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Newby D, Taylor N, Joyce DW, Winchester LM. Optimising the use of electronic medical records for large scale research in psychiatry. Transl Psychiatry 2024; 14:232. [PMID: 38824136 PMCID: PMC11144247 DOI: 10.1038/s41398-024-02911-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 04/13/2024] [Accepted: 04/15/2024] [Indexed: 06/03/2024] Open
Abstract
The explosion and abundance of digital data could facilitate large-scale research for psychiatry and mental health. Research using so-called "real world data"-such as electronic medical/health records-can be resource-efficient, facilitate rapid hypothesis generation and testing, complement existing evidence (e.g. from trials and evidence-synthesis) and may enable a route to translate evidence into clinically effective, outcomes-driven care for patient populations that may be under-represented. However, the interpretation and processing of real-world data sources is complex because the clinically important 'signal' is often contained in both structured and unstructured (narrative or "free-text") data. Techniques for extracting meaningful information (signal) from unstructured text exist and have advanced the re-use of routinely collected clinical data, but these techniques require cautious evaluation. In this paper, we survey the opportunities, risks and progress made in the use of electronic medical record (real-world) data for psychiatric research.
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Affiliation(s)
- Danielle Newby
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Centre for Statistics in Medicine, University of Oxford, Oxford, UK
| | - Niall Taylor
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Dan W Joyce
- Department of Primary Care and Mental Health and Civic Health, Innovation Labs, Institute of Population Health, University of Liverpool, Liverpool, UK
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Bell G, El Baou C, Saunders R, Buckman JEJ, Charlesworth G, Richards M, Fearn C, Brown B, Nurock S, Michael S, Ware P, Marchant NL, Aguirre E, Rio M, Cooper C, Pilling S, John A, Stott J. Predictors of primary care psychological therapy outcomes for depression and anxiety in people living with dementia: evidence from national healthcare records in England. Br J Psychiatry 2024; 224:205-212. [PMID: 38328941 DOI: 10.1192/bjp.2024.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
BACKGROUND Psychological therapies can be effective in reducing symptoms of depression and anxiety in people living with dementia (PLWD). However, factors associated with better therapy outcomes in PLWD are currently unknown. AIMS To investigate whether dementia-specific and non-dementia-specific factors are associated with therapy outcomes in PLWD. METHOD National linked healthcare records were used to identify 1522 PLWD who attended psychological therapy services across England. Associations between various factors and therapy outcomes were explored. RESULTS People with frontotemporal dementia were more likely to experience reliable deterioration in depression/anxiety symptoms compared with people with vascular dementia (odds ratio 2.98, 95% CI 1.08-8.22; P = 0.03) or Alzheimer's disease (odds ratio 2.95, 95% CI 1.15-7.55; P = 0.03). Greater depression severity (reliable recovery: odds ratio 0.95, 95% CI 0.92-0.98, P < 0.001; reliable deterioration: odds ratio 1.73, 95% CI 1.04-2.90, P = 0.04), lower work and social functioning (recovery: odds ratio 0.98, 95% CI 0.96-0.99, P = 0.002), psychotropic medication use (recovery: odds ratio 0.67, 95% CI 0.51-0.90, P = 0.01), being of working age (recovery: odds ratio 2.03, 95% CI 1.10-3.73, P = 0.02) and fewer therapy sessions (recovery: odds ratio 1.12, 95% CI 1.09-1.16, P < 0.001) were associated with worse therapy outcomes in PLWD. CONCLUSIONS Dementia type was generally not associated with outcomes, whereas clinical factors were consistent with those identified for the general population. Additional support and adaptations may be required to improve therapy outcomes in PLWD, particularly in those who are younger and have more severe depression.
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Affiliation(s)
- Georgia Bell
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, University College London, UK
| | - Celine El Baou
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, University College London, UK
| | - Rob Saunders
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, University College London, UK; and Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, UK
| | - Joshua E J Buckman
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, UK; and iCope Psychological Therapies Service, Camden & Islington NHS Foundation Trust, St Pancras Hospital, London, UK
| | - Georgina Charlesworth
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, University College London, UK
| | - Marcus Richards
- MRC Unit for Lifelong Health and Ageing at UCL, University College London, UK
| | - Caroline Fearn
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, University College London, UK
| | - Barbara Brown
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, University College London, UK
| | - Shirley Nurock
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, University College London, UK
| | - Stuart Michael
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, University College London, UK
| | - Paul Ware
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, University College London, UK
| | | | - Elisa Aguirre
- Redbridge Talking Therapies Service, North East London NHS Foundation Trust, UK
| | - Miguel Rio
- Department of Electronic and Electrical Engineering, University College London, UK
| | - Claudia Cooper
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University, UK
| | - Stephen Pilling
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, UK; and Camden & Islington NHS Foundation Trust, St Pancras Hospital, London, UK
| | - Amber John
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, University College London, UK
| | - Joshua Stott
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, University College London, UK
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Brooks K, Yoshimura H, Gonzalez-Izquierdo A, Zakkak N, Kukendra-Rajah K, Lip GYH, Providencia R. The association between atrial fibrillation and dementia: A UK linked electronic health records cohort study. Eur J Clin Invest 2024; 54:e14154. [PMID: 38217524 DOI: 10.1111/eci.14154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 12/27/2023] [Accepted: 01/01/2024] [Indexed: 01/15/2024]
Abstract
BACKGROUND We investigated the association between atrial fibrillation (AF) and dementia, and its subtypes (vascular-VaD, Alzheimer, mixed and rare dementia), and identified predictors for dementia in AF patients. METHODS The analysis was based on 183,610 patients with new-onset AF and 367,220 non-AF controls in the United Kingdom between 1998 and 2016, identified in three prospectively collected, linked electronic health records sources. Time-to-event (dementia or subtypes) analyses were performed using Cox proportional hazards and weighted Cox. Sub-analyses performed: including & censoring stroke and age (median used as cut-off). RESULTS Over a median follow-up of 2.67 years (IQR .65-6.02) for AF patients and 5.84 years for non-AF patients (IQR 2.26-11.80), incidence of dementia in the AF cohort was 2.65 per 100 person-years, compared to 2.02 in the non-AF cohort. After adjustment, a significant association was observed between AF and all-cause dementia (HR = 1.38, 95% CI: 1.31-1.45), driven by a strong association with VaD (HR = 1.55, 95% CI: 1.41-1.70). AF was also associated with mixed dementia (HR = 1.26, 95% CI: 1.01-1.56), but we could not confirm an association with Alzheimer (HR = 1.05, 95% CI: .94-1.16) and rare dementia forms (HR = 1.19, 95% CI: .90-1.56). Ischemic stroke (HR = 1.40, 95% CI: 1.26-1.56), subarachnoid haemorrhage (HR = 2.08, 95% CI: 1.47-2.96), intracerebral haemorrhage (HR = 1.95, 95% CI: 1.54-2.48) and diabetes (HR = 1.32, 95% CI: 1.24-1.41) were identified as the strongest predictors of dementia in AF patients. CONCLUSIONS AF patients have an increased risk of dementia, independent of stroke, with highest risk of VaD. Management and prevention of the identified risk factors could be crucial to reduce the increasing burden of dementia.
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Affiliation(s)
- Kieran Brooks
- Institute of Health Informatics Research, University College London, London, UK
| | - Hiroyuki Yoshimura
- Institute of Health Informatics Research, University College London, London, UK
| | | | - Nadine Zakkak
- Institute of Health Informatics Research, University College London, London, UK
| | - Kishore Kukendra-Rajah
- Institute of Health Informatics Research, University College London, London, UK
- Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Department of Clinical Medicine, Danish Center for Health Services Research, Aalborg University, Aalborg, Denmark
| | - Rui Providencia
- Institute of Health Informatics Research, University College London, London, UK
- Barts Heart Centre, Barts Health NHS Trust, London, UK
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O'Sullivan JL, Kohl R, Lech S, Romanescu L, Schuster J, Kuhlmey A, Gellert P, Yasar S. Statin Use and All-Cause Mortality in Nursing Home Residents With and Without Dementia: A Retrospective Cohort Study Using Claims Data. Neurology 2024; 102:e209189. [PMID: 38412394 DOI: 10.1212/wnl.0000000000209189] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 12/12/2023] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Little is known about the benefits of statin therapy in older adults with dementia. We aimed to evaluate the role of statin use for all-cause mortality in nursing home residents with and without dementia. METHODS This retrospective cohort study used claims data collected between January 2015 and December 2019 from a German health and long-term care insurance provider. Propensity score-based Cox proportional hazards models were used to evaluate the association of statin use with all-cause mortality and adjusted for potential confounders in nursing home residents. Subgroup analyses were performed based on the presence or absence of atherosclerotic cardiovascular disease (ASCVD), statin intensity (low, moderate, high), dementia type, age, sex, and level of care required. RESULTS A total of 282,693 participants were included in the study, of which 96,162 were matched. In total, 68.9% were women, and the mean age was 82.91 years (SD ±7.97). The average observation period was 2.25 years (SD ±1.35), and 54,269 deaths were recorded. Statin use in individuals with dementia resulted in lower all-cause mortality (hazard ratio [HR] 0.80, 95% CI 0.78-0.82, p < 0.001) compared with statin nonusers. Similarly, in individuals without dementia, statin use was associated with lower all-cause mortality (HR 0.73, 95% CI 0.71-0.76, p < 0.001) compared with statin nonusers. Similar findings were observed in subanalyses excluding participants with a history of ASCVD and across subgroups stratified by age, sex, care level required, and dementia type. Statin benefits were consistent among individuals with and without dementia. DISCUSSION Statin benefits were consistent among individuals with and without dementia. Statin therapy may be continued in nursing home residents with dementia to mitigate the risk of all-cause mortality. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that nursing home patients receiving statins have a lower mortality rate, whether they have a dementia diagnosis or not.
