Department of Community Mental Health, University of Haifa, Haifa, Israel; Meuhedet Health Services, Mental Health, Tel Aviv, Israel.
Faculty of Industrial Engineering and Management, Israel Institute of Technology, Haifa,Israel.
Schizophr Res. 2020 Sep;223:220-226. doi: 10.1016/j.schres.2020.07.020. Epub 2020 Aug 14.
Knowledge is limited regarding the risks of death and dementia in very-late onset schizophrenia-like psychosis (VLOS). This study aims to scrutinize the associations between VLOS with the risks of death and dementia. Based on a prospective Israeli cohort study with national coverage, 94,120 persons without dementia or schizophrenia diagnoses aged 60 to 90 in 2012 were followed-up for the risks of dementia or death from 2013 to 2017. VLOS was classified as present from the age of the first ICD-9 diagnosis during follow-up, otherwise as absent. Hazard ratios (HR) with confidence intervals (95% CI) were computed with survival models to quantify the associations between VLOS and the risks of death and dementia, without and with adjustment for confounding. Nine sensitivity analyses were computed to examine the robustness of the results. The group with VLOS, compared to the group without, had higher death (n = 61, 18.5% vs. n = 7028, 7.5%, respectively) and dementia (n = 64, 19.5% vs. n = 5962, 6.4%, respectively) rates. In the primary analysis, the group with VLOS compared to the group without had increased risks of death (unadjusted HR = 3.10, 95% CI = 2.36, 4.06, P < .001; adjusted HR = 2.89, 95% CI = 2.15, 3.89; P < .001) and dementia (unadjusted HR = 3.81, 95% CI = 2.90, 4.99, P < .001; adjusted HR = 2.67, 95% CI = 1.82, 3.91; P < .001). The results remained statistically significant (P < .05) in all sensitivity analyses, including among persons without antipsychotic medication. The results may support notions of increased dementia risk and accelerated aging in VLOS, or that VLOS is a prodromal state of dementia.
关于极晚发性精神分裂样精神病（VLOS）的死亡和痴呆风险，目前相关知识有限。本研究旨在深入研究 VLOS 与死亡和痴呆风险之间的关联。本研究基于一项具有全国覆盖范围的前瞻性以色列队列研究，在 2012 年，94120 名年龄在 60 至 90 岁、无痴呆或精神分裂症诊断的人群纳入研究，并在 2013 年至 2017 年期间随访痴呆或死亡风险。VLOS 定义为在随访期间从首次 ICD-9 诊断时开始存在，否则为不存在。使用生存模型计算风险比（HR）和置信区间（95%CI），以量化 VLOS 与死亡和痴呆风险之间的关联，包括和不包括混杂因素调整。进行了 9 项敏感性分析，以检验结果的稳健性。与无 VLOS 组相比，VLOS 组的死亡率（n=61，18.5% vs. n=7028，7.5%）和痴呆率（n=64，19.5% vs. n=5962，6.4%）更高。在主要分析中，与无 VLOS 组相比，VLOS 组的死亡风险更高（未调整 HR=3.10，95%CI=2.36，4.06，P<0.001；调整 HR=2.89，95%CI=2.15，3.89；P<0.001）和痴呆风险（未调整 HR=3.81，95%CI=2.90，4.99，P<0.001；调整 HR=2.67，95%CI=1.82，3.91；P<0.001）。所有敏感性分析的结果均具有统计学意义（P<0.05），包括未使用抗精神病药物的人群。这些结果可能支持 VLOS 存在痴呆风险增加和加速衰老的观点，或者 VLOS 是痴呆的前驱状态。
