Mental Health Outcomes in Alzheimer's Disease Patients and Their Partners

阿尔茨海默病（AD）是发病率和死亡率的主要原因，并且预计其患病率将增加两倍 到2050年在全球范围内。AD具有高疾病负担，可能导致AD患者的心理社会困扰， 他们的配偶/伴侣，并可能增加精神疾病的风险。重要的是，精神障碍是可以治疗的， 早期干预可以减少AD患者的痛苦，改善生活质量，预防过早死亡 患者和他们的伴侣。尽管精神障碍给公共卫生带来了沉重的负担， 与AD的躯体结局相比。全面了解心理健康后遗症是 迫切需要改善AD患者及其伴侣的临床护理和结局。先前的研究 有关键的局限性，包括有限的随访时间和样本量，以及精神障碍的确定 使用自我报告（可能存在报告偏倚）或医院记录（仅记录 最严重的病例。没有大规模的研究包括合作伙伴。我们将通过以下方式解决这些局限性： 进行了第一次全面的研究，在AD患者及其合作伙伴的心理健康结果， 使用来自初级保健、专科门诊和住院患者的高度完整数据的国家队列（N = 6 M） 设置.我们假设AD患者及其伴侣患主要精神障碍的风险增加 和自杀为了验证这一假设，我们将在233，792名诊断为AD的患者中检查这些结果 1998年，瑞典有660，807人患有任何痴呆症（包括与AD结果进行比较）， 2018年和他们的342，298名伴侣，相比之下，330万没有痴呆症（性别和出生年份匹配5：1） 以及他们的170万名合作伙伴，随访至2020年。瑞典是一个理想的环境，因为个人层面的数据 AD和全因痴呆诊断，心理健康结果和协变量可用于整个 人口此外，AD和常见精神障碍的发病率和治疗与 我们我们的具体目标是确定4个主要心理健康结果的风险（严重抑郁症，焦虑症， 疾病，酒精使用障碍和自杀）在AD和全因痴呆患者及其配偶/伴侣， 并确定高危亚组。这项拟议中的研究意义重大，因为AD是全球主要的健康问题， 这是一个日益普遍的问题，其心理健康后遗症可能会产生重大影响， 未被充分研究并且是可预防或可治疗的。它是创新的，因为它将提供第一个全面的 评估全国AD和全因痴呆患者队列的4个主要心理健康结局， 通过整合600万人无与伦比的个人层面数据，帮助他们的合作伙伴。它具有很高的成本效益，因为 我们将利用瑞典多个国家登记处的数据，这些数据不可用或成本过高， 在美国组装。研究结果将首次通过确定心理健康来填补关键的知识空白 AD和全因痴呆患者，他们的伴侣和高风险亚组的结果， 这将有助于指导及时的干预措施，以改善他们的生活质量和健康结果。

Alzheimer's disease (AD) is a leading cause of morbidity and mortality and is expected to triple in prevalence worldwide by 2050. AD has a high disease burden that may cause psychosocial distress in AD patients and their spouses/partners, and may increase risks of mental illness. Importantly, mental disorders are treatable, and early intervention could reduce suffering, improve quality of life, and prevent premature death in AD patients and their partners. Despite the high public health burden of mental disorders, they are understudied compared with somatic outcomes of AD. A comprehensive understanding of mental health sequelae is critically needed to improve clinical care and outcomes for AD patients and their partners. Prior studies have had key limitations, including limited follow-up times and sample sizes, and ascertainment of mental disorders using either self-report which is potentially subject to reporting bias, or hospital records which capture only the most severe cases. No large-scale studies have included partners. We will address these limitations by conducting the first comprehensive study of mental health outcomes in AD patients and their partners in a national cohort (N = 6 M) using highly complete data from primary care, specialty outpatient, and inpatient settings. We hypothesize that AD patients and their partners have increased risks of major mental disorders and suicide. To test this hypothesis, we will examine these outcomes in 233,792 persons diagnosed with AD and 660,807 persons with any dementia (included for comparison with AD findings) in Sweden during 1998- 2018 and their 342,298 partners, compared with 3.3 M without dementia (matched 5:1 on sex and birth year) and their 1.7 M partners, followed up through 2020. Sweden is an ideal setting because individual-level data on AD and all-cause dementia diagnoses, mental health outcomes, and covariates are available for the entire population. Moreover, the incidence and treatment of AD and common mental disorders are comparable to the US. Our specific aims are to determine risks of 4 major mental health outcomes (major depression, anxiety disorders, alcohol use disorder, and suicide) in AD and all-cause dementia patients and their spouses/partners, and identify high-risk subgroups. The proposed research is significant because AD is a major global health problem that is increasing in prevalence, and its mental health sequelae may have substantial impacts that are understudied and preventable or treatable. It is innovative because it will provide the first comprehensive assessment of 4 major mental health outcomes in a national cohort of AD and all-cause dementia patients and their partners by integrating unparalleled individual-level data for 6 M people. It is highly cost-efficient because we will leverage data from multiple national registries in Sweden that are unavailable or prohibitively costly to assemble in the US. The results will fill critical knowledge gaps by identifying, for the first time, mental health outcomes in AD and all-cause dementia patients, their partners, and high-risk subgroups in a national population, which will help guide timely interventions to improve their quality of life and health outcomes.