Medicine Service, Birmingham VA Medical Center, 700 19th St S, Birmingham, AL, 35233, USA.
Department of Medicine at School of Medicine, University of Alabama at Birmingham, 1720 Second Ave. South, Birmingham, AL, 35294-0022, USA.
BMC Geriatr. 2018 Nov 14;18(1):281. doi: 10.1186/s12877-018-0975-0.
Conflicting data in the literature raise the question whether gout, independent of its treatment, increases the risk of dementia in the elderly. Our objective was to assess whether gout in older adults is associated with the risk of incident dementia.
We used the 5% Medicare claims data for this observational cohort study. We used multivariable-adjusted Cox proportional hazard models to assess the association of gout with a new diagnosis of dementia (incident dementia), adjusting for potential confounders/covariates including demographics (age, race, sex), comorbidities (Charlson-Romano comorbidity index), and medications commonly used for cardiac diseases (statins, beta-blockers, diuretics, and angiotensin converting enzyme (ACE)-inhibitors) and gout (allopurinol and febuxostat).
In our cohort of 1.71 million Medicare beneficiaries, 111,656 had incident dementia. The crude incidence rates of dementia in people without and with gout were 10.9 and 17.9 per 1000 person-years, respectively. In multivariable-adjusted analyses, gout was independently associated with a significantly higher hazard ratio of incident dementia, with a HR of 1.15 (95% CI, 1.12, 1.18); sensitivity analyses confirmed the main findings. Compared to age 65 to < 75 years, age 75 to < 85 and ≥ 85 years were associated with 3.5 and 7.8-fold higher hazards of dementia; hazards were also higher for females, black race or people with higher medical comorbidity.
Gout was independently associated with a 15% higher risk of incident dementia in the elderly. Future studies need to understand the pathogenic pathways involved in this increased risk.
文献中的矛盾数据引发了这样一个问题，即痛风是否会增加老年人痴呆的风险，而与治疗无关。我们的目的是评估老年人痛风是否与痴呆的发生风险相关。
我们使用了这项观察性队列研究的 5%医疗保险索赔数据。我们使用多变量调整的 Cox 比例风险模型来评估痛风与新发痴呆（新发痴呆）的相关性，调整了潜在的混杂因素/协变量，包括人口统计学因素（年龄、种族、性别）、合并症（Charlson-Romano 合并症指数）以及常用于心脏病的药物（他汀类药物、β受体阻滞剂、利尿剂和血管紧张素转换酶（ACE）抑制剂）和痛风（别嘌醇和非布司他）。
在我们的 171 万医疗保险受益人的队列中，有 111656 人患有新发痴呆。无痛风和有痛风的人痴呆的粗发病率分别为每 1000 人年 10.9 和 17.9 例。在多变量调整分析中，痛风与痴呆的发生风险显著增加相关，风险比（HR）为 1.15（95%CI，1.12，1.18）；敏感性分析证实了主要发现。与 65 岁至<75 岁相比，75 岁至<85 岁和≥85 岁与痴呆的风险分别增加了 3.5 倍和 7.8 倍；女性、黑人或合并症较高的人发生痴呆的风险也更高。
痛风与老年人新发痴呆的风险增加 15%独立相关。未来的研究需要了解涉及这种风险增加的发病机制途径。
