Department of Neurology, Danish Dementia Research Centre, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark.
Department of Economics and Business Economics, National Centre for Register-based Research, Aarhus BSS, Aarhus University, Aarhus, Denmark.
J Alzheimers Dis. 2024;98(4):1503-1514. doi: 10.3233/JAD-231349.
Population-based studies have shown an increased risk of dementia after infections, but weaker links were reported for autoimmune diseases. Evidence is scarce for whether the links may be modified by the dementia or exposure subtype.
We aimed to investigate the association between infections and/or autoimmune diseases and rates of major types of dementias in the short- and long terms.
Nationwide nested case-control study of dementia cases (65+ years) diagnosed in Denmark 2016-2020 and dementia-free controls. Exposures were hospital-diagnosed infections and autoimmune diseases in the preceding 35 years. Two groups of dementia cases were those diagnosed in memory clinics (MC) and those diagnosed outside memory clinics (non-memory clinic cases, NMC).
In total, 26,738 individuals were MC and 12,534 were NMC cases. Following any infection, the incidence rate ratio (IRR) for MC cases was 1.23 (95% CI 1.20-1.27) and 1.70 for NMC cases (1.62-1.76). Long-term increased rates were seen for vascular dementia and NMC cases. IRRs for autoimmune diseases were overall statistically insignificant.
Cases with vascular dementia and not Alzheimer's disease, and a subgroup of cases identified with poorer health have increased long-term risk following infections. Autoimmune diseases were not associated with any type of dementia. Notably increased risks (attributed to the short term) and for NMC cases may indicate that immunosenescence rather than de novo infection explains the links. Future focus on such groups and on the role of vascular pathology will explain the infection-dementia links, especially in the long term.
基于人群的研究表明，感染后痴呆的风险增加，但自身免疫性疾病的关联较弱。目前关于这些关联是否可以通过痴呆或暴露亚型来修饰，证据有限。
我们旨在调查感染和/或自身免疫性疾病与短期和长期内主要类型痴呆的发生率之间的关系。
这是一项在丹麦进行的全国巢式病例对照研究，纳入了 2016 年至 2020 年期间诊断为痴呆的病例（65 岁以上）和无痴呆的对照。暴露因素是发病前 35 年内的医院诊断的感染和自身免疫性疾病。两组痴呆病例分别为在记忆诊所（MC）诊断的病例和在记忆诊所外诊断的病例（非记忆诊所病例，NMC）。
共有 26738 名 MC 病例和 12534 名 NMC 病例。在任何感染后，MC 病例的发病率比（IRR）为 1.23（95%CI 1.20-1.27），NMC 病例为 1.70（1.62-1.76）。血管性痴呆和 NMC 病例的长期发生率较高。自身免疫性疾病的总体 IRR 无统计学意义。
血管性痴呆病例而非阿尔茨海默病病例，以及健康状况较差的病例亚组，在感染后长期风险增加。自身免疫性疾病与任何类型的痴呆无关。值得注意的是，风险增加（归因于短期）和 NMC 病例可能表明免疫衰老而不是新感染解释了这些关联。未来的研究重点应放在这些人群和血管病理的作用上，以解释感染和痴呆之间的联系，尤其是在长期。
