Abstract
This study aimed to investigate the risk and prognosis of Alzheimer's disease (AD) and vascular dementia (VaD) in patients with insomnia using the National Health Insurance Service database covering the entire population of the Republic of Korea from 2007 to 2014. In total, 2,796,871 patients aged 40 years or older with insomnia were enrolled, and 5,593,742 controls were matched using a Greedy digit match algorithm. Mortality and the rate of admission to a long-term care facility were estimated using multivariable Cox analysis. Of all patients with insomnia, 138,270 (4.94%) and 26,706 (0.96%) were newly diagnosed with AD and VaD, respectively. The incidence rate ratios for AD and VaD were 1.73 and 2.10, respectively, in patients with insomnia compared with those without. Higher mortality rates and long-term care facility admission rates were also observed in patients with dementia in the insomnia group. Known cardiovascular risk factors showed interactions with the effects of insomnia on the risk of AD and VaD. However, the effects of insomnia on the incidence of AD and VaD were consistent between the groups with and without cardiovascular risk factors. Insomnia is a medically modifiable and policy-accessible risk factor and prognostic marker of AD and VaD.
Highlights
Dementia is a progressive neurodegenerative disorder characterized by impairment in cognition that interferes with daily life activities [1]
ischemic heart disease (IHD), congestive heart failure (CHF), atrial fibrillation (AF), and COPD were higher in the insomnia group (Table 1)
In this study using medical data of the national population, both incidence rates and changes in the cumulative incidence of Alzheimer’s disease (AD) and vascular dementia (VaD) were found to be greater in individuals with insomnia than in those without
Summary
Dementia is a progressive neurodegenerative disorder characterized by impairment in cognition that interferes with daily life activities [1]. Dementia is a burden on both patients and caregivers, and increases the global socioeconomic burden [3]. To effectively counter these burdens, a number of national policies have focused on the management and prevention of the risk factors associated with dementia. Insomnia is characterized by difficulty in sleep initiation or maintenance with compromised daytime function [4]. Deposition of Aβ was caused by inhibition of clearance pathway, and increased synaptic activity that facilitate the accumulation of Aβ [5, 6].
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