Schools of Pharmacy and Public Health, Sciences University of Waterloo, Waterloo, Ontario, Canada.
ICES, Toronto, Ontario, Canada.
Age Ageing. 2022 Feb 2;51(2). doi: 10.1093/ageing/afab277.
Comprehensive, population-based investigations of the extent and temporality of associations between common neurological and psychiatric disorders are scarce.
This retrospective cohort study used linked health administrative data for Ontarians aged 40-85 years on 1 April 2002, to estimate the adjusted rate of incident dementia, Parkinson's disease (PD), stroke or mood/anxiety disorder (over 14 years) according to the presence and time since diagnosis of a prior disorder. Sex differences in the cumulative incidence of a later disorder were also examined.
The cohort included 5,283,546 Ontarians (mean age 56.2 ± 12.1 years, 52% female). The rate of dementia was significantly higher for those with prior PD (adjusted hazard ratio [adjHR] 4.05, 95% confidence interval [CI] 3.99-4.11); stroke (adjHR 2.49, CI 2.47-2.52) and psychiatric disorder (adjHR 1.79, CI 1.78-1.80). The rate of PD was significantly higher for those with prior dementia (adjHR 2.23, CI 2.17-2.30) and psychiatric disorder (adjHR 1.77, CI 1.74-1.81). The rate of stroke was significantly higher among those with prior dementia (adjHR 1.56, CI 1.53-1.58). Prior dementia (adjHR 2.36, CI 2.33-2.39), PD (adjHR 1.80, CI 1.75-1.85) and stroke (adjHR 1.47, CI 1.45-1.49) were associated with a higher rate of an incident psychiatric disorder. Generally, associations were strongest in the 6 months following a prior diagnosis and demonstrated a J-shape relationship over time. Significant sex differences were evident in the absolute risks for several disorders.
The observed nature of bidirectional associations between these neurological and psychiatric disorders indicates opportunities for earlier diagnosis and interventions to improve patient care.
全面的、基于人群的常见神经和精神障碍之间关联的范围和时间性的研究很少。
本回顾性队列研究使用安大略省 2002 年 4 月 1 日年龄在 40-85 岁之间的人群的链接健康管理数据，根据先前疾病的存在和诊断后时间来估计痴呆、帕金森病 (PD)、中风或情绪/焦虑障碍的发病风险（超过 14 年）。还检查了后来发生疾病的累积发生率的性别差异。
队列包括 5283546 名安大略省居民（平均年龄 56.2±12.1 岁，52%为女性）。与先前的 PD（调整后的危险比 [adjHR] 4.05，95%置信区间 [CI] 3.99-4.11）；中风（adjHR 2.49，CI 2.47-2.52）和精神障碍（adjHR 1.79，CI 1.78-1.80）相比，痴呆的发病率明显更高。与先前的痴呆症（adjHR 2.23，CI 2.17-2.30）和精神障碍（adjHR 1.77，CI 1.74-1.81）相比，PD 的发病率明显更高。与先前的痴呆症（adjHR 1.56，CI 1.53-1.58）相比，中风的发病率明显更高。先前的痴呆症（adjHR 2.36，CI 2.33-2.39）、PD（adjHR 1.80，CI 1.75-1.85）和中风（adjHR 1.47，CI 1.45-1.49）与精神障碍发病风险增加相关。一般来说，关联在先前诊断后的 6 个月内最强，并随着时间的推移呈 J 形关系。在几种疾病的绝对风险中，明显存在性别差异。
观察到这些神经和精神障碍之间的双向关联的性质表明有机会进行更早的诊断和干预，以改善患者的护理。
