Department of Psychiatry, Taipei City Hospital, Renai Branch, Taipei, Taiwan.
National Yang-Ming University, School of Medicine, Taipei, Taiwan.
Biomed Res Int. 2020 Jan 29;2020:1704879. doi: 10.1155/2020/1704879. eCollection 2020.
Late onset depression (LOD) often occurs in the context of vascular disease and may be associated with risk of dementia. Aspirin is widely used to reduce the risk of cardiovascular disease and stroke. However, its role in patients with LOD and risk of dementia remains inconclusive. A population-based study was conducted using data from National Health Insurance of Taiwan during 1996-2009. Patients fulfil diagnostic criteria for LOD with or without subsequent dementia (incident dementia) and among whom users of aspirin (75 mg daily for at least 6 months) were identified. The time-dependent Cox proportional hazards model was applied for multivariate analyses. Propensity scores with the one-to-one nearest-neighbor matching model were used to select matching patients. Cumulative incidence of incident dementia after diagnosis of LOD was calculated by Kaplan-Meier Method.
A total of 6028 (13.4%) and 40,411 (86.6%) patients were defined as, with and without diagnosis of LOD, among whom 2,424 (41.9%) were aspirin users. Patients with LOD had more comorbidities such as cardiovascular diseases, diabetes, and hypertension comparing to those without LOD. Among patients with LOD, aspirin users had lower incidence of subsequent incident dementia than non-users (Hazard Ratio = 0.734, 95% CI 0.641-0.841, < 0.001). After matching aspirin users with non-users by propensity scores-matching method, the cumulative incidence of incident dementia was significantly lower in aspirin users of LOD patients ( < 0.001). After matching aspirin users with non-users by propensity scores-matching method, the cumulative incidence of incident dementia was significantly lower in aspirin users of LOD patients (.
Aspirin may be associated with a lower risk of incident dementia in patients with LOD. This beneficial effect of aspirin in LOD patients needs validation in prospective clinical trials and our results should be interpreted with caution.
迟发性抑郁症（LOD）常发生于血管疾病背景下，且与痴呆风险相关。阿司匹林被广泛用于降低心血管疾病和中风风险。然而，其在 LOD 患者中的作用及对痴呆风险的影响仍不确定。本研究使用台湾全民健康保险数据库的数据，于 1996 年至 2009 年进行了一项基于人群的研究。研究纳入符合 LOD 诊断标准且有（或无）后续痴呆（新发痴呆）的患者，以及至少使用 6 个月 75mg 每日剂量阿司匹林的患者。采用多变量 Cox 比例风险模型进行分析。采用 1:1 最近邻匹配模型进行倾向评分匹配，选择匹配患者。通过 Kaplan-Meier 法计算 LOD 诊断后新发痴呆的累积发生率。
共定义 6028 例（13.4%）和 40411 例（86.6%）患者患有或未患有 LOD，其中 2424 例（41.9%）为阿司匹林使用者。与无 LOD 患者相比，LOD 患者合并症更多，如心血管疾病、糖尿病和高血压。在 LOD 患者中，阿司匹林使用者新发痴呆的发生率低于非使用者（风险比=0.734，95%置信区间 0.641-0.841，<0.001）。通过倾向评分匹配法匹配阿司匹林使用者与非使用者后，LOD 患者中阿司匹林使用者的新发痴呆累积发生率显著降低（<0.001）。通过倾向评分匹配法匹配阿司匹林使用者与非使用者后，LOD 患者中阿司匹林使用者的新发痴呆累积发生率显著降低（<0.001）。
阿司匹林可能与 LOD 患者新发痴呆风险降低相关。这一阿司匹林在 LOD 患者中的有益作用需要前瞻性临床试验的验证，我们的结果应谨慎解释。
