Increased risk of dementia in patients with Schizophrenia: A population-based cohort study in Taiwan
Increased risk of dementia in patients with Schizophrenia: A population-based cohort study in Taiwan
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DOI：
10.1016/j.eurpsy.2018.05.005
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发表时间：
2018-09-01
影响因子：
7.8
通讯作者：
Chi, Mei-Ju
中科院分区：
文献类型：
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作者：
Lin, Ching-En;Chung, Chi-Hsiang;Chi, Mei-Ju
背景：精神分裂症与全因痴呆风险的相关程度存在争议。本研究探讨了痴呆症的风险类型的精神分裂症patients.Methods：数据收集自2005年台湾国民健康保险数据库，并使用多变量考克斯比例风险回归模型进行分析，以确定精神分裂症对痴呆症的风险调整后的人口统计学特征，合并症，和药物治疗的效果。精细和灰色的竞争风险分析被用来确定痴呆症的风险，死亡可以作为一个竞争的危险因素dementions.Results：我们评估了6040精神分裂症患者和24,160倾向量表匹配的对照组患者。在调整协变量后，精神分裂症患者患痴呆的风险是对照组的1.80倍（调整后的风险比[aHR] = 1.80，95%置信区间[CI] = 1.36，与2.21相似，p < 0.001）。心血管疾病（aHR = 5.26; 95% CI = 4.50，与6.72相似; p < 0.001），高血压（aHR = 1.83; 95% CI = 1.77，与2.04相似; p = 0.002），创伤性头部损伤（aHR = 1.35; 95% CI = 1.24，类似于1.78; p < 0.001），慢性肺部疾病（aHR = 1.64; 95% CI = 1.13，与2.56相似; p < 0.001），酒精相关疾病（aHR = 3.67; 95%CI = 2.68，类似于4.92; p < 0.001）和帕金森病（aHR = 1.72; 95%CI = 1.25，类似于2.40; p < 0.001）与痴呆风险显著相关。值得注意的是，第一代抗精神病药物（aHR = 0.80; 95%CI = 0.56，类似于0.95; p = 0.044）和第二代抗精神病药物（aHR = 0.24; 95%CI = 0.11，类似于0.60; p < 0.001）与痴呆风险较低相关。在排除第一年和前3年的观察后，敏感性试验得出了一致的结果。精神分裂症患者患阿尔茨海默病的风险最高[痴呆/疾病？]在痴呆亚型中，（aHR = 2.10; 95% CI = 1.88，类似于3.86; p < 0.001），其次是血管性痴呆（aHR = 1.67; 95% CI = 1.27，与2.12相似; p < 0.001）和未指明的痴呆（aHR = 1.30; 95%CI = 1.04与2.01相似; p < 0.001）。结论：精神分裂症与全因痴呆的风险显著相关。关于抗精神病药物保护精神分裂症患者免于发展为痴呆的机制的数据很少。建议进一步研究以阐明精神分裂症和痴呆之间相关性的神经生物学机制，以及抗精神病药物是否可以预防精神分裂症痴呆的发展。(c)2018 Elsevier Masson SAS。All rights reserved.
Background: The extent to which schizophrenia is associated with the risk of all-cause dementia is controversial. This study investigated the risk of dementia by type in patients with schizophrenia.Methods: Data were collected from the Taiwanese National Health Insurance Database 2005 and analyzed using multivariate Cox proportional hazard regression models to determine the effect of schizophrenia on the dementia risk after adjusting for demographic characteristics, comorbidities, and medications. Fine and Gray's competing risk analysis was used to determine the risk of dementia, as death can act as a competing risk factor for dementia.Results: We assessed 6040 schizophrenia patients and 24,160 propensity scale-matched control patients. Schizophrenia patients exhibited a 1.80-fold risk of dementia compared to controls (adjusted hazard ratio [aHR] = 1.80, 95% confidence interval [CI] = 1.36 similar to 2.21, p < 0.001) after adjusting for covariates. Cardiovascular disease (aHR = 5.26; 95% CI = 4.50 similar to 6.72; p < 0.001), hypertension (aHR = 1.83; 95% CI = 1.77 similar to 2.04; p = 0.002), traumatic head injury (aHR = 1.35; 95% CI = 1.24 similar to 1.78; p < 0.001), chronic lung diseases (aHR = 1.64; 95% CI = 1.13 similar to 2.56; p < 0.001), alcohol-related disorders (aHR = 3.67; 95% CI = 2.68 similar to 4.92; p < 0.001), and Parkinson's disease (aHR = 1.72; 95% CI = 1.25 similar to 2.40; p < 0.001) were significantly associated with dementia risk. Notably, first-generation antipsychotics (aHR = 0.80; 95% CI = 0.56 similar to 0.95; p = 0.044) and second-generation antipsychotics (aHR = 0.24; 95% CI = 0.11 similar to 0.60; p < 0.001) were associated with a lower dementia risk. Sensitivity tests yielded consistent findings after excluding the first year and first 3 years of observation. Patients with schizophrenia had the highest risk of developing Alzheimer's [dementia/disease?] among dementia subtypes (aHR = 2.10; 95% CI = 1.88 similar to 3.86; p < 0.001), followed by vascular dementia (aHR = 1.67; 95% CI = 1.27 similar to 2.12; p < 0.001) and unspecified dementia (aHR = 1.30; 95% CI = 1.04 similar to 2.01; p < 0.001).Conclusions: Schizophrenia was significantly associated with the risk of all-cause dementia. Data are scarce on the mechanisms through which antipsychotic agents protect persons with schizophrenia from developing dementia. Further research is recommended to elucidate the neurobiological mechanisms underlying the association between schizophrenia and dementia, and whether antipsychotics protect against the development of dementia in schizophrenia. (c) 2018 Elsevier Masson SAS. All rights reserved.