Matthewman Julian, Mansfield Kathryn E, Cadogan Sharon L, Abuabara Katrina, Smith Catherine, Bhaskaran Krishnan, Langan Sinéad M, Warren-Gash Charlotte
Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
Department of Dermatology, University of California San Francisco, 1701 Divisadero Street, San Francisco, California, 94115, USA.
Ann Clin Transl Neurol. 2025 Feb;12(2):393-404. doi: 10.1002/acn3.52283. Epub 2025 Jan 1.
Evidence for an association between psoriasis and dementia is limited and conflicting. We aimed to investigate the association using large and representative population-based data and describe risk by dementia subtype and over time.
We compared dementia risk between people with and without psoriasis using an age-, sex- and primary care practice-matched cohort of adults aged ≥40 years from the Clinical Practice Research Datalink Aurum in England (1997-2021) linked to hospital admissions data, analysed with stratified Cox regression.
Among 360,014 individuals with psoriasis and 1,799,617 without, psoriasis was associated with a small increased risk of all-cause dementia (adjusted hazard ratio [aHR] 1.06, 95% CI 1.04-1.08; absolute rate difference 24 per 100,000 person-years). Strength of association increased with time since psoriasis diagnosis (e.g. aHR 0.99, 0.96-1.03 within 0 to 5 years; 1.20, 1.05-1.37 within 20 to 25 years). The association was stronger for vascular dementia (aHR 1.10, 1.06-1.14) than Alzheimer's dementia (aHR 1.03, 1.00-1.06). Hazard ratios were larger for severe psoriasis (all-cause aHR 1.32, 1.25-1.39; vascular aHR 1.58, 1.44-1.74; Alzheimer's aHR 1.11, 1.02-1.21).
Long-term risk of all-cause dementia and vascular dementia, but not Alzheimer's dementia, was slightly higher in people with psoriasis, but absolute risk differences were small. Risks were more substantially raised with time since psoriasis diagnosis and in severe psoriasis compared to mild to moderate psoriasis, suggesting a potential dose-response relationship.
银屑病与痴呆症之间关联的证据有限且相互矛盾。我们旨在利用大规模且具有代表性的基于人群的数据来研究这种关联，并按痴呆症亚型及随时间推移描述风险。
我们使用来自英国临床实践研究数据链奥鲁姆（1997 - 2021年）中年龄、性别和初级医疗实践匹配的≥40岁成年人队列，将有银屑病和无银屑病的人群的痴呆症风险进行比较，该队列与医院入院数据相链接，并采用分层Cox回归分析。
在360,014例有银屑病的个体和1,799,617例无银屑病的个体中，银屑病与全因痴呆症风险略有增加相关（调整后风险比[aHR] 1.06，95%置信区间1.04 - 1.08；每100,000人年的绝对率差为24）。关联强度随银屑病诊断后的时间增加而增强（例如，0至5年内aHR为0.99，0.96 - 1.03；20至25年内为1.20，1.05 - 1.37）。血管性痴呆的关联（aHR 1.10，1.06 - 1.14）比阿尔茨海默病性痴呆（aHR 1.03，1.00 - 1.06）更强。重度银屑病的风险比更大（全因aHR 1.32，1.25 - 1.39；血管性aHR 1.58，1.44 - 1.74；阿尔茨海默病性aHR 1.11，1.02 - 1.21）。
银屑病患者发生全因痴呆症和血管性痴呆症的长期风险略高，但阿尔茨海默病性痴呆症风险不高，不过绝对风险差异较小。与轻度至中度银屑病相比，自银屑病诊断后的时间越长以及重度银屑病患者的风险升高幅度更大，提示可能存在剂量反应关系。
