Li Cheng-Yuan, Tai Ying-Hsuan, Dai Ying-Xiu, Chang Yun-Ting, Bai Ya-Mei, Tsai Shih-Jen, Chen Tzeng-Ji, Chen Mu-Hong
Department of Dermatology, Taipei Veterans General Hospital, Taipei, Taiwan.
School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
J Clin Psychiatry. 2021 Oct 26;82(6):21m13931. doi: 10.4088/JCP.21m13931.
Alopecia areata (AA) is associated with multiple comorbidities and shares a similar inflammatory signature with dementia. The great negative psychosocial impact of AA may result in poor social engagement, a typical risk factor for dementia. However, little is known about the association between AA and dementia. Via the Taiwan National Health Insurance Research Database, 2,534 patients with AA ( code: 704.01) aged ≥ 45 years and 25,340 controls matched for age, sex, residence, income, dementia-related comorbidities, systemic steroid use, and annual outpatient visit were included between 1998 and 2011 for investigation of subsequent dementia from enrollment to the end of 2013. After controlling for potential confounders, stratified Cox regression analysis on each matched pair was applied to assess the dementia risk between the AA and control groups. Patients with AA were more likely to develop any dementia (adjusted hazard ratio [aHR] = 3.24; 95% CI, 2.14-4.90), Alzheimer's disease (aHR = 4.34; 95% CI, 1.45-12.97), and unspecified dementia (aHR = 3.36; 95% CI, 2.06-5.48) than the control cohort. Stratification analysis by age and sex revealed increased risks of any dementia and unspecified dementia in both age groups (ie, < 65 and ≥ 65 years) and both sex groups and increased risks of AD in male patients and in those with age at dementia onset ≥ 65 years. Sensitivity analyses after exclusion of the first year or first 3 years of observation showed consistent findings. Patients with AA had a higher risk of developing dementia. Further studies are needed to elucidate the underlying pathophysiology between AA and dementia risk.
斑秃（AA）与多种合并症相关，且与痴呆症具有相似的炎症特征。AA巨大的负面心理社会影响可能导致社交参与度低，而社交参与度低是痴呆症的典型风险因素。然而，关于AA与痴呆症之间的关联知之甚少。通过台湾国民健康保险研究数据库，纳入了1998年至2011年间年龄≥45岁的2534例AA患者（编码：704.01）以及25340例年龄、性别、居住地、收入、痴呆相关合并症、全身使用类固醇情况和年度门诊就诊次数相匹配的对照，以调查从入组到2013年底后续的痴呆症发病情况。在控制潜在混杂因素后，对每对匹配对象进行分层Cox回归分析，以评估AA组和对照组之间的痴呆症风险。与对照组相比，AA患者更易发生任何类型的痴呆症（调整后风险比[aHR]=3.24；95%置信区间[CI]，2.14 - 4.90）、阿尔茨海默病（aHR = 4.34；95%CI，1.45 - 12.97）和未特定类型的痴呆症（aHR = 3.36；95%CI，2.06 - 5.48）。按年龄和性别进行的分层分析显示，在两个年龄组（即<65岁和≥65岁）以及两个性别组中，任何类型痴呆症和未特定类型痴呆症的风险均增加，男性患者以及痴呆症发病年龄≥65岁的患者患阿尔茨海默病的风险增加。排除第一年或前三年观察期后的敏感性分析显示结果一致。AA患者患痴呆症的风险更高。需要进一步研究以阐明AA与痴呆症风险之间潜在的病理生理学机制。
