Health and Aging, a population‐based, prospective cohort study. Participants screened as cognitively intact at baseline had complete data on migraine history and all covariates at baseline and were assessed for cognitive outcomes (all‐cause dementia, AD, and VaD) 5 years later. The association of exposure (lifetime history of migraines), confounding (age, gender, education, and depression), and intervening variables (hypertension, myocardial infarction, other heart conditions, stroke, and diabetes) with all‐cause dementia and dementia subtypes (AD and VaD) was assessed using multiple logistic regression models.
Results
A history of migraines was significantly associated with both all‐cause dementia (odds ratio [OR]=2.97; 95% confidence interval [CI]=1.25‐6.61) and AD (OR=4.22; 95% CI=1.59‐10.42), even after adjustment for confounding and intervening variables. Migraines were not significantly associated with VaD either before (OR=1.83; 95% CI=0.39‐8.52) or after (OR=1.52; 95% CI=0.20‐7.23) such adjustment.
Conclusions
Migraines were a significant risk factor for AD and all‐cause dementia. Despite the vascular mechanisms involved in migraine physiology, migraines were not significantly associated with VaD in this study. Recognition of the long‐term detrimental consequences of migraines for AD and dementia has implications for migraine management, as well as for our understanding of AD etiology.
Key points
Evidence of an association between migraines and dementia is unclear and may vary by dementia subtype, headache/migraine measure, gender, comorbidities, and clinical vs. community‐based sample.
A history of migraines was a significant risk factor for Alzheimer's disease and for all‐cause dementia, even after adjustment for confounding and intervening variables in a community‐dwelling population of older adults.
A history of migraines was not significantly associated with vascular dementia.
INTRODUCTION
As the global population ages, the prevalence of age‐related conditions, such as dementia, will continue to rise.1 Although dementia is the most common neurological disease in older adults, headaches are the most common neurological disorder across all ages, affecting almost half of the global population of adults.2 Migraines are the most debilitating form of headaches, affecting 20% of women and 8% of men.3 Both neurological disorders—dementia and migraines—cause significant impacts on individuals and their families, as well as on society more broadly. The relationship between migraines and dementia, including Alzheimer's disease (AD) and vascular dementia (VaD), has not yet been clearly established and has the potential to inform prevention and treatment as well as further understanding of the etiology of these disorders.
Cognitive consequences of migraines have been more thoroughly studied for cognition in general than for cognitive states such as dementia. Although one systematic review concluded that migraines were associated with mild cognitive changes across several domains,4 particularly in patient populations, other reviews5, 6 focusing on stronger cohort study designs have concluded that current evidence does not support an association between migraines and cognitive decline. However, evidence is less clear on the impact of migraines on dementia. A recent meta‐analysis7 of the limited number of cohort studies available noted substantial heterogeneity in these studies. Overall, it concluded that migraines did not increase the risk of dementia, although it did find an association with the broader category of headache disorders. An earlier meta‐analysis of four case‐control studies found a marginally significant inverse relationship between migraines and AD.8 In contrast, results from individual studies have suggested that migraines significantly increase the risk of dementia, but that the effect may be restricted to specific subgroups (eg, women9) or subtypes of dementia (eg, VaD10), or that headache disorders broadly11 or nonmigrainous headaches12, 13 may be risk factors rather than migraines specifically. Evidence of a significant association between migraines and dementia has been primarily based on patient populations, which are susceptible to selection biases.
The purpose of this study was to determine if migraines are a risk factor for dementia and its subtypes, AD and VaD, in a population‐based prospective cohort study of community‐dwelling older adults. The impact of possible intervening variables—hypertension, myocardial infarction, other heart conditions, stroke, and diabetes—was also investigated.
Rebecca E. Morton Philip D. St. John Suzanne L. Tyas
First published: 04 September 2019 https://doi.org/10.1002/gps.5180
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