Increased Risk of Dementia Among Veterans With Bipolar Disorder or Schizophrenia Receiving Care in the VA Health System.
Increased Risk of Dementia Among Veterans With Bipolar Disorder or Schizophrenia Receiving Care in the VA Health System.
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在VA卫生系统中接受护理的双相情感障碍或精神分裂症的退伍军人中痴呆症的风险增加。
DOI：
10.1176/appi.ps.201900325
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发表时间：
2020-10-01
期刊：
影响因子：
--
通讯作者：
McCarthy JF
中科院分区：
文献类型：
--
作者：
Ahearn EP;Szymanski BR;Chen P;Sajatovic M;Katz IR;McCarthy JF
退伍军人健康管理局(VHA)在整个生命过程中提供持续的护理。在美国成年人中，双相情感障碍和精神分裂症与痴呆症风险增加有关。为了给服务规划提供信息，这项研究评估了患有双相情感障碍或精神分裂症的退伍军人VHA患者的痴呆症发生率，并根据合并的医疗条件进行了调整。使用VHA公司数据仓库的数据，我们确定了2004年和2005年接受VHA护理但未被诊断为痴呆症的所有退伍军人，他们截至2006年1月1日还活着，年龄在18-100岁之间。根据2004-2005年的VHA诊断，个人被归类为双相情感障碍、精神分裂症或两者都不存在。在持续使用VHA的人中，对痴呆症的发病率进行了长达10年的评估，时间为2006-2015年。研究队列包括3,648,852人。在控制了基础医疗合并症和药物使用后，退伍军人VHA患者合并精神分裂症的痴呆发生率比为2.92，双相情感障碍患者为2.26，而没有任何疾病的退伍军人VHA患者痴呆的发生率比为2.26。在接受持续VHA护理的退伍军人中，双相情感障碍和精神分裂症的诊断分别与接受新诊断的痴呆症的风险增加相关，并将医疗合并症控制在基线水平。与这两种疾病的患者相比，这两种疾病的发病率都很高，精神分裂症的风险最高。VHA临床医生应该在出现认知障碍的迹象或症状时评估可能的痴呆。研究结果也可能与普通人群中患痴呆症的风险有关。
The Veterans Health Administration (VHA) provides a continuum of care over the life course. Among US adults, bipolar disorder and schizophrenia are associated with increased risk for dementia. To inform service planning, this study assessed the incidence of dementia among Veteran VHA patients with bipolar disorder or schizophrenia, adjusting for comorbid medical conditions. Using data from VHA Corporate Data Warehouse, we identified all Veterans who received VHA care in 2004 and 2005 without a dementia diagnosis and who were alive and 18–100 years old as of January 1, 2006. Individuals were categorized as having bipolar disorder, schizophrenia, or neither condition based on VHA diagnoses in 2004–2005. Among ongoing VHA users, incidence of dementia was assessed for up to 10 years, 2006–2015. The study cohort included 3,648,852 individuals. After controlling for baseline medical comorbidity and substance use, the incidence rate ratio for dementia for Veteran VHA patients with schizophrenia was 2.92 and it was 2.26 for those with bipolar disorder, as compared to Veteran VHA patients with neither condition. Among Veterans receiving ongoing VHA care, diagnoses of bipolar disorder and schizophrenia were each associated with increased risk for receiving a new diagnosis of dementia, controlling for medical comorbidity at baseline. Both conditions had elevated incidence ratios compared to patients with neither condition, and those with schizophrenia were at highest risk. VHA clinicians should evaluate for possible dementia when there are signs or symptoms of cognitive impairment. Findings may also be relevant to dementia risk in the general population.
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