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Affiliation(s)
- Julie Lorraine O'Sullivan
- From The Institute for Medical Sociology and Rehabilitation Science (J.L.O.S., R.K., S.L., L.R. J.S. A.K. P.G.), Universitätsmedizin Berlin, corporate member of Freie Universität Berlin; German Center for Mental Health (DZPG) (J.L.O.S., P.G.), partner site Berlin/Potsdam; Department of Psychiatry and Psychotherapy (S.L.) and Friede Springer Cardiovascular Prevention Center (P.G.), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; and Divison of Geriatric Medicine and Gerontology (S.Y.), Department of Medicine, Johns Hopkins University, School of Medicine, Baltimore, MD
| | - Raphael Kohl
- From The Institute for Medical Sociology and Rehabilitation Science (J.L.O.S., R.K., S.L., L.R. J.S. A.K. P.G.), Universitätsmedizin Berlin, corporate member of Freie Universität Berlin; German Center for Mental Health (DZPG) (J.L.O.S., P.G.), partner site Berlin/Potsdam; Department of Psychiatry and Psychotherapy (S.L.) and Friede Springer Cardiovascular Prevention Center (P.G.), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; and Divison of Geriatric Medicine and Gerontology (S.Y.), Department of Medicine, Johns Hopkins University, School of Medicine, Baltimore, MD
| | - Sonia Lech
- From The Institute for Medical Sociology and Rehabilitation Science (J.L.O.S., R.K., S.L., L.R. J.S. A.K. P.G.), Universitätsmedizin Berlin, corporate member of Freie Universität Berlin; German Center for Mental Health (DZPG) (J.L.O.S., P.G.), partner site Berlin/Potsdam; Department of Psychiatry and Psychotherapy (S.L.) and Friede Springer Cardiovascular Prevention Center (P.G.), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; and Divison of Geriatric Medicine and Gerontology (S.Y.), Department of Medicine, Johns Hopkins University, School of Medicine, Baltimore, MD
| | - Laura Romanescu
- From The Institute for Medical Sociology and Rehabilitation Science (J.L.O.S., R.K., S.L., L.R. J.S. A.K. P.G.), Universitätsmedizin Berlin, corporate member of Freie Universität Berlin; German Center for Mental Health (DZPG) (J.L.O.S., P.G.), partner site Berlin/Potsdam; Department of Psychiatry and Psychotherapy (S.L.) and Friede Springer Cardiovascular Prevention Center (P.G.), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; and Divison of Geriatric Medicine and Gerontology (S.Y.), Department of Medicine, Johns Hopkins University, School of Medicine, Baltimore, MD
| | - Johanna Schuster
- From The Institute for Medical Sociology and Rehabilitation Science (J.L.O.S., R.K., S.L., L.R. J.S. A.K. P.G.), Universitätsmedizin Berlin, corporate member of Freie Universität Berlin; German Center for Mental Health (DZPG) (J.L.O.S., P.G.), partner site Berlin/Potsdam; Department of Psychiatry and Psychotherapy (S.L.) and Friede Springer Cardiovascular Prevention Center (P.G.), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; and Divison of Geriatric Medicine and Gerontology (S.Y.), Department of Medicine, Johns Hopkins University, School of Medicine, Baltimore, MD
| | - Adelheid Kuhlmey
- From The Institute for Medical Sociology and Rehabilitation Science (J.L.O.S., R.K., S.L., L.R. J.S. A.K. P.G.), Universitätsmedizin Berlin, corporate member of Freie Universität Berlin; German Center for Mental Health (DZPG) (J.L.O.S., P.G.), partner site Berlin/Potsdam; Department of Psychiatry and Psychotherapy (S.L.) and Friede Springer Cardiovascular Prevention Center (P.G.), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; and Divison of Geriatric Medicine and Gerontology (S.Y.), Department of Medicine, Johns Hopkins University, School of Medicine, Baltimore, MD
| | - Paul Gellert
- From The Institute for Medical Sociology and Rehabilitation Science (J.L.O.S., R.K., S.L., L.R. J.S. A.K. P.G.), Universitätsmedizin Berlin, corporate member of Freie Universität Berlin; German Center for Mental Health (DZPG) (J.L.O.S., P.G.), partner site Berlin/Potsdam; Department of Psychiatry and Psychotherapy (S.L.) and Friede Springer Cardiovascular Prevention Center (P.G.), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; and Divison of Geriatric Medicine and Gerontology (S.Y.), Department of Medicine, Johns Hopkins University, School of Medicine, Baltimore, MD
| | - Sevil Yasar
- From The Institute for Medical Sociology and Rehabilitation Science (J.L.O.S., R.K., S.L., L.R. J.S. A.K. P.G.), Universitätsmedizin Berlin, corporate member of Freie Universität Berlin; German Center for Mental Health (DZPG) (J.L.O.S., P.G.), partner site Berlin/Potsdam; Department of Psychiatry and Psychotherapy (S.L.) and Friede Springer Cardiovascular Prevention Center (P.G.), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; and Divison of Geriatric Medicine and Gerontology (S.Y.), Department of Medicine, Johns Hopkins University, School of Medicine, Baltimore, MD
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Adesuyan M, Jani YH, Alsugeir D, Howard R, Ju C, Wei L, Brauer R. Phosphodiesterase Type 5 Inhibitors in Men With Erectile Dysfunction and the Risk of Alzheimer Disease: A Cohort Study. Neurology 2024; 102:e209131. [PMID: 38324745 PMCID: PMC10890837 DOI: 10.1212/wnl.0000000000209131] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 11/21/2023] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Repurposing phosphodiesterase type 5 inhibitors (PDE5Is) as drugs for Alzheimer disease (AD) risk reduction has shown promise based on animal studies. However, evidence in humans remains inconclusive. Therefore, we conducted a cohort study to evaluate the association between PDE5I initiation compared with nonuse and the risk of developing AD in men with erectile dysfunction (ED). METHODS Using electronic health records from IQVIA Medical Research Data UK (formerly known as the THIN database), we identified men aged ≥40 years with a new diagnosis of ED between 2000 and 2017. Individuals with a previous diagnosis of dementia, cognitive impairment, confusion, or prescription for dementia symptoms were excluded. The occurrence of incident AD was identified using diagnostic read codes. To minimize immortal-time bias, PDE5I initiation was treated as a time-varying exposure variable. Potential confounders were adjusted using inverse probability of treatment weighting based on propensity scores. Cox proportional hazard models were used to estimate the adjusted hazard ratio (HR) with 95% CIs. A secondary analysis explored the association between AD and the cumulative number of PDE5I prescriptions. Sensitivity analyses included lag (delay) periods of 1 and 3 years after cohort entry to address the prodromal stage of AD. RESULTS The study included 269,725 men, with 1,119 newly diagnosed with AD during a median follow-up of 5.1 (interquartile range 2.9-8.9) years. The adjusted HR in PDE5I initiators compared with nonuse was 0.82 (95% CI 0.72-0.93). The associated risk of AD decreased in individuals issued >20 prescriptions: HR 0.56 (95% CI 0.43-0.73) for 21-50 prescriptions and HR 0.65 (95% CI 0.49-0.87) for >50 prescriptions. Sensitivity analysis with a 1-year lag period supported the primary findings (HR 0.82, 95% CI 0.72-0.94), but the results differed with the inclusion of a 3-year lag period (HR 0.93, 95% CI 0.80-1.08). DISCUSSION PDE5I initiation in men with ED was associated with a lower risk of AD, particularly in those most frequently issued prescriptions. The differences between primary and sensitivity analyses highlight the need to explore the optimal lag period. To enhance the generalizability of our findings, a randomized controlled trial including both sexes and exploring various PDE5I doses would be beneficial to confirm the association between PDE5I and AD.
