Effect of depression and diabetes mellitus on the risk for dementia: a national population-based cohort study.
Effect of depression and diabetes mellitus on the risk for dementia: a national population-based cohort study.
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DOI：
10.1001/jamapsychiatry.2015.0082
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发表时间：
2015-06
期刊：
影响因子：
25.8
通讯作者：
Vestergaard M
中科院分区：
文献类型：
--
作者：
Katon W;Pedersen HS;Ribe AR;Fenger-Grøn M;Davydow D;Waldorff FB;Vestergaard M
虽然抑郁症和2型糖尿病可能会独立增加痴呆症的风险，但没有研究表明两者的痴呆症风险是否高于各自的总和。研究患有抑郁症、糖尿病或两者兼有的人与两者都没有的人患全因痴呆症的风险。一项基于人群的队列研究，研究对象为2，454，532名成年人，包括477，133名（19.4%）抑郁症患者，223，174名（9.1%）糖尿病患者和95，691名（3.9%）两者均患有。丹麦2007年1月1日至2013年期间年龄≥50岁的所有无痴呆症的丹麦公民。通过丹麦国家患者登记处、丹麦精神病中心登记处（DPCR）的医生诊断和/或丹麦国家处方登记处（DNPR）的胆碱酯酶抑制剂或美金刚处方确定痴呆。抑郁症是由精神科医生诊断从DPCR或抗抑郁药处方从DNPR。使用丹麦国家糖尿病登记册确定糖尿病。使用考克斯比例风险回归模型估计与糖尿病、抑郁症或两者相关的全因痴呆的风险，该模型调整了潜在的混杂因素，如人口统计学和潜在的中间因素，如医学合并症。在13，834，645百万人年的随访中，59，663人（2.4%）患上了痴呆症，其中6，466人（10.8%）患有糖尿病，15，729人（26.4%）患有抑郁症，4，022人（6.7%）两者兼而有之。与没有抑郁症的人相比，患有抑郁症的人发生全因痴呆的校正风险比为1.83（95%置信区间：1.80，1.87），患有糖尿病的人为1.20（95% CI：1.17，1.23），患有两者的人为2.17（95% CI：2.10，2.24）。在抑郁症和糖尿病共病的个体中观察到的全因痴呆症的额外风险超过了与两者单独相关的总风险，特别是对于年轻人。65岁以下和65岁以上的受试者中，共病抑郁症和糖尿病相互作用的相应归因比例分别为0.25（95%CI = 0.13，0.36; P<0.001）和0.06（95%CI = 0.02，0.10; P=0.001）。抑郁症和糖尿病与更大的痴呆风险独立相关，两种疾病与全因痴呆风险的联合关联比相加更强。
Although depression and type 2 diabetes may independently increase dementia risk, no studies have examined whether the risk of dementia among people with both is higher than the sum of each individually. To examine risk of all-cause dementia among persons with depression, diabetes or both compared to those with neither. A population-based cohort study of 2,454,532 adults, including 477,133 (19.4%) with depression, 223,174 (9.1%) with diabetes and 95,691 (3.9%) with both. Denmark All dementia-free Danish citizens ≥50 years old between January 1, 2007 through 2013. Dementia was ascertained by physician diagnosis from the Danish National Patient Register, the Danish Psychiatric Central Register (DPCR), and/or prescription of a cholinesterase inhibitor or memantine from the Danish National Prescription Registry (DNPR). Depression was ascertained by psychiatrist diagnosis from the DPCR or antidepressant prescription from the DNPR. Diabetes was identified using the Danish National Diabetes Register. The risk of all-cause dementia associated with diabetes, depression or both was estimated using Cox proportional hazards regression models that adjusted for potential confounding factors such as demographics and potential intermediates such as medical comorbidity. During 13,834,645 million person-years of follow-up, 59,663 (2.4%) developed dementia of whom 6,466 (10.8%) had diabetes, 15,729 (26.4%) had depression and 4,022 (6.7%) had both. The adjusted hazard ratio of developing all-cause dementia was 1.83 (95% confidence interval: 1.80, 1.87) for persons with depression, 1.20 (95% CI: 1.17, 1.23) for persons with diabetes, and 2.17 (95% CI: 2.10, 2.24) for those with both as compared to those with neither. The excess risk of all-cause dementia observed for individuals with comorbid depression and diabetes surpassed the summed risk associated with the two individually, especially for younger persons. The corresponding Attributable Proportion due to the interaction of comorbid depression and diabetes was 0.25 (95% CI = 0.13, 0.36; P<0.001) for those under 65 years old and 0.06 (95% CI = 0.02, 0.10; P=0.001) for those over 65. Depression and diabetes were independently associated with greater dementia risk and the combined association of the two disorders with risk of all-cause dementia was stronger than additive.