Ahearn Eileen P, Szymanski Benjamin R, Chen Peijun, Sajatovic Martha, Katz Ira R, McCarthy John F
Department of Psychiatry, William S. Middleton Department of Veterans Affairs (VA) Hospital, Madison, Wisconsin, and Department of Psychiatry, University of Wisconsin-Madison, Madison (Ahearn); Office of Mental Health and Suicide Prevention, VA, Washington, D.C. (Szymanski, Katz, McCarthy); Department of Geriatric Research, Education, and Clinical Center, Louis Stokes Cleveland VA Medical Center, Cleveland (Chen); Department of Psychiatry, Case Western Reserve University, Cleveland (Chen, Sajatovic).
Psychiatr Serv. 2020 Oct 1;71(10):998-1004. doi: 10.1176/appi.ps.201900325. Epub 2020 Jun 10.
The Veterans Health Administration (VHA) provides a continuum of care over the life course. Among U.S. adults, bipolar disorder and schizophrenia are associated with increased risk of dementia. To inform service planning, this study assessed the incidence of dementia among veteran VHA patients with bipolar disorder or schizophrenia, with adjustment for comorbid medical conditions.
Using data from the VHA Corporate Data Warehouse, the authors identified all veterans who received VHA care in 2004 and 2005 without a dementia diagnosis and who were alive and between ages 18 and 100 as of January 1, 2006. Individuals were categorized as having bipolar disorder, schizophrenia, or neither condition on the basis of diagnoses in 2004-2005. Among ongoing VHA users, incidence of dementia was assessed for up to 10 years (2006-2015).
The cohort included 3,648,852 individuals. After analyses controlled for baseline comorbid general medical conditions and substance use disorders, the incidence rate ratios (IRRs) for dementia were 2.92 for those with schizophrenia and 2.26 for those with bipolar disorder, compared with VHA patients with neither condition.
Among veterans receiving VHA care, diagnoses of bipolar disorder and schizophrenia were each associated with increased risk of receiving a new diagnosis of dementia, even when analyses controlled for baseline medical comorbidities. IRRs were elevated for patients with either condition, compared with those with neither condition, and highest for those with schizophrenia. VHA clinicians should evaluate patients for dementia when signs or symptoms of cognitive impairment are present.
退伍军人健康管理局（VHA）提供贯穿生命全程的连续护理。在美国成年人中，双相情感障碍和精神分裂症与痴呆风险增加有关。为指导服务规划，本研究评估了患有双相情感障碍或精神分裂症的退伍军人VHA患者中痴呆的发病率，并对合并的医疗状况进行了调整。
利用VHA企业数据仓库的数据，作者识别出了所有在2004年和2005年接受VHA护理且无痴呆诊断、截至2006年1月1日存活且年龄在18至100岁之间的退伍军人。根据2004 - 2005年的诊断，将个体分为患有双相情感障碍、精神分裂症或两者皆无。在持续使用VHA的用户中，评估长达10年（2006 - 2015年）的痴呆发病率。
该队列包括3,648,852名个体。在对基线合并的一般医疗状况和物质使用障碍进行分析控制后，与既无双相情感障碍也无精神分裂症的VHA患者相比，精神分裂症患者的痴呆发病率比（IRR）为2.92，双相情感障碍患者为2.26。
在接受VHA护理的退伍军人中，双相情感障碍和精神分裂症的诊断均与新诊断痴呆的风险增加有关，即使在分析中对基线医疗合并症进行了控制。与两者皆无的患者相比，患有任何一种疾病的患者IRR均升高，其中精神分裂症患者最高。当出现认知障碍的体征或症状时，VHA临床医生应评估患者是否患有痴呆。