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Affiliation(s)
- Matthew Adesuyan
- From the Research Department of Practice and Policy (M.A., Y.H.J., D.A., C.J., L.W., R.B.), UCL School of Pharmacy; Centre for Medicines Optimisation Research and Education (M.A., Y.H.J.), University College London Hospitals NHS Foundation Trust, United Kingdom; Pharmacy Practice Department (D.A.), College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; and Division of Psychiatry (R.H.), University College London, United Kingdom
| | - Yogini H Jani
- From the Research Department of Practice and Policy (M.A., Y.H.J., D.A., C.J., L.W., R.B.), UCL School of Pharmacy; Centre for Medicines Optimisation Research and Education (M.A., Y.H.J.), University College London Hospitals NHS Foundation Trust, United Kingdom; Pharmacy Practice Department (D.A.), College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; and Division of Psychiatry (R.H.), University College London, United Kingdom
| | - Dana Alsugeir
- From the Research Department of Practice and Policy (M.A., Y.H.J., D.A., C.J., L.W., R.B.), UCL School of Pharmacy; Centre for Medicines Optimisation Research and Education (M.A., Y.H.J.), University College London Hospitals NHS Foundation Trust, United Kingdom; Pharmacy Practice Department (D.A.), College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; and Division of Psychiatry (R.H.), University College London, United Kingdom
| | - Robert Howard
- From the Research Department of Practice and Policy (M.A., Y.H.J., D.A., C.J., L.W., R.B.), UCL School of Pharmacy; Centre for Medicines Optimisation Research and Education (M.A., Y.H.J.), University College London Hospitals NHS Foundation Trust, United Kingdom; Pharmacy Practice Department (D.A.), College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; and Division of Psychiatry (R.H.), University College London, United Kingdom
| | - Chengsheng Ju
- From the Research Department of Practice and Policy (M.A., Y.H.J., D.A., C.J., L.W., R.B.), UCL School of Pharmacy; Centre for Medicines Optimisation Research and Education (M.A., Y.H.J.), University College London Hospitals NHS Foundation Trust, United Kingdom; Pharmacy Practice Department (D.A.), College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; and Division of Psychiatry (R.H.), University College London, United Kingdom
| | - Li Wei
- From the Research Department of Practice and Policy (M.A., Y.H.J., D.A., C.J., L.W., R.B.), UCL School of Pharmacy; Centre for Medicines Optimisation Research and Education (M.A., Y.H.J.), University College London Hospitals NHS Foundation Trust, United Kingdom; Pharmacy Practice Department (D.A.), College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; and Division of Psychiatry (R.H.), University College London, United Kingdom
| | - Ruth Brauer
- From the Research Department of Practice and Policy (M.A., Y.H.J., D.A., C.J., L.W., R.B.), UCL School of Pharmacy; Centre for Medicines Optimisation Research and Education (M.A., Y.H.J.), University College London Hospitals NHS Foundation Trust, United Kingdom; Pharmacy Practice Department (D.A.), College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; and Division of Psychiatry (R.H.), University College London, United Kingdom
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Doran W, Tunnicliffe L, Muzambi R, Rentsch CT, Bhaskaran K, Smeeth L, Brayne C, Williams DM, Chaturvedi N, Eastwood SV, Dunachie SJ, Mathur R, Warren-Gash C. Incident dementia risk among patients with type 2 diabetes receiving metformin versus alternative oral glucose-lowering therapy: an observational cohort study using UK primary healthcare records. BMJ Open Diabetes Res Care 2024; 12:e003548. [PMID: 38272537 PMCID: PMC10823924 DOI: 10.1136/bmjdrc-2023-003548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 12/21/2023] [Indexed: 01/27/2024] Open
Abstract
INTRODUCTION 4.2 million individuals in the UK have type 2 diabetes, a known risk factor for dementia and mild cognitive impairment (MCI). Diabetes treatment may modify this association, but existing evidence is conflicting. We therefore aimed to assess the association between metformin therapy and risk of incident all-cause dementia or MCI compared with other oral glucose-lowering therapies (GLTs). RESEARCH DESIGN AND METHODS We conducted an observational cohort study using the Clinical Practice Research Datalink among UK adults diagnosed with diabetes at ≥40 years between 1990 and 2019. We used an active comparator new user design to compare risks of dementia and MCI among individuals initially prescribed metformin versus an alternative oral GLT using Cox proportional hazards regression controlling for sociodemographic, lifestyle and clinical confounders. We assessed for interaction by age and sex. Sensitivity analyses included an as-treated analysis to mitigate potential exposure misclassification. RESULTS We included 211 396 individuals (median age 63 years; 42.8% female), of whom 179 333 (84.8%) initiated on metformin therapy. Over median follow-up of 5.4 years, metformin use was associated with a lower risk of dementia (adjusted HR (aHR) 0.86 (95% CI 0.79 to 0.94)) and MCI (aHR 0.92 (95% CI 0.86 to 0.99)). Metformin users aged under 80 years had a lower dementia risk (aHR 0.77 (95% CI 0.68 to 0.85)), which was not observed for those aged ≥80 years (aHR 0.95 (95% CI 0.87 to 1.05)). There was no interaction with sex. The as-treated analysis showed a reduced effect size compared with the main analysis (aHR 0.90 (95% CI 0.83 to 0.98)). CONCLUSIONS Metformin use was associated with lower risks of incident dementia and MCI compared with alternative GLT among UK adults with diabetes. While our findings are consistent with a neuroprotective effect of metformin against dementia, further research is needed to reduce risks of confounding by indication and assess causality.
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Affiliation(s)
- William Doran
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Louis Tunnicliffe
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Rutendo Muzambi
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Christopher T Rentsch
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Krishnan Bhaskaran
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Liam Smeeth
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Carol Brayne
- Cambridge Public Health, University of Cambridge, Cambridge, UK
| | - Dylan M Williams
- MRC Unit for Lifelong Health and Ageing, University College London, London, UK
| | - Nish Chaturvedi
- MRC Unit for Lifelong Health and Ageing, University College London, London, UK
| | - Sophie V Eastwood
- MRC Unit for Lifelong Health and Ageing, University College London, London, UK
| | - Susanna J Dunachie
- NDM Centre for Global Health Research, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Rohini Mathur
- Centre for Primary Care, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Charlotte Warren-Gash
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
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Mukadam N, Marston L, Lewis G, Mathur R, Lowther E, Rait G, Livingston G. South Asian, Black and White ethnicity and the effect of potentially modifiable risk factors for dementia: A study in English electronic health records. PLoS One 2023; 18:e0289893. [PMID: 37819899 PMCID: PMC10566703 DOI: 10.1371/journal.pone.0289893] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 07/28/2023] [Indexed: 10/13/2023] Open
Abstract
INTRODUCTION We aimed to investigate ethnic differences in the associations of potentially modifiable risk factors with dementia. METHODS We used anonymised data from English electronic primary care records for adults aged 65 and older between 1997 and 2018. We used Cox regression to investigate main effects for each risk factor and interaction effects between each risk factor and ethnicity. RESULTS We included 865,674 people with 8,479,973 person years of follow up. Hypertension, dyslipidaemia, obesity and diabetes were more common in people from minority ethnic groups than White people. The impact of hypertension, obesity, diabetes, low HDL and sleep disorders on dementia risk was increased in South Asian people compared to White people. The impact of hypertension was greater in Black compared to White people. DISCUSSION Dementia prevention efforts should be targeted towards people from minority ethnic groups and tailored to risk factors of particular importance.
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Affiliation(s)
- Naaheed Mukadam
- Division of Psychiatry, University College London, London, United Kingdom
| | - Louise Marston
- Primary Care & Population Health, University College London, London, United Kingdom
| | - Gemma Lewis
- Division of Psychiatry, University College London, London, United Kingdom
| | - Rohini Mathur
- Wolfson Institute of Population Health, Queen Mary University London, London, United Kingdom
| | - Ed Lowther
- Advanced Research Computing Centre, University College London, London, United Kingdom
| | - Greta Rait
- Primary Care & Population Health, University College London, London, United Kingdom
| | - Gill Livingston
- Division of Psychiatry, University College London, London, United Kingdom
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Adesuyan M, Jani YH, Alsugeir D, Howard R, Wong ICK, Wei L, Brauer R. Trends in the incidence of dementia in people with hypertension in the UK 2000 to 2021. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2023; 15:e12466. [PMID: 37529121 PMCID: PMC10387744 DOI: 10.1002/dad2.12466] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 05/23/2023] [Indexed: 08/03/2023]
Abstract
INTRODUCTION We investigated trends in the incidence of dementia in UK adults with hypertension. METHODS Primary care electronic health records from IQVIA Medical Research Data UK, previously known as THIN, were used to identify 2,133,118 adults aged ≥40 years with hypertension over 2000 to 2021. The annual incidence rate and average annual percentage change in recorded dementia diagnoses were estimated and stratified by sex, 10-year age bands, Townsend deprivation quintiles and dementia subtype. RESULTS The crude incidence rate of dementia in people with hypertension increased from 1.98 (95% confidence internal [CI] 1.89-2.07) per 1000 person-years at risk (PYAR) in 2000 to 5.29 per 1000 PYAR (95% CI 5.07-5.53) in 2021, corresponding to an average annual increase of 4.1% (95% CI 3.3-5.0). Those aged ≥80 years, the most economically deprived (Townsend = 5), and Alzheimer's disease subtype reported the highest incidence rate within their respective categories. DISCUSSION The annual incidence rate of dementia in the hypertensive population has increased over the last 22 years. Highlights New dementia diagnosis in the hypertensive population has increased over 22 years.The Alzheimer's disease subtype reported the highest incidence rate in people with hypertension.Difference in dementia incidence between hypertensive females and males has reduced.Difference in dementia incidence among deprivation categories has reduced in recent years.
