title: Plasma parathyroid hormone is associated with vascular dementia and cerebral hyperintensities in two community-based cohorts.
abstract: BACKGROUND
  In diseases with increased PTH such as hyperparathyroidism and chronic renal failure, dementia is common. Little is known of PTH and dementia in the community.
  
  
  OBJECTIVE
  We sought to investigate relations between PTH, clinical dementia and cerebral micro-vascular disease.
  
  
  METHODS
  The Uppsala Longitudinal Study Of Adult Men (ULSAM) was prospective, baseline, 1991-1995; followup, 15.8 years. The Prospective Investigation Of The Vasculature In Uppsala Seniors (PIVUS) was cross-sectional, baseline, 2001. Both settings were community based. PARTICIPANTS AND MAIN OUTCOME MEASURE: In the ULSAM study of 998 men (age 71) the association between PTH and dementia was investigated. In the PIVUS study of 406 men and women (age 70) the relation between PTH and magnetic resonance imaging signs of cerebral small vascular disease was investigated.
  
  
  RESULTS
  During followup, 56 individuals were diagnosed with vascular, 91 with Alzheimer's, and 59 with other dementias. In Cox-regression analyses, higher PTH was associated with vascular dementia (hazard ratio per 1 SD increase of PTH, 1.41; P < .01), but not with other dementias. The top tertile of PTH accounted for 18.5% of the population-attributable risk for vascular dementia, exceeding all other risk factors. In linear regression analysis in PIVUS, PTH was associated with increasing white matter hyperintensities (WMHI), reflecting increasing burden of cerebral small vessel disease (1 SD PTH increase, 0.31 higher category of WMHI; P = .016). All models were adjusted for vascular risk factors and mineral metabolism.
  
  
  CONCLUSIONS
  In two community-based samples, PTH predicted clinically diagnosed vascular dementia as well as neuroimaging indices of cerebral small vessel disease. Our data suggest a role for PTH in the development of vascular dementia.
authors.affiliation: Uppsala Clinical Research Center (E.H., J.Ä.), Departments of Public Health and Caring Sciences/Geriatrics (L.K.), Radiology (R.N., E.-M.L., H.A., L.J.), Surgical Sciences (K.M.), and Medical Sciences (E.H., H.M., L.L., J.Ä.), Uppsala University, 75185 Uppsala, Sweden; and the School of Health and Social Studies (J.Ä.), Dalarna University, 79131 Falun, Sweden.
authors.forename: Emil
authors.initials: E
authors.lastname: Hagström
authors.forename: Lena
authors.initials: L
authors.lastname: Kilander
authors.forename: Ruta
authors.initials: R
authors.lastname: Nylander
authors.forename: Elna-Marie
authors.initials: EM
authors.lastname: Larsson
authors.forename: Karl
authors.initials: K
authors.lastname: Michaëlsson
authors.forename: Håkan
authors.initials: H
authors.lastname: Melhus
authors.forename: Håkan
authors.initials: H
authors.lastname: Ahlström
authors.forename: Lars
authors.initials: L
authors.lastname: Johansson
authors.forename: Lars
authors.initials: L
authors.lastname: Lind
authors.forename: Johan
authors.initials: J
authors.lastname: Arnlöv
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000473:pathology*; D059345:Cerebral Small Vessel Diseases / Q000097:blood / Q000175:diagnosis* / Q000473:pathology; D015140:Dementia, Vascular / Q000097:blood / Q000175:diagnosis* / Q000473:pathology; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood*; D012307:Risk Factors; D066127:White Matter / Q000473:pathology
chemical_list: D010281:Parathyroid Hormone