Bendayan Rebecca, Mascio Aurelie, Stewart Robert, Roberts Angus, Dobson Richard J
Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience (RB, AM, AR, RJD), King's College London, London, United Kingdom; NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust (RB, AR, RJD), London, United Kingdom.
Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience (RB, AM, AR, RJD), King's College London, London, United Kingdom.
Am J Geriatr Psychiatry. 2021 Jun;29(6):604-616. doi: 10.1016/j.jagp.2020.10.018. Epub 2020 Nov 6.
We aimed to compare trajectories of cognitive performance in individuals diagnosed with dementia with and without severe mental illness (SMI).
Retrospective cohort study.
We used data from a large longitudinal mental healthcare case register, the Clinical Record Interactive Search (CRIS), at the South London and Maudsley NHS Foundation Trust (SLaM) which provides mental health services to four south London boroughs.
Our sample (N = 4718) consisted of any individual who had a primary or secondary diagnosis of dementia from 2007 to 2018, was 50 years old or over at first diagnosis of dementia and had at least 3 recorded Mini-Mental State Examination (MMSE) scores.
Cognitive performance was measured using MMSE. Linear mixed models were fitted to explore whether MMSE trajectories differed between individuals with or without prior/current SMI diagnoses. Models were adjusted by socio-demographics, cardiovascular risk, smoking, and medication.
Our results showed differences in the rate of change, where individuals with comorbid SMI had a faster decline when compared with those that have dementia without comorbid SMI. However, this association was partially attenuated when adjusted by socio-demographics, smoking and cardiovascular risk factors; and more substantially attenuated when medication was included in models. Additional analyses showed that this accelerated decline might be more evident in individuals with bipolar disorders. Future research to detangle the potential biological underlying mechanisms of these associations is needed.
我们旨在比较被诊断患有痴呆症且伴有或不伴有严重精神疾病（SMI）的个体的认知能力轨迹。
回顾性队列研究。
我们使用了来自一个大型纵向精神卫生保健病例登记处——南伦敦和莫兹利国民保健服务基金会信托基金（SLaM）的临床记录交互式搜索（CRIS）的数据，该信托基金为伦敦南部的四个行政区提供精神卫生服务。
我们的样本（N = 4718）包括2007年至2018年期间任何被初步或二次诊断为痴呆症的个体，这些个体在首次诊断为痴呆症时年龄在50岁及以上，并且至少有3次记录的简易精神状态检查表（MMSE）评分。
使用MMSE测量认知能力。采用线性混合模型来探究有或没有先前/当前SMI诊断的个体之间MMSE轨迹是否存在差异。模型根据社会人口统计学、心血管风险、吸烟和药物治疗进行了调整。
我们的结果显示了变化率的差异，即与患有痴呆症但无合并SMI的个体相比，合并SMI的个体下降速度更快。然而，当根据社会人口统计学、吸烟和心血管危险因素进行调整时，这种关联部分减弱；当模型中纳入药物治疗时，减弱程度更大。进一步分析表明，这种加速下降在双相情感障碍患者中可能更为明显。未来需要开展研究以理清这些关联潜在的生物学机制。