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Affiliation(s)
- Matthew Adesuyan
- Research Department of Practice and PolicyUCL School of PharmacyLondonUK
- Centre for Medicines Optimisation Research and EducationUniversity College London Hospitals NHS Foundation TrustLondonUK
| | - Yogini H. Jani
- Research Department of Practice and PolicyUCL School of PharmacyLondonUK
- Centre for Medicines Optimisation Research and EducationUniversity College London Hospitals NHS Foundation TrustLondonUK
| | - Dana Alsugeir
- Research Department of Practice and PolicyUCL School of PharmacyLondonUK
- Department of Pharmacy Practice, College of Clinical PharmacyImam Abdulrahman Bin Faisal UniversityDammamSaudi Arabia
| | - Robert Howard
- Division of PsychiatryUniversity College LondonLondonUK
| | - Ian C. K. Wong
- Research Department of Practice and PolicyUCL School of PharmacyLondonUK
- Centre for Medicines Optimisation Research and EducationUniversity College London Hospitals NHS Foundation TrustLondonUK
- Centre for Safe Medication Practice and ResearchDepartment of Pharmacology and PharmacyLi Ka Shing Faculty of MedicineThe University of Hong KongHong Kong SARChina
| | - Li Wei
- Research Department of Practice and PolicyUCL School of PharmacyLondonUK
| | - Ruth Brauer
- Research Department of Practice and PolicyUCL School of PharmacyLondonUK
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9
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Eyting M, Xie M, Heß S, Geldsetzer P. Causal evidence that herpes zoster vaccination prevents a proportion of dementia cases. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.05.23.23290253. [PMID: 37292746 PMCID: PMC10246135 DOI: 10.1101/2023.05.23.23290253] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The root causes of dementia are still largely unclear, and the medical community lacks highly effective preventive and therapeutic pharmaceutical agents for dementia despite large investments into their development. There is growing interest in the question if infectious agents play a role in the development of dementia, with herpesviruses attracting particular attention. To provide causal as opposed to merely correlational evidence on this question, we take advantage of the fact that in Wales eligibility for the herpes zoster vaccine (Zostavax) for shingles prevention was determined based on an individual's exact date of birth. Those born before September 2 1933 were ineligible and remained ineligible for life, while those born on or after September 2 1933 were eligible to receive the vaccine. By using country-wide data on all vaccinations received, primary and secondary care encounters, death certificates, and patients' date of birth in weeks, we first show that the percentage of adults who received the vaccine increased from 0.01% among patients who were merely one week too old to be eligible, to 47.2% among those who were just one week younger. Apart from this large difference in the probability of ever receiving the herpes zoster vaccine, there is no plausible reason why those born just one week prior to September 2 1933 should differ systematically from those born one week later. We demonstrate this empirically by showing that there were no systematic differences (e.g., in pre-existing conditions or uptake of other preventive interventions) between adults across the date-of-birth eligibility cutoff, and that there were no other interventions that used the exact same date-of-birth eligibility cutoff as was used for the herpes zoster vaccine program. This unique natural randomization, thus, allows for robust causal, rather than correlational, effect estimation. We first replicate the vaccine's known effect from clinical trials of reducing the occurrence of shingles. We then show that receiving the herpes zoster vaccine reduced the probability of a new dementia diagnosis over a follow-up period of seven years by 3.5 percentage points (95% CI: 0.6 - 7.1, p=0.019), corresponding to a 19.9% relative reduction in the occurrence of dementia. Besides preventing shingles and dementia, the herpes zoster vaccine had no effects on any other common causes of morbidity and mortality. In exploratory analyses, we find that the protective effects from the vaccine for dementia are far stronger among women than men. Randomized trials are needed to determine the optimal population groups and time interval for administration of the herpes zoster vaccine to prevent or delay dementia, as well as to quantify the magnitude of the causal effect when more precise measures of cognition are used. Our findings strongly suggest an important role of the varicella zoster virus in the etiology of dementia.
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Affiliation(s)
- Markus Eyting
- Division of Primary Care and Population Health, Department of
Medicine, Stanford University; Stanford, CA 94305, USA
- Heidelberg Institute of Global Health (HIGH), Heidelberg
University; 69120 Heidelberg, Germany
- Gutenberg School of Management and Economics, Johannes Gutenberg
University Mainz; 55128 Mainz, Germany
| | - Min Xie
- Division of Primary Care and Population Health, Department of
Medicine, Stanford University; Stanford, CA 94305, USA
- Heidelberg Institute of Global Health (HIGH), Heidelberg
University; 69120 Heidelberg, Germany
| | - Simon Heß
- Department of Economics, University of Vienna; 1090 Vienna,
Austria
| | - Pascal Geldsetzer
- Division of Primary Care and Population Health, Department of
Medicine, Stanford University; Stanford, CA 94305, USA
- Department of Epidemiology and Population Health, Stanford
University; Stanford, CA 94305, USA
- Chan Zuckerberg Biohub – San Francisco; San Francisco, CA
94158, USA
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10
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Ebinger JE, Driver MP, Botting P, Wang M, Cheng S, Tan ZS. Association of blood pressure variability during acute care hospitalization and incident dementia. Front Neurol 2023; 14:1085885. [PMID: 36824417 PMCID: PMC9941567 DOI: 10.3389/fneur.2023.1085885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 01/17/2023] [Indexed: 02/10/2023] Open
Abstract
Background and objectives Recognized as a potential risk factor for Alzheimer's disease and related dementias (ADRD), blood pressure variability (BPV) could be leveraged to facilitate identification of at-risk individuals at a population level. Granular BPV data are available during acute care hospitalization periods for potentially high-risk patients, but the incident ADRD risk association with BPV measured in this setting is unknown. Our objective was to evaluate the relation of BPV, measured during acute care hospitalization, and incidence of ADRD. Methods We retrospectively studied adults, without a prior ADRD diagnosis, who were admitted to a large quaternary care medical center in Southern California between January 1, 2013 and December 31, 2019. For all patients, determined BPV, calculated as variability independent of the mean (VIM), using blood pressure readings obtained as part of routine clinical care. We used multivariable Cox proportional hazards regression to examine the association between BP VIM during hospitalization and the development of incident dementia, determined by new ICD-9/10 coding or the new prescription of dementia medication, occurring at least 2 years after the index hospitalization. Results Of 81,892 adults hospitalized without a prior ADRD diagnosis, 2,442 (2.98%) went on to develop ADRD (2.6 to 5.2 years after hospitalization). In multivariable-adjusted Cox models, both systolic (HR 1.05, 95% CI 1.00-1.09) and diastolic (1.06, 1.02-1.10) VIM were associated with incident ADRD. In pre-specified stratified analyses, the VIM associations with incident ADRD were most pronounced in individuals over age 60 years and among those with renal disease or hypertension. Results were similar when repeated to include incident ADRD diagnoses made at least 1 or 3 years after index hospitalization. Discussion We found that measurements of BPV from acute care hospitalizations can be used to identify individuals at risk for developing a diagnosis of ADRD within approximately 5 years. Use of the readily accessible BPV measure may allow healthcare systems to risk stratify patients during periods of intense patient-provider interaction and, in turn, facilitate engagement in ADRD screening programs.
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Affiliation(s)
- Joseph E. Ebinger
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States,*Correspondence: Joseph E. Ebinger ✉
| | - Matthew P. Driver
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Patrick Botting
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Minhao Wang
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Susan Cheng
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Zaldy S. Tan
- Department of Neurology and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, United States,David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
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11
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Huang J, Su B, Karhunen V, Gill D, Zuber V, Ahola-Olli A, Palaniswamy S, Auvinen J, Herzig KH, Keinänen-Kiukaanniemi S, Salmi M, Jalkanen S, Lehtimäki T, Salomaa V, Raitakari OT, Matthews PM, Elliott P, Tsilidis KK, Jarvelin MR, Tzoulaki I, Dehghan A. Inflammatory Diseases, Inflammatory Biomarkers, and Alzheimer Disease: An Observational Analysis and Mendelian Randomization. Neurology 2023; 100:e568-e581. [PMID: 36384659 PMCID: PMC9946179 DOI: 10.1212/wnl.0000000000201489] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 09/14/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Whether chronic autoimmune inflammatory diseases causally affect the risk of Alzheimer disease (AD) is controversial. We characterized the relationship between inflammatory diseases and risk of AD and explored the role of circulating inflammatory biomarkers in the relationships between inflammatory diseases and AD. METHODS We performed observational analyses for chronic autoimmune inflammatory diseases and risk of AD using data from 2,047,513 participants identified in the UK Clinical Practice Research Datalink (CPRD). Using data of a total of more than 1,100,000 individuals from 15 large-scale genome-wide association study data sets, we performed 2-sample Mendelian randomizations (MRs) to investigate the relationships between chronic autoimmune inflammatory diseases, circulating inflammatory biomarker levels, and risk of AD. RESULTS Cox regression models using CPRD data showed that the overall incidence of AD was higher among patients with inflammatory bowel disease (hazard ratio [HR] 1.17; 95% CI 1.15-1.19; p = 2.1 × 10-4), other inflammatory polyarthropathies and systematic connective tissue disorders (HR 1.13; 95% CI 1.12-1.14; p = 8.6 × 10-5), psoriasis (HR 1.13; 95% CI 1.10-1.16; p = 2.6 × 10-4), rheumatoid arthritis (HR 1.08; 95% CI 1.06-1.11; p = 4.0 × 10-4), and multiple sclerosis (HR 1.06; 95% CI 1.04-1.07; p = 2.8 × 10-4) compared with the age (±5 years) and sex-matched comparison groups free from all inflammatory diseases under investigation. Bidirectional MR analysis identified relationships between chronic autoimmune inflammatory diseases and circulating inflammatory biomarkers. Particularly, circulating monokine induced by gamma interferon (MIG) level was suggestively associated with a higher risk of AD (odds ratio from inverse variance weighted [ORIVW] 1.23; 95% CI 1.06-1.42; p IVW = 0.007) and lower risk of Crohn disease (ORIVW 0.73; 95% CI -0.62 to 0.86; p IVW = 1.3 × 10-4). Colocalization supported a common causal single nucleotide polymorphism for MIG and Crohn disease (posterior probability = 0.74), but not AD (posterior probability = 0.03). Using a 2-sample MR approach, genetically predicted risks of inflammatory diseases were not associated with higher AD risk. DISCUSSION Our data suggest that the association between inflammatory diseases and risk of AD is unlikely to be causal and may be a result of confounding. In support, although inflammatory biomarkers showed evidence for causal associations with inflammatory diseases, evidence was weak that they affected both inflammatory disease and AD.
