Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan.
Div Gastroenterology, University of California San Francisco, San Francisco, California, USA.
Gut. 2021 Jan;70(1):85-91. doi: 10.1136/gutjnl-2020-320789. Epub 2020 Jun 23.
Increasing evidence supports reciprocal communication between the enteric and the central nervous system in disease, termed the 'gut-brain axis'. Recent findings suggest a connection between IBD and development of Parkinson's disease. The role of IBD in dementia, another insidious neurodegenerative disorder, has not been explored.
Using the Taiwanese National Health Insurance Research Database, we performed comparative analysis of 1742 patients with IBD ≥45 years old against 17 420 controls to assess dementia risk following IBD diagnosis. Controls were matched on bases of sex, access to healthcare, income and dementia-related comorbidities. All individuals were followed for dementia diagnosis for up to 16 years. Subanalyses included the relationship between sex, ulcerative colitis (UC) and Crohn's disease (CD), and dementia risk.
Overall incidence of dementia among patients with IBD was significantly elevated (5.5% vs 1.4% among controls). Patients with IBD were diagnosed with dementia at 76.24 years old on average, compared with 83.45 among controls. The HR of developing dementia among patients with IBD was 2.54 (95% CI 1.91 to 3.37). Among dementia types, the risk of developing Alzheimer's dementia demonstrated the greatest increase. Dementia risk did not differ between sex differences nor UC versus CD.
This population-based cohort study demonstrates significant association between IBD and subsequent development of dementia. Dementia was diagnosed at an earlier age among patients with IBD, and disease risk appeared to increase with IBD chronicity. These findings highlight the need for future research to elucidate the relationship between IBD and dementia.
越来越多的证据支持疾病中肠和中枢神经系统之间的相互交流，这被称为“肠-脑轴”。最近的研究结果表明，炎症性肠病（IBD）与帕金森病的发展之间存在联系。IBD 在另一种隐匿性神经退行性疾病——痴呆症中的作用尚未得到探索。
我们利用台湾全民健康保险研究数据库，对 1742 名年龄≥45 岁的 IBD 患者与 17420 名对照者进行了比较分析，以评估 IBD 诊断后痴呆症的发病风险。对照者根据性别、获得医疗保健的机会、收入和与痴呆症相关的合并症进行匹配。所有患者均随访 16 年以诊断痴呆症。亚分析包括性别、溃疡性结肠炎（UC）和克罗恩病（CD）与痴呆症风险之间的关系。
IBD 患者的总体痴呆症发病率明显升高（5.5%比对照组的 1.4%）。IBD 患者平均在 76.24 岁被诊断为痴呆症，而对照组为 83.45 岁。IBD 患者发生痴呆症的 HR 为 2.54（95%CI 1.91~3.37）。在痴呆症类型中，阿尔茨海默病痴呆症的风险增加最大。痴呆症风险在性别差异或 UC 与 CD 之间没有差异。
这项基于人群的队列研究表明 IBD 与随后发生的痴呆症之间存在显著关联。IBD 患者的痴呆症诊断年龄更早，且疾病风险似乎随着 IBD 的慢性化而增加。这些发现强调了未来研究阐明 IBD 与痴呆症之间关系的必要性。
