PDF(Pubmed)
Abstract：
BACKGROUND: Individuals with psychiatric disorders have an increased risk of developing dementia. Most cross-sectional studies suffer from selection bias, underdiagnosis and poor population representation, while there is only limited evidence from longitudinal studies on the role of anxiety, bipolar and psychotic disorders. Electronic health records (EHRs) permit large cohorts to be followed across the lifespan and include a wide range of diagnostic information.
OBJECTIVE: To assess the association between four groups of psychiatric disorders (schizophrenia, bipolar disorder/mania, depression and anxiety) with dementia in two large population-based samples with EHR.
METHODS: Using EHR on nearly 1 million adult individuals in Wales, and from 228 937 UK Biobank participants, we studied the relationships between schizophrenia, mania/bipolar disorder, depression, anxiety and subsequent risk of dementia.
RESULTS: In Secure Anonymised Information Linkage, there was a steep increase in the incidence of a first diagnosis of psychiatric disorder in the years prior to the diagnosis of dementia, reaching a peak in the year prior to dementia diagnosis for all psychiatric diagnoses. Psychiatric disorders, except anxiety, were highly significantly associated with a subsequent diagnosis of dementia: HRs=2.87, 2.80, 1.63 for schizophrenia, mania/bipolar disorder and depression, respectively. A similar pattern was found in the UK Biobank (HRs=4.46, 3.65, 2.39, respectively) and anxiety was also associated with dementia (HR=1.34). Increased risk of dementia was observed for all ages at onset of psychiatric diagnoses when these were divided into 10-year bins.
CONCLUSIONS: Psychiatric disorders are associated with an increased risk of subsequent dementia, with a greater risk of more severe disorders.
CONCLUSIONS: A late onset of psychiatric disorders should alert clinicians of possible incipient dementia.
OBJECTIVE: To assess the association between four groups of psychiatric disorders (schizophrenia, bipolar disorder/mania, depression and anxiety) with dementia in two large population-based samples with EHR.
METHODS: Using EHR on nearly 1 million adult individuals in Wales, and from 228 937 UK Biobank participants, we studied the relationships between schizophrenia, mania/bipolar disorder, depression, anxiety and subsequent risk of dementia.
RESULTS: In Secure Anonymised Information Linkage, there was a steep increase in the incidence of a first diagnosis of psychiatric disorder in the years prior to the diagnosis of dementia, reaching a peak in the year prior to dementia diagnosis for all psychiatric diagnoses. Psychiatric disorders, except anxiety, were highly significantly associated with a subsequent diagnosis of dementia: HRs=2.87, 2.80, 1.63 for schizophrenia, mania/bipolar disorder and depression, respectively. A similar pattern was found in the UK Biobank (HRs=4.46, 3.65, 2.39, respectively) and anxiety was also associated with dementia (HR=1.34). Increased risk of dementia was observed for all ages at onset of psychiatric diagnoses when these were divided into 10-year bins.
CONCLUSIONS: Psychiatric disorders are associated with an increased risk of subsequent dementia, with a greater risk of more severe disorders.
CONCLUSIONS: A late onset of psychiatric disorders should alert clinicians of possible incipient dementia.
摘要：
背景：患有精神疾病的个体患痴呆的风险增加。大多数横断面研究都存在选择偏差，诊断不足和人口代表性差，虽然关于焦虑作用的纵向研究证据有限，躁郁症和精神病。电子健康记录（EHR）允许在整个生命周期中跟踪大型队列，并包括广泛的诊断信息。
目的：评估四组精神疾病（精神分裂症，双相情感障碍/躁狂症,抑郁和焦虑)在两个基于人群的大型EHR样本中伴有痴呆。
方法：在威尔士近100万成年人身上使用EHR，来自228937名英国生物银行参与者，我们研究了精神分裂症之间的关系，躁狂症/双相情感障碍，抑郁症,焦虑和随后患痴呆症的风险。
结果：在安全的匿名信息链接中，在痴呆症诊断之前的几年中，首次诊断为精神疾病的发病率急剧增加，所有精神病诊断在痴呆症诊断前一年达到高峰。精神病,除了焦虑,与随后的痴呆诊断高度显著相关:精神分裂症的HR=2.87,2.80,1.63,躁狂症/双相情感障碍和抑郁症，分别。在英国生物银行中发现了类似的模式（HR分别为4.46、3.65、2.39），焦虑也与痴呆相关（HR=1.34）。当将这些疾病分为10年分类时，所有年龄在精神病诊断开始时都观察到痴呆的风险增加。
结论：精神疾病与随后的痴呆风险增加有关，患更严重疾病的风险更大。
结论：晚发性精神疾病应提醒临床医生注意可能的初期痴呆。
目的：评估四组精神疾病（精神分裂症，双相情感障碍/躁狂症,抑郁和焦虑)在两个基于人群的大型EHR样本中伴有痴呆。
方法：在威尔士近100万成年人身上使用EHR，来自228937名英国生物银行参与者，我们研究了精神分裂症之间的关系，躁狂症/双相情感障碍，抑郁症,焦虑和随后患痴呆症的风险。
结果：在安全的匿名信息链接中，在痴呆症诊断之前的几年中，首次诊断为精神疾病的发病率急剧增加，所有精神病诊断在痴呆症诊断前一年达到高峰。精神病,除了焦虑,与随后的痴呆诊断高度显著相关:精神分裂症的HR=2.87,2.80,1.63,躁狂症/双相情感障碍和抑郁症，分别。在英国生物银行中发现了类似的模式（HR分别为4.46、3.65、2.39），焦虑也与痴呆相关（HR=1.34）。当将这些疾病分为10年分类时，所有年龄在精神病诊断开始时都观察到痴呆的风险增加。
结论：精神疾病与随后的痴呆风险增加有关，患更严重疾病的风险更大。
结论：晚发性精神疾病应提醒临床医生注意可能的初期痴呆。