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Affiliation(s)
- Jian Huang
- From the Department of Epidemiology and Biostatistics (J.H., B.S., V.K., D.G., V.Z., S.P., P.E., K.K.T., M.-r.J., A.D.), School of Public Health, Imperial College London, United Kingdom; Singapore Institute for Clinical Sciences (SICS) (J.H.), Agency for Science, Technology and Research (A*STAR); Center for Life Course Health Research (V.K., S.P., J.A., S.K.-K., M.-r.J.), Faculty of Medicine, Research Unit of Mathematical Sciences (V.K.), University of Oulu, Finland; The Stanley Center for Psychiatric Research (A.A.-O.), Broad Institute of MIT and Harvard, Cambridge, MA; Analytical and Translational Genetics Unit (A.A.-O.), Massachusetts General Hospital, Boston; Institute for Molecular Medicine Finland (A.A.-O.), University of Helsinki; Research Unit of Biomedicine (K.-H.H.), Medical Research Center (MRC), University of Oulu, University Hospital, Finland; Department of Gastroenterology and Metabolism (K.-H.H.), Poznan University of Medical Sciences, Poland; Unit of Primary Care (S.K.-K., M.-r.J.), Oulu University Hospital; Healthcare and Social Services of Selänne (S.K.-K., I.T.), Pyhäjärvi, Finland and City of Oulu; MediCity and Institute of Biomedicine (M.S., S.J.), University of Turku; Department of Clinical Chemistry (T.L.), Fimlab Laboratories, and Finnish Cardiovascular Research Center, Tampere, Faculty of Medicine and Health Technology, Tampere University; Finnish Institute for Health and Welfare (V.S.), Helsinki; Research Centre of Applied and Preventive Cardiovascular Medicine (O.T.R.), University of Turku; Department of Clinical Physiology and Nuclear Medicine (O.T.R.), Turku University Hospital; Centre for Population Health Research (O.T.R.), University of Turku and Turku University Hospital, Finland; Department of Brain Sciences (P.M.M.), Faculty of Medicine, Imperial College London; UK Dementia Research Institute at Imperial College London (P.M.M., P.E.); MRC Centre for Environment and Health (P.E., M.-r.J.), School of Public Health, Imperial College London, United Kingdom; Department of Hygiene and Epidemiology (K.K.T.), University of Ioannina Medical School, Greece; Biocenter Oulu (M.-r.J.), University of Oulu, Finland; and Department of Life Sciences (M.-r.J.), College of Health and Life Sciences, Brunel University London, United Kingdom
| | - Bowen Su
- From the Department of Epidemiology and Biostatistics (J.H., B.S., V.K., D.G., V.Z., S.P., P.E., K.K.T., M.-r.J., A.D.), School of Public Health, Imperial College London, United Kingdom; Singapore Institute for Clinical Sciences (SICS) (J.H.), Agency for Science, Technology and Research (A*STAR); Center for Life Course Health Research (V.K., S.P., J.A., S.K.-K., M.-r.J.), Faculty of Medicine, Research Unit of Mathematical Sciences (V.K.), University of Oulu, Finland; The Stanley Center for Psychiatric Research (A.A.-O.), Broad Institute of MIT and Harvard, Cambridge, MA; Analytical and Translational Genetics Unit (A.A.-O.), Massachusetts General Hospital, Boston; Institute for Molecular Medicine Finland (A.A.-O.), University of Helsinki; Research Unit of Biomedicine (K.-H.H.), Medical Research Center (MRC), University of Oulu, University Hospital, Finland; Department of Gastroenterology and Metabolism (K.-H.H.), Poznan University of Medical Sciences, Poland; Unit of Primary Care (S.K.-K., M.-r.J.), Oulu University Hospital; Healthcare and Social Services of Selänne (S.K.-K., I.T.), Pyhäjärvi, Finland and City of Oulu; MediCity and Institute of Biomedicine (M.S., S.J.), University of Turku; Department of Clinical Chemistry (T.L.), Fimlab Laboratories, and Finnish Cardiovascular Research Center, Tampere, Faculty of Medicine and Health Technology, Tampere University; Finnish Institute for Health and Welfare (V.S.), Helsinki; Research Centre of Applied and Preventive Cardiovascular Medicine (O.T.R.), University of Turku; Department of Clinical Physiology and Nuclear Medicine (O.T.R.), Turku University Hospital; Centre for Population Health Research (O.T.R.), University of Turku and Turku University Hospital, Finland; Department of Brain Sciences (P.M.M.), Faculty of Medicine, Imperial College London; UK Dementia Research Institute at Imperial College London (P.M.M., P.E.); MRC Centre for Environment and Health (P.E., M.-r.J.), School of Public Health, Imperial College London, United Kingdom; Department of Hygiene and Epidemiology (K.K.T.), University of Ioannina Medical School, Greece; Biocenter Oulu (M.-r.J.), University of Oulu, Finland; and Department of Life Sciences (M.-r.J.), College of Health and Life Sciences, Brunel University London, United Kingdom
| | - Ville Karhunen
- From the Department of Epidemiology and Biostatistics (J.H., B.S., V.K., D.G., V.Z., S.P., P.E., K.K.T., M.-r.J., A.D.), School of Public Health, Imperial College London, United Kingdom; Singapore Institute for Clinical Sciences (SICS) (J.H.), Agency for Science, Technology and Research (A*STAR); Center for Life Course Health Research (V.K., S.P., J.A., S.K.-K., M.-r.J.), Faculty of Medicine, Research Unit of Mathematical Sciences (V.K.), University of Oulu, Finland; The Stanley Center for Psychiatric Research (A.A.-O.), Broad Institute of MIT and Harvard, Cambridge, MA; Analytical and Translational Genetics Unit (A.A.-O.), Massachusetts General Hospital, Boston; Institute for Molecular Medicine Finland (A.A.-O.), University of Helsinki; Research Unit of Biomedicine (K.-H.H.), Medical Research Center (MRC), University of Oulu, University Hospital, Finland; Department of Gastroenterology and Metabolism (K.-H.H.), Poznan University of Medical Sciences, Poland; Unit of Primary Care (S.K.-K., M.-r.J.), Oulu University Hospital; Healthcare and Social Services of Selänne (S.K.-K., I.T.), Pyhäjärvi, Finland and City of Oulu; MediCity and Institute of Biomedicine (M.S., S.J.), University of Turku; Department of Clinical Chemistry (T.L.), Fimlab Laboratories, and Finnish Cardiovascular Research Center, Tampere, Faculty of Medicine and Health Technology, Tampere University; Finnish Institute for Health and Welfare (V.S.), Helsinki; Research Centre of Applied and Preventive Cardiovascular Medicine (O.T.R.), University of Turku; Department of Clinical Physiology and Nuclear Medicine (O.T.R.), Turku University Hospital; Centre for Population Health Research (O.T.R.), University of Turku and Turku University Hospital, Finland; Department of Brain Sciences (P.M.M.), Faculty of Medicine, Imperial College London; UK Dementia Research Institute at Imperial College London (P.M.M., P.E.); MRC Centre for Environment and Health (P.E., M.-r.J.), School of Public Health, Imperial College London, United Kingdom; Department of Hygiene and Epidemiology (K.K.T.), University of Ioannina Medical School, Greece; Biocenter Oulu (M.-r.J.), University of Oulu, Finland; and Department of Life Sciences (M.-r.J.), College of Health and Life Sciences, Brunel University London, United Kingdom
| | - Dipender Gill
- From the Department of Epidemiology and Biostatistics (J.H., B.S., V.K., D.G., V.Z., S.P., P.E., K.K.T., M.-r.J., A.D.), School of Public Health, Imperial College London, United Kingdom; Singapore Institute for Clinical Sciences (SICS) (J.H.), Agency for Science, Technology and Research (A*STAR); Center for Life Course Health Research (V.K., S.P., J.A., S.K.-K., M.-r.J.), Faculty of Medicine, Research Unit of Mathematical Sciences (V.K.), University of Oulu, Finland; The Stanley Center for Psychiatric Research (A.A.-O.), Broad Institute of MIT and Harvard, Cambridge, MA; Analytical and Translational Genetics Unit (A.A.-O.), Massachusetts General Hospital, Boston; Institute for Molecular Medicine Finland (A.A.-O.), University of Helsinki; Research Unit of Biomedicine (K.-H.H.), Medical Research Center (MRC), University of Oulu, University Hospital, Finland; Department of Gastroenterology and Metabolism (K.-H.H.), Poznan University of Medical Sciences, Poland; Unit of Primary Care (S.K.-K., M.-r.J.), Oulu University Hospital; Healthcare and Social Services of Selänne (S.K.-K., I.T.), Pyhäjärvi, Finland and City of Oulu; MediCity and Institute of Biomedicine (M.S., S.J.), University of Turku; Department of Clinical Chemistry (T.L.), Fimlab Laboratories, and Finnish Cardiovascular Research Center, Tampere, Faculty of Medicine and Health Technology, Tampere University; Finnish Institute for Health and Welfare (V.S.), Helsinki; Research Centre of Applied and Preventive Cardiovascular Medicine (O.T.R.), University of Turku; Department of Clinical Physiology and Nuclear Medicine (O.T.R.), Turku University Hospital; Centre for Population Health Research (O.T.R.), University of Turku and Turku University Hospital, Finland; Department of Brain Sciences (P.M.M.), Faculty of Medicine, Imperial College London; UK Dementia Research Institute at Imperial College London (P.M.M., P.E.); MRC Centre for Environment and Health (P.E., M.-r.J.), School of Public Health, Imperial College London, United Kingdom; Department of Hygiene and Epidemiology (K.K.T.), University of Ioannina Medical School, Greece; Biocenter Oulu (M.-r.J.), University of Oulu, Finland; and Department of Life Sciences (M.-r.J.), College of Health and Life Sciences, Brunel University London, United Kingdom
