Danish Dementia Research Centre, Department of Neurology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
National Centre for Register-based Research, Department of Economics and Business Economics, Aarhus University, Aarhus, Denmark.
Alzheimers Res Ther. 2024 Jul 5;16(1):150. doi: 10.1186/s13195-024-01523-7.
Patients with young onset Alzheimer's disease (YOAD) face long diagnostic delays. Prescription medication use may provide insights into early signs and symptoms, which may help facilitate timely diagnosis.
In a register-based nested case-control study, we examined medication use for everyone diagnosed with YOAD in a Danish memory clinic during 2016-2020 compared to cognitively healthy controls. Prescription medication use were grouped into 13 overall categories (alimentary tract and metabolism, blood and blood forming organs, cardiovascular system, dermatologicals, genitourinary system and sex hormones, systemic hormonal preparations, antiinfectives for systemic use, antineoplastic and immunomodulating agents, musculo-skeletal system, nervous system, antiparasitic products, respiratory system, and sensory organs). Further stratifications were done for predetermined subcategories with a use-prevalence of at least 5% in the study population. Conditional logistic regression produced odds ratios, which given the use of incidence-density matching is interpretable as incidence rate ratios (IRRs). The association between prescription medication use and subsequent YOAD diagnosis was examined in the entire 10-year study period and in three time-intervals.
The study included 1745 YOAD cases and 5235 controls. In the main analysis, several overall categories showed significant associations with YOAD in one or more time-intervals, namely blood and blood forming organs and nervous system. Prescription medication use in the nervous system category was increased for YOAD cases compared to controls already 10->5 years prior to diagnosis (IRR 1.17, 95% CI 1.05-1.31), increasing to 1.57 (95% CI 1.39-1.78) in the year preceding diagnosis. This was largely driven by antidepressant and antipsychotic use, and especially prominent for first-time users.
In this study, medication use in several categories was associated with YOAD. Onset of treatment-requiring psychiatric symptoms such as depression or psychosis in mid-life may serve as potential early indicators of YOAD.
患有早发性阿尔茨海默病（YOAD）的患者面临着较长的诊断延迟。处方药物的使用可能提供早期迹象和症状的见解，这可能有助于促进及时诊断。
在一项基于登记的嵌套病例对照研究中，我们比较了在丹麦记忆诊所 2016-2020 年间诊断为 YOAD 的患者与认知健康对照组的药物使用情况。将处方药物使用分为 13 个总体类别（消化道和代谢、血液和造血器官、心血管系统、皮肤科、泌尿生殖系统和性激素、全身激素类制剂、全身抗感染药、抗肿瘤药和免疫调节剂、肌肉骨骼系统、神经系统、驱虫产品、呼吸系统和感觉器官）。对于研究人群中使用频率至少为 5%的预定亚类，进一步进行了分层。条件逻辑回归得出了优势比，根据发病率密度匹配的使用，这可以解释为发病率比值（IRR）。在整个 10 年的研究期间以及在三个时间间隔内，检查了处方药物使用与随后的 YOAD 诊断之间的关联。
该研究包括 1745 例 YOAD 病例和 5235 例对照。在主要分析中，有几个总体类别在一个或多个时间间隔内与 YOAD 有显著关联，即血液和造血器官以及神经系统。与对照组相比，YOAD 病例在诊断前 10-5 年内已经开始使用神经系统类别的药物（IRR 1.17，95%CI 1.05-1.31），在诊断前一年增加到 1.57（95%CI 1.39-1.78）。这主要是由抗抑郁药和抗精神病药的使用驱动的，尤其是首次使用者更为明显。
在这项研究中，几种类别的药物使用与 YOAD 有关。中年开始需要治疗的精神症状（如抑郁或精神病）的发作可能是 YOAD 的潜在早期指标。
