Abstract
ObjectivesSystemic rheumatic disease is characterized by autoimmunity and systemic inflammation and affects multiple organs. Few studies have investigated whether autoimmune diseases increase the risk of dementia. Herein, we evaluate the relationship between systemic rheumatic disease and dementia through a population-based study using the Korean National Health Insurance Service (NHIS) claims database.MethodsWe conducted a nationwide population-based study using the Korean NHIS database, consisting of individuals who submitted medical claims from 2002–2013. Dementia was defined as having an acetylcholinesterase inhibitors (AChEIs) prescription along with symptoms satisfying the Alzhemier’s disease (AD) International Classification of Diseases (ICD)-10 codes (F00 or G30), or vascular dementia (VaD; ICD-10 or F01) criteria. Control subjects were matched to the dementia patients by age and sex. The study group was limited to those diagnosed with rheumatic disease at least 6 months prior to diagnosis of dementia. Rheumatic disease was defined by the following ICD-10 codes: Rheumatoid arthritis (RA: M05), Sjögren’s syndrome (SS: M35), systemic lupus erythematosus (SLE: M32), and Behcet’s disease (BD: M35.2).ResultsOf the 6,028 dementia patients, 261 (4.3%) had RA, 108 (1.6%) had SS, 12 (0.2%) had SLE, and 6 (0.1%) had BD. SLE history was significantly higher in dementia patients (0.2%) than in controls (0.1%) and was associated with dementia (odds ratio [OR], 2.48; 95% confidence interval [CI], 1.19–5.15). In subgroup analysis, SLE significantly increased dementia risk, regardless of dementia type (AD: OR, 2.29; 95% CI, 1.06–4.91; VaD: OR, 4.54; 95% CI, 1.36–15.14). However, these associations were not sustained in the mild CCI or elderly group.ConclusionSLE was independently associated with a higher risk of dementia, including AD and VaD when compared to the control group, even after adjustment. SLE patients (<65 years old) are a high-risk group for early vascular dementia and require screening for early detection and active prevention.
Highlights
Dementia is a common mental illness associated with aging, and its increasing prevalence has led to an increased economic burden worldwide [1]
systemic lupus erythematosus (SLE) history was significantly higher in dementia patients (0.2%) than in controls (0.1%) and was associated with dementia
SLE significantly increased dementia risk, regardless of dementia type
Summary
Dementia is a common mental illness associated with aging, and its increasing prevalence has led to an increased economic burden worldwide [1]. The elderly population of Korea is known to have the fastest increase in dementia prevalence in the world, with dementia being one of the most serious mental illnesses in the Korean population [2, 3]. Alzheimer’s disease (AD) is the most common cause of dementia in the elderly. Vascular dementia (VaD) is the second most common cause of dementia, accompanied by varying degrees of ischemia or hemorrhagic cerebrovascular disease (CVD) [8]. VaD is known to be associated with atherosclerosis and arteriolosclerosis, which cause brain parenchymal lesions or chronic systemic inflammation [9]. There have been various studies for the risk factors of dementia, and Weber, et al [10] recently reported that the risk of dementia is increased in patients with osteoarthritis through meta-analysis
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