| | - Verena Zuber
- From the Department of Epidemiology and Biostatistics (J.H., B.S., V.K., D.G., V.Z., S.P., P.E., K.K.T., M.-r.J., A.D.), School of Public Health, Imperial College London, United Kingdom; Singapore Institute for Clinical Sciences (SICS) (J.H.), Agency for Science, Technology and Research (A*STAR); Center for Life Course Health Research (V.K., S.P., J.A., S.K.-K., M.-r.J.), Faculty of Medicine, Research Unit of Mathematical Sciences (V.K.), University of Oulu, Finland; The Stanley Center for Psychiatric Research (A.A.-O.), Broad Institute of MIT and Harvard, Cambridge, MA; Analytical and Translational Genetics Unit (A.A.-O.), Massachusetts General Hospital, Boston; Institute for Molecular Medicine Finland (A.A.-O.), University of Helsinki; Research Unit of Biomedicine (K.-H.H.), Medical Research Center (MRC), University of Oulu, University Hospital, Finland; Department of Gastroenterology and Metabolism (K.-H.H.), Poznan University of Medical Sciences, Poland; Unit of Primary Care (S.K.-K., M.-r.J.), Oulu University Hospital; Healthcare and Social Services of Selänne (S.K.-K., I.T.), Pyhäjärvi, Finland and City of Oulu; MediCity and Institute of Biomedicine (M.S., S.J.), University of Turku; Department of Clinical Chemistry (T.L.), Fimlab Laboratories, and Finnish Cardiovascular Research Center, Tampere, Faculty of Medicine and Health Technology, Tampere University; Finnish Institute for Health and Welfare (V.S.), Helsinki; Research Centre of Applied and Preventive Cardiovascular Medicine (O.T.R.), University of Turku; Department of Clinical Physiology and Nuclear Medicine (O.T.R.), Turku University Hospital; Centre for Population Health Research (O.T.R.), University of Turku and Turku University Hospital, Finland; Department of Brain Sciences (P.M.M.), Faculty of Medicine, Imperial College London; UK Dementia Research Institute at Imperial College London (P.M.M., P.E.); MRC Centre for Environment and Health (P.E., M.-r.J.), School of Public Health, Imperial College London, United Kingdom; Department of Hygiene and Epidemiology (K.K.T.), University of Ioannina Medical School, Greece; Biocenter Oulu (M.-r.J.), University of Oulu, Finland; and Department of Life Sciences (M.-r.J.), College of Health and Life Sciences, Brunel University London, United Kingdom
| | - Ari Ahola-Olli
- From the Department of Epidemiology and Biostatistics (J.H., B.S., V.K., D.G., V.Z., S.P., P.E., K.K.T., M.-r.J., A.D.), School of Public Health, Imperial College London, United Kingdom; Singapore Institute for Clinical Sciences (SICS) (J.H.), Agency for Science, Technology and Research (A*STAR); Center for Life Course Health Research (V.K., S.P., J.A., S.K.-K., M.-r.J.), Faculty of Medicine, Research Unit of Mathematical Sciences (V.K.), University of Oulu, Finland; The Stanley Center for Psychiatric Research (A.A.-O.), Broad Institute of MIT and Harvard, Cambridge, MA; Analytical and Translational Genetics Unit (A.A.-O.), Massachusetts General Hospital, Boston; Institute for Molecular Medicine Finland (A.A.-O.), University of Helsinki; Research Unit of Biomedicine (K.-H.H.), Medical Research Center (MRC), University of Oulu, University Hospital, Finland; Department of Gastroenterology and Metabolism (K.-H.H.), Poznan University of Medical Sciences, Poland; Unit of Primary Care (S.K.-K., M.-r.J.), Oulu University Hospital; Healthcare and Social Services of Selänne (S.K.-K., I.T.), Pyhäjärvi, Finland and City of Oulu; MediCity and Institute of Biomedicine (M.S., S.J.), University of Turku; Department of Clinical Chemistry (T.L.), Fimlab Laboratories, and Finnish Cardiovascular Research Center, Tampere, Faculty of Medicine and Health Technology, Tampere University; Finnish Institute for Health and Welfare (V.S.), Helsinki; Research Centre of Applied and Preventive Cardiovascular Medicine (O.T.R.), University of Turku; Department of Clinical Physiology and Nuclear Medicine (O.T.R.), Turku University Hospital; Centre for Population Health Research (O.T.R.), University of Turku and Turku University Hospital, Finland; Department of Brain Sciences (P.M.M.), Faculty of Medicine, Imperial College London; UK Dementia Research Institute at Imperial College London (P.M.M., P.E.); MRC Centre for Environment and Health (P.E., M.-r.J.), School of Public Health, Imperial College London, United Kingdom; Department of Hygiene and Epidemiology (K.K.T.), University of Ioannina Medical School, Greece; Biocenter Oulu (M.-r.J.), University of Oulu, Finland; and Department of Life Sciences (M.-r.J.), College of Health and Life Sciences, Brunel University London, United Kingdom
| | - Saranya Palaniswamy
- From the Department of Epidemiology and Biostatistics (J.H., B.S., V.K., D.G., V.Z., S.P., P.E., K.K.T., M.-r.J., A.D.), School of Public Health, Imperial College London, United Kingdom; Singapore Institute for Clinical Sciences (SICS) (J.H.), Agency for Science, Technology and Research (A*STAR); Center for Life Course Health Research (V.K., S.P., J.A., S.K.-K., M.-r.J.), Faculty of Medicine, Research Unit of Mathematical Sciences (V.K.), University of Oulu, Finland; The Stanley Center for Psychiatric Research (A.A.-O.), Broad Institute of MIT and Harvard, Cambridge, MA; Analytical and Translational Genetics Unit (A.A.-O.), Massachusetts General Hospital, Boston; Institute for Molecular Medicine Finland (A.A.-O.), University of Helsinki; Research Unit of Biomedicine (K.-H.H.), Medical Research Center (MRC), University of Oulu, University Hospital, Finland; Department of Gastroenterology and Metabolism (K.-H.H.), Poznan University of Medical Sciences, Poland; Unit of Primary Care (S.K.-K., M.-r.J.), Oulu University Hospital; Healthcare and Social Services of Selänne (S.K.-K., I.T.), Pyhäjärvi, Finland and City of Oulu; MediCity and Institute of Biomedicine (M.S., S.J.), University of Turku; Department of Clinical Chemistry (T.L.), Fimlab Laboratories, and Finnish Cardiovascular Research Center, Tampere, Faculty of Medicine and Health Technology, Tampere University; Finnish Institute for Health and Welfare (V.S.), Helsinki; Research Centre of Applied and Preventive Cardiovascular Medicine (O.T.R.), University of Turku; Department of Clinical Physiology and Nuclear Medicine (O.T.R.), Turku University Hospital; Centre for Population Health Research (O.T.R.), University of Turku and Turku University Hospital, Finland; Department of Brain Sciences (P.M.M.), Faculty of Medicine, Imperial College London; UK Dementia Research Institute at Imperial College London (P.M.M., P.E.); MRC Centre for Environment and Health (P.E., M.-r.J.), School of Public Health, Imperial College London, United Kingdom; Department of Hygiene and Epidemiology (K.K.T.), University of Ioannina Medical School, Greece; Biocenter Oulu (M.-r.J.), University of Oulu, Finland; and Department of Life Sciences (M.-r.J.), College of Health and Life Sciences, Brunel University London, United Kingdom
| | - Juha Auvinen
- From the Department of Epidemiology and Biostatistics (J.H., B.S., V.K., D.G., V.Z., S.P., P.E., K.K.T., M.-r.J., A.D.), School of Public Health, Imperial College London, United Kingdom; Singapore Institute for Clinical Sciences (SICS) (J.H.), Agency for Science, Technology and Research (A*STAR); Center for Life Course Health Research (V.K., S.P., J.A., S.K.-K., M.-r.J.), Faculty of Medicine, Research Unit of Mathematical Sciences (V.K.), University of Oulu, Finland; The Stanley Center for Psychiatric Research (A.A.-O.), Broad Institute of MIT and Harvard, Cambridge, MA; Analytical and Translational Genetics Unit (A.A.-O.), Massachusetts General Hospital, Boston; Institute for Molecular Medicine Finland (A.A.-O.), University of Helsinki; Research Unit of Biomedicine (K.-H.H.), Medical Research Center (MRC), University of Oulu, University Hospital, Finland; Department of Gastroenterology and Metabolism (K.-H.H.), Poznan University of Medical Sciences, Poland; Unit of Primary Care (S.K.-K., M.-r.J.), Oulu University Hospital; Healthcare and Social Services of Selänne (S.K.-K., I.T.), Pyhäjärvi, Finland and City of Oulu; MediCity and Institute of Biomedicine (M.S., S.J.), University of Turku; Department of Clinical Chemistry (T.L.), Fimlab Laboratories, and Finnish Cardiovascular Research Center, Tampere, Faculty of Medicine and Health Technology, Tampere University; Finnish Institute for Health and Welfare (V.S.), Helsinki; Research Centre of Applied and Preventive Cardiovascular Medicine (O.T.R.), University of Turku; Department of Clinical Physiology and Nuclear Medicine (O.T.R.), Turku University Hospital; Centre for Population Health Research (O.T.R.), University of Turku and Turku University Hospital, Finland; Department of Brain Sciences (P.M.M.), Faculty of Medicine, Imperial College London; UK Dementia Research Institute at Imperial College London (P.M.M., P.E.); MRC Centre for Environment and Health (P.E., M.-r.J.), School of Public Health, Imperial College London, United Kingdom; Department of Hygiene and Epidemiology (K.K.T.), University of Ioannina Medical School, Greece; Biocenter Oulu (M.-r.J.), University of Oulu, Finland; and Department of Life Sciences (M.-r.J.), College of Health and Life Sciences, Brunel University London, United Kingdom
