Abstract
Background Late onset depression (LOD) often occurs in the context of vascular disease and may be associated with risk of dementia. Aspirin is widely used to reduce the risk of cardiovascular disease and stroke. However, its role in patients with LOD and risk of dementia remains inconclusive. Materials and Methods. A population-based study was conducted using data from National Health Insurance of Taiwan during 1996–2009. Patients fulfil diagnostic criteria for LOD with or without subsequent dementia (incident dementia) and among whom users of aspirin (75 mg daily for at least 6 months) were identified. The time-dependent Cox proportional hazards model was applied for multivariate analyses. Propensity scores with the one-to-one nearest-neighbor matching model were used to select matching patients. Cumulative incidence of incident dementia after diagnosis of LOD was calculated by Kaplan–Meier Method. Results A total of 6028 (13.4%) and 40,411 (86.6%) patients were defined as, with and without diagnosis of LOD, among whom 2,424 (41.9%) were aspirin users. Patients with LOD had more comorbidities such as cardiovascular diseases, diabetes, and hypertension comparing to those without LOD. Among patients with LOD, aspirin users had lower incidence of subsequent incident dementia than non-users (Hazard Ratio = 0.734, 95% CI 0.641–0.841, p < 0.001). After matching aspirin users with non-users by propensity scores-matching method, the cumulative incidence of incident dementia was significantly lower in aspirin users of LOD patients (p < 0.001). After matching aspirin users with non-users by propensity scores-matching method, the cumulative incidence of incident dementia was significantly lower in aspirin users of LOD patients (Conclusions Aspirin may be associated with a lower risk of incident dementia in patients with LOD. This beneficial effect of aspirin in LOD patients needs validation in prospective clinical trials and our results should be interpreted with caution.
Highlights
Late-onset depression (LOD) and cognitive impairment have emerged as important public health issues among the elderly following a global trend in population aging [1, 2]
Longitudinal Health Insurance Database (LHID) 2005 contains all original claims data of 1,000,000 beneficiaries included in year 2005. ey selected data, by random sampling, from the 2005 Registry for Beneficiaries (ID) of the National Health Insurance Research Database (NHIRD), in which registration data of every beneficiary of the National Health Insurance program during the period of January 1, 2005 to January 1, 2006 were recorded. e LHID 2005 included comprehensive information about insured people, including demographic data, dates of clinical visits, diagnostic codes, details of prescriptions expenditure levels and dates of enrolment and withdrawal between January 1996 and December 2009. ere was no significant difference in the gender distribution (Χ2 = 0.008, df = 1, -value = 0.931) between the enrollees listed in the LHID 2005 and those originally included under NHIRD
We used the same criteria to sort out the vulnerable population, but we searched a population with different risk factor. e aspirin users were not necessarily overlapped with statin users reported in previous literature [15]
Summary
Late-onset depression (LOD) and cognitive impairment have emerged as important public health issues among the elderly following a global trend in population aging [1, 2]. Case-control studies have revealed a positive correlation between depression and subsequent onset of Alzheimer’s disease in patients with LOD [8]. Late onset depression (LOD) o en occurs in the context of vascular disease and may be associated with risk of dementia. Among patients with LOD, aspirin users had lower incidence of subsequent incident dementia than non-users (Hazard Ratio = 0.734, 95% CI 0.641–0.841, 푝 < 0.001). A er matching aspirin users with non-users by propensity scores-matching method, the cumulative incidence of incident dementia was significantly lower in aspirin users of LOD patients (푝 = 0.022). Aspirin may be associated with a lower risk of incident dementia in patients with LOD. Aspirin may be associated with a lower risk of incident dementia in patients with LOD. is beneficial effect of aspirin in LOD patients needs validation in prospective clinical trials and our results should be interpreted with caution
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