Medical School, University of Western Australia,Perth,Australia.
Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University,Townsville,Australia.
Psychol Med. 2019 Jan;49(2):232-242. doi: 10.1017/S003329171800065X. Epub 2018 Mar 22.
Recent research has identified several potentially modifiable risk factors for dementia, including mental disorders. Psychotic disorders, such as schizophrenia and delusional disorder, have also been associated with increased risk of cognitive impairment and dementia, but currently available data difficult to generalise because of bias and confounding. We designed the present study to investigate if the presence of a psychotic disorder increased the risk of incident dementia in later life.
Prospective cohort study of a community-representative sample of 37 770 men aged 65-85 years who were free of dementia at study entry. They were followed for up to 17.7 years using electronic health records. Clinical diagnoses followed the International Classification of Diseases guidelines. As psychotic disorders increase mortality, we considered death a competing risk.
A total of 8068 (21.4%) men developed dementia and 23 999 (63.5%) died during follow up. The sub-hazard ratio of dementia associated with a psychotic disorder was 2.67 (95% CI 2.30-3.09), after statistical adjustments for age and prevalent cardiovascular, respiratory, gastrointestinal and renal diseases, cancer, as well as hearing loss, depressive and bipolar disorders, and alcohol use disorder. The association between psychotic disorder and dementia risk varied slightly according to the duration of the psychotic disorder (highest for those with the shortest illness duration), but not the age of onset. No information about the use of antipsychotics was available.
Older men with a psychotic disorder have nearly three times greater risk of developing dementia than those without psychosis. The pathways linking psychotic disorders to dementia remain unclear but may involve mechanisms other than those associated with Alzheimer's disease and other common dementia syndromes.
最近的研究已经确定了一些潜在的可改变的痴呆风险因素，包括精神障碍。精神疾病，如精神分裂症和妄想症，也与认知障碍和痴呆的风险增加有关，但目前可用的数据由于存在偏差和混杂因素，难以推广。我们设计了本研究来调查是否存在精神疾病会增加晚年发生痴呆的风险。
这是一项对 37770 名年龄在 65-85 岁、无痴呆的社区代表性样本进行的前瞻性队列研究。他们通过电子健康记录进行了长达 17.7 年的随访。临床诊断遵循国际疾病分类指南。由于精神疾病会增加死亡率，我们将死亡视为竞争风险。
共有 8068 名（21.4%）男性在随访期间发生痴呆，23999 名（63.5%）男性在随访期间死亡。在统计学上调整了年龄和常见的心血管、呼吸、胃肠道和肾脏疾病、癌症以及听力损失、抑郁和双相情感障碍以及酒精使用障碍等因素后，精神疾病与痴呆的亚风险比为 2.67（95%置信区间 2.30-3.09）。精神疾病与痴呆风险之间的关联略有差异，与精神病的持续时间有关（持续时间最短的风险最高），但与发病年龄无关。没有关于使用抗精神病药物的信息。
患有精神疾病的老年男性患痴呆的风险几乎是没有精神病的男性的三倍。将精神疾病与痴呆联系起来的途径仍不清楚，但可能涉及与阿尔茨海默病和其他常见痴呆综合征无关的机制。