| | - Karl-Heinz Herzig
- From the Department of Epidemiology and Biostatistics (J.H., B.S., V.K., D.G., V.Z., S.P., P.E., K.K.T., M.-r.J., A.D.), School of Public Health, Imperial College London, United Kingdom; Singapore Institute for Clinical Sciences (SICS) (J.H.), Agency for Science, Technology and Research (A*STAR); Center for Life Course Health Research (V.K., S.P., J.A., S.K.-K., M.-r.J.), Faculty of Medicine, Research Unit of Mathematical Sciences (V.K.), University of Oulu, Finland; The Stanley Center for Psychiatric Research (A.A.-O.), Broad Institute of MIT and Harvard, Cambridge, MA; Analytical and Translational Genetics Unit (A.A.-O.), Massachusetts General Hospital, Boston; Institute for Molecular Medicine Finland (A.A.-O.), University of Helsinki; Research Unit of Biomedicine (K.-H.H.), Medical Research Center (MRC), University of Oulu, University Hospital, Finland; Department of Gastroenterology and Metabolism (K.-H.H.), Poznan University of Medical Sciences, Poland; Unit of Primary Care (S.K.-K., M.-r.J.), Oulu University Hospital; Healthcare and Social Services of Selänne (S.K.-K., I.T.), Pyhäjärvi, Finland and City of Oulu; MediCity and Institute of Biomedicine (M.S., S.J.), University of Turku; Department of Clinical Chemistry (T.L.), Fimlab Laboratories, and Finnish Cardiovascular Research Center, Tampere, Faculty of Medicine and Health Technology, Tampere University; Finnish Institute for Health and Welfare (V.S.), Helsinki; Research Centre of Applied and Preventive Cardiovascular Medicine (O.T.R.), University of Turku; Department of Clinical Physiology and Nuclear Medicine (O.T.R.), Turku University Hospital; Centre for Population Health Research (O.T.R.), University of Turku and Turku University Hospital, Finland; Department of Brain Sciences (P.M.M.), Faculty of Medicine, Imperial College London; UK Dementia Research Institute at Imperial College London (P.M.M., P.E.); MRC Centre for Environment and Health (P.E., M.-r.J.), School of Public Health, Imperial College London, United Kingdom; Department of Hygiene and Epidemiology (K.K.T.), University of Ioannina Medical School, Greece; Biocenter Oulu (M.-r.J.), University of Oulu, Finland; and Department of Life Sciences (M.-r.J.), College of Health and Life Sciences, Brunel University London, United Kingdom
| | - Sirkka Keinänen-Kiukaanniemi
- From the Department of Epidemiology and Biostatistics (J.H., B.S., V.K., D.G., V.Z., S.P., P.E., K.K.T., M.-r.J., A.D.), School of Public Health, Imperial College London, United Kingdom; Singapore Institute for Clinical Sciences (SICS) (J.H.), Agency for Science, Technology and Research (A*STAR); Center for Life Course Health Research (V.K., S.P., J.A., S.K.-K., M.-r.J.), Faculty of Medicine, Research Unit of Mathematical Sciences (V.K.), University of Oulu, Finland; The Stanley Center for Psychiatric Research (A.A.-O.), Broad Institute of MIT and Harvard, Cambridge, MA; Analytical and Translational Genetics Unit (A.A.-O.), Massachusetts General Hospital, Boston; Institute for Molecular Medicine Finland (A.A.-O.), University of Helsinki; Research Unit of Biomedicine (K.-H.H.), Medical Research Center (MRC), University of Oulu, University Hospital, Finland; Department of Gastroenterology and Metabolism (K.-H.H.), Poznan University of Medical Sciences, Poland; Unit of Primary Care (S.K.-K., M.-r.J.), Oulu University Hospital; Healthcare and Social Services of Selänne (S.K.-K., I.T.), Pyhäjärvi, Finland and City of Oulu; MediCity and Institute of Biomedicine (M.S., S.J.), University of Turku; Department of Clinical Chemistry (T.L.), Fimlab Laboratories, and Finnish Cardiovascular Research Center, Tampere, Faculty of Medicine and Health Technology, Tampere University; Finnish Institute for Health and Welfare (V.S.), Helsinki; Research Centre of Applied and Preventive Cardiovascular Medicine (O.T.R.), University of Turku; Department of Clinical Physiology and Nuclear Medicine (O.T.R.), Turku University Hospital; Centre for Population Health Research (O.T.R.), University of Turku and Turku University Hospital, Finland; Department of Brain Sciences (P.M.M.), Faculty of Medicine, Imperial College London; UK Dementia Research Institute at Imperial College London (P.M.M., P.E.); MRC Centre for Environment and Health (P.E., M.-r.J.), School of Public Health, Imperial College London, United Kingdom; Department of Hygiene and Epidemiology (K.K.T.), University of Ioannina Medical School, Greece; Biocenter Oulu (M.-r.J.), University of Oulu, Finland; and Department of Life Sciences (M.-r.J.), College of Health and Life Sciences, Brunel University London, United Kingdom
| | - Marko Salmi
- From the Department of Epidemiology and Biostatistics (J.H., B.S., V.K., D.G., V.Z., S.P., P.E., K.K.T., M.-r.J., A.D.), School of Public Health, Imperial College London, United Kingdom; Singapore Institute for Clinical Sciences (SICS) (J.H.), Agency for Science, Technology and Research (A*STAR); Center for Life Course Health Research (V.K., S.P., J.A., S.K.-K., M.-r.J.), Faculty of Medicine, Research Unit of Mathematical Sciences (V.K.), University of Oulu, Finland; The Stanley Center for Psychiatric Research (A.A.-O.), Broad Institute of MIT and Harvard, Cambridge, MA; Analytical and Translational Genetics Unit (A.A.-O.), Massachusetts General Hospital, Boston; Institute for Molecular Medicine Finland (A.A.-O.), University of Helsinki; Research Unit of Biomedicine (K.-H.H.), Medical Research Center (MRC), University of Oulu, University Hospital, Finland; Department of Gastroenterology and Metabolism (K.-H.H.), Poznan University of Medical Sciences, Poland; Unit of Primary Care (S.K.-K., M.-r.J.), Oulu University Hospital; Healthcare and Social Services of Selänne (S.K.-K., I.T.), Pyhäjärvi, Finland and City of Oulu; MediCity and Institute of Biomedicine (M.S., S.J.), University of Turku; Department of Clinical Chemistry (T.L.), Fimlab Laboratories, and Finnish Cardiovascular Research Center, Tampere, Faculty of Medicine and Health Technology, Tampere University; Finnish Institute for Health and Welfare (V.S.), Helsinki; Research Centre of Applied and Preventive Cardiovascular Medicine (O.T.R.), University of Turku; Department of Clinical Physiology and Nuclear Medicine (O.T.R.), Turku University Hospital; Centre for Population Health Research (O.T.R.), University of Turku and Turku University Hospital, Finland; Department of Brain Sciences (P.M.M.), Faculty of Medicine, Imperial College London; UK Dementia Research Institute at Imperial College London (P.M.M., P.E.); MRC Centre for Environment and Health (P.E., M.-r.J.), School of Public Health, Imperial College London, United Kingdom; Department of Hygiene and Epidemiology (K.K.T.), University of Ioannina Medical School, Greece; Biocenter Oulu (M.-r.J.), University of Oulu, Finland; and Department of Life Sciences (M.-r.J.), College of Health and Life Sciences, Brunel University London, United Kingdom
| | - Sirpa Jalkanen
- From the Department of Epidemiology and Biostatistics (J.H., B.S., V.K., D.G., V.Z., S.P., P.E., K.K.T., M.-r.J., A.D.), School of Public Health, Imperial College London, United Kingdom; Singapore Institute for Clinical Sciences (SICS) (J.H.), Agency for Science, Technology and Research (A*STAR); Center for Life Course Health Research (V.K., S.P., J.A., S.K.-K., M.-r.J.), Faculty of Medicine, Research Unit of Mathematical Sciences (V.K.), University of Oulu, Finland; The Stanley Center for Psychiatric Research (A.A.-O.), Broad Institute of MIT and Harvard, Cambridge, MA; Analytical and Translational Genetics Unit (A.A.-O.), Massachusetts General Hospital, Boston; Institute for Molecular Medicine Finland (A.A.-O.), University of Helsinki; Research Unit of Biomedicine (K.-H.H.), Medical Research Center (MRC), University of Oulu, University Hospital, Finland; Department of Gastroenterology and Metabolism (K.-H.H.), Poznan University of Medical Sciences, Poland; Unit of Primary Care (S.K.-K., M.-r.J.), Oulu University Hospital; Healthcare and Social Services of Selänne (S.K.-K., I.T.), Pyhäjärvi, Finland and City of Oulu; MediCity and Institute of Biomedicine (M.S., S.J.), University of Turku; Department of Clinical Chemistry (T.L.), Fimlab Laboratories, and Finnish Cardiovascular Research Center, Tampere, Faculty of Medicine and Health Technology, Tampere University; Finnish Institute for Health and Welfare (V.S.), Helsinki; Research Centre of Applied and Preventive Cardiovascular Medicine (O.T.R.), University of Turku; Department of Clinical Physiology and Nuclear Medicine (O.T.R.), Turku University Hospital; Centre for Population Health Research (O.T.R.), University of Turku and Turku University Hospital, Finland; Department of Brain Sciences (P.M.M.), Faculty of Medicine, Imperial College London; UK Dementia Research Institute at Imperial College London (P.M.M., P.E.); MRC Centre for Environment and Health (P.E., M.-r.J.), School of Public Health, Imperial College London, United Kingdom; Department of Hygiene and Epidemiology (K.K.T.), University of Ioannina Medical School, Greece; Biocenter Oulu (M.-r.J.), University of Oulu, Finland; and Department of Life Sciences (M.-r.J.), College of Health and Life Sciences, Brunel University London, United Kingdom
