RESUMO
OBJECTIVES: To relate cancer since entry into the Framingham Heart Study with the risk of incident Alzheimer's disease and to estimate the risk of incident cancer among participants with and without Alzheimer's disease. DESIGN: Community based prospective cohort study; nested age and sex matched case-control study. SETTING: Framingham Heart Study, USA. PARTICIPANTS: 1278 participants with and without a history of cancer who were aged 65 or more and free of dementia at baseline (1986-90). MAIN OUTCOME MEASURES: Hazard ratios and 95% confidence intervals for the risks of Alzheimer's disease and cancer. RESULTS: Over a mean follow-up of 10 years, 221 cases of probable Alzheimer's disease were diagnosed. Cancer survivors had a lower risk of probable Alzheimer's disease (hazard ratio 0.67, 95% confidence interval 0.47 to 0.97), adjusted for age, sex, and smoking. The risk was lower among survivors of smoking related cancers (0.26, 0.08 to 0.82) than among survivors of non-smoking related cancers (0.82, 0.57 to 1.19). In contrast with their decreased risk of Alzheimer's disease, survivors of smoking related cancer had a substantially increased risk of stroke (2.18, 1.29 to 3.68). In the nested case-control analysis, participants with probable Alzheimer's disease had a lower risk of subsequent cancer (0.39, 0.26 to 0.58) than reference participants, as did participants with any Alzheimer's disease (0.38) and any dementia (0.44). CONCLUSIONS: Cancer survivors had a lower risk of Alzheimer's disease than those without cancer, and patients with Alzheimer's disease had a lower risk of incident cancer. The risk of Alzheimer's disease was lowest in survivors of smoking related cancers, and was not primarily explained by survival bias. This pattern for cancer is similar to that seen in Parkinson's disease and suggests an inverse association between cancer and neurodegeneration.
Assuntos
Doença de Alzheimer/epidemiologia , Neoplasias , Fumar/efeitos adversos , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Estudos de Coortes , Intervalos de Confiança , Feminino , Humanos , Incidência , Masculino , Neoplasias/epidemiologia , Neoplasias/etiologia , Neoplasias/mortalidade , Modelos de Riscos Proporcionais , Fatores de Risco , Fatores Sexuais , Taxa de SobrevidaRESUMO
Children of persons with Alzheimer disease (AD), as a group, face an increased risk of developing AD. Many of them, throughout their adult lives, seek input on how to reduce their chances of one day suffering their parent's fate. We examine the state of knowledge with respect to risk and protective factors for AD and recommend a research agenda with special emphasis on AD offspring.