| | - Terho Lehtimäki
- From the Department of Epidemiology and Biostatistics (J.H., B.S., V.K., D.G., V.Z., S.P., P.E., K.K.T., M.-r.J., A.D.), School of Public Health, Imperial College London, United Kingdom; Singapore Institute for Clinical Sciences (SICS) (J.H.), Agency for Science, Technology and Research (A*STAR); Center for Life Course Health Research (V.K., S.P., J.A., S.K.-K., M.-r.J.), Faculty of Medicine, Research Unit of Mathematical Sciences (V.K.), University of Oulu, Finland; The Stanley Center for Psychiatric Research (A.A.-O.), Broad Institute of MIT and Harvard, Cambridge, MA; Analytical and Translational Genetics Unit (A.A.-O.), Massachusetts General Hospital, Boston; Institute for Molecular Medicine Finland (A.A.-O.), University of Helsinki; Research Unit of Biomedicine (K.-H.H.), Medical Research Center (MRC), University of Oulu, University Hospital, Finland; Department of Gastroenterology and Metabolism (K.-H.H.), Poznan University of Medical Sciences, Poland; Unit of Primary Care (S.K.-K., M.-r.J.), Oulu University Hospital; Healthcare and Social Services of Selänne (S.K.-K., I.T.), Pyhäjärvi, Finland and City of Oulu; MediCity and Institute of Biomedicine (M.S., S.J.), University of Turku; Department of Clinical Chemistry (T.L.), Fimlab Laboratories, and Finnish Cardiovascular Research Center, Tampere, Faculty of Medicine and Health Technology, Tampere University; Finnish Institute for Health and Welfare (V.S.), Helsinki; Research Centre of Applied and Preventive Cardiovascular Medicine (O.T.R.), University of Turku; Department of Clinical Physiology and Nuclear Medicine (O.T.R.), Turku University Hospital; Centre for Population Health Research (O.T.R.), University of Turku and Turku University Hospital, Finland; Department of Brain Sciences (P.M.M.), Faculty of Medicine, Imperial College London; UK Dementia Research Institute at Imperial College London (P.M.M., P.E.); MRC Centre for Environment and Health (P.E., M.-r.J.), School of Public Health, Imperial College London, United Kingdom; Department of Hygiene and Epidemiology (K.K.T.), University of Ioannina Medical School, Greece; Biocenter Oulu (M.-r.J.), University of Oulu, Finland; and Department of Life Sciences (M.-r.J.), College of Health and Life Sciences, Brunel University London, United Kingdom
| | - Veikko Salomaa
- From the Department of Epidemiology and Biostatistics (J.H., B.S., V.K., D.G., V.Z., S.P., P.E., K.K.T., M.-r.J., A.D.), School of Public Health, Imperial College London, United Kingdom; Singapore Institute for Clinical Sciences (SICS) (J.H.), Agency for Science, Technology and Research (A*STAR); Center for Life Course Health Research (V.K., S.P., J.A., S.K.-K., M.-r.J.), Faculty of Medicine, Research Unit of Mathematical Sciences (V.K.), University of Oulu, Finland; The Stanley Center for Psychiatric Research (A.A.-O.), Broad Institute of MIT and Harvard, Cambridge, MA; Analytical and Translational Genetics Unit (A.A.-O.), Massachusetts General Hospital, Boston; Institute for Molecular Medicine Finland (A.A.-O.), University of Helsinki; Research Unit of Biomedicine (K.-H.H.), Medical Research Center (MRC), University of Oulu, University Hospital, Finland; Department of Gastroenterology and Metabolism (K.-H.H.), Poznan University of Medical Sciences, Poland; Unit of Primary Care (S.K.-K., M.-r.J.), Oulu University Hospital; Healthcare and Social Services of Selänne (S.K.-K., I.T.), Pyhäjärvi, Finland and City of Oulu; MediCity and Institute of Biomedicine (M.S., S.J.), University of Turku; Department of Clinical Chemistry (T.L.), Fimlab Laboratories, and Finnish Cardiovascular Research Center, Tampere, Faculty of Medicine and Health Technology, Tampere University; Finnish Institute for Health and Welfare (V.S.), Helsinki; Research Centre of Applied and Preventive Cardiovascular Medicine (O.T.R.), University of Turku; Department of Clinical Physiology and Nuclear Medicine (O.T.R.), Turku University Hospital; Centre for Population Health Research (O.T.R.), University of Turku and Turku University Hospital, Finland; Department of Brain Sciences (P.M.M.), Faculty of Medicine, Imperial College London; UK Dementia Research Institute at Imperial College London (P.M.M., P.E.); MRC Centre for Environment and Health (P.E., M.-r.J.), School of Public Health, Imperial College London, United Kingdom; Department of Hygiene and Epidemiology (K.K.T.), University of Ioannina Medical School, Greece; Biocenter Oulu (M.-r.J.), University of Oulu, Finland; and Department of Life Sciences (M.-r.J.), College of Health and Life Sciences, Brunel University London, United Kingdom
| | - Olli T Raitakari
- From the Department of Epidemiology and Biostatistics (J.H., B.S., V.K., D.G., V.Z., S.P., P.E., K.K.T., M.-r.J., A.D.), School of Public Health, Imperial College London, United Kingdom; Singapore Institute for Clinical Sciences (SICS) (J.H.), Agency for Science, Technology and Research (A*STAR); Center for Life Course Health Research (V.K., S.P., J.A., S.K.-K., M.-r.J.), Faculty of Medicine, Research Unit of Mathematical Sciences (V.K.), University of Oulu, Finland; The Stanley Center for Psychiatric Research (A.A.-O.), Broad Institute of MIT and Harvard, Cambridge, MA; Analytical and Translational Genetics Unit (A.A.-O.), Massachusetts General Hospital, Boston; Institute for Molecular Medicine Finland (A.A.-O.), University of Helsinki; Research Unit of Biomedicine (K.-H.H.), Medical Research Center (MRC), University of Oulu, University Hospital, Finland; Department of Gastroenterology and Metabolism (K.-H.H.), Poznan University of Medical Sciences, Poland; Unit of Primary Care (S.K.-K., M.-r.J.), Oulu University Hospital; Healthcare and Social Services of Selänne (S.K.-K., I.T.), Pyhäjärvi, Finland and City of Oulu; MediCity and Institute of Biomedicine (M.S., S.J.), University of Turku; Department of Clinical Chemistry (T.L.), Fimlab Laboratories, and Finnish Cardiovascular Research Center, Tampere, Faculty of Medicine and Health Technology, Tampere University; Finnish Institute for Health and Welfare (V.S.), Helsinki; Research Centre of Applied and Preventive Cardiovascular Medicine (O.T.R.), University of Turku; Department of Clinical Physiology and Nuclear Medicine (O.T.R.), Turku University Hospital; Centre for Population Health Research (O.T.R.), University of Turku and Turku University Hospital, Finland; Department of Brain Sciences (P.M.M.), Faculty of Medicine, Imperial College London; UK Dementia Research Institute at Imperial College London (P.M.M., P.E.); MRC Centre for Environment and Health (P.E., M.-r.J.), School of Public Health, Imperial College London, United Kingdom; Department of Hygiene and Epidemiology (K.K.T.), University of Ioannina Medical School, Greece; Biocenter Oulu (M.-r.J.), University of Oulu, Finland; and Department of Life Sciences (M.-r.J.), College of Health and Life Sciences, Brunel University London, United Kingdom
| | - Paul M Matthews
- From the Department of Epidemiology and Biostatistics (J.H., B.S., V.K., D.G., V.Z., S.P., P.E., K.K.T., M.-r.J., A.D.), School of Public Health, Imperial College London, United Kingdom; Singapore Institute for Clinical Sciences (SICS) (J.H.), Agency for Science, Technology and Research (A*STAR); Center for Life Course Health Research (V.K., S.P., J.A., S.K.-K., M.-r.J.), Faculty of Medicine, Research Unit of Mathematical Sciences (V.K.), University of Oulu, Finland; The Stanley Center for Psychiatric Research (A.A.-O.), Broad Institute of MIT and Harvard, Cambridge, MA; Analytical and Translational Genetics Unit (A.A.-O.), Massachusetts General Hospital, Boston; Institute for Molecular Medicine Finland (A.A.-O.), University of Helsinki; Research Unit of Biomedicine (K.-H.H.), Medical Research Center (MRC), University of Oulu, University Hospital, Finland; Department of Gastroenterology and Metabolism (K.-H.H.), Poznan University of Medical Sciences, Poland; Unit of Primary Care (S.K.-K., M.-r.J.), Oulu University Hospital; Healthcare and Social Services of Selänne (S.K.-K., I.T.), Pyhäjärvi, Finland and City of Oulu; MediCity and Institute of Biomedicine (M.S., S.J.), University of Turku; Department of Clinical Chemistry (T.L.), Fimlab Laboratories, and Finnish Cardiovascular Research Center, Tampere, Faculty of Medicine and Health Technology, Tampere University; Finnish Institute for Health and Welfare (V.S.), Helsinki; Research Centre of Applied and Preventive Cardiovascular Medicine (O.T.R.), University of Turku; Department of Clinical Physiology and Nuclear Medicine (O.T.R.), Turku University Hospital; Centre for Population Health Research (O.T.R.), University of Turku and Turku University Hospital, Finland; Department of Brain Sciences (P.M.M.), Faculty of Medicine, Imperial College London; UK Dementia Research Institute at Imperial College London (P.M.M., P.E.); MRC Centre for Environment and Health (P.E., M.-r.J.), School of Public Health, Imperial College London, United Kingdom; Department of Hygiene and Epidemiology (K.K.T.), University of Ioannina Medical School, Greece; Biocenter Oulu (M.-r.J.), University of Oulu, Finland; and Department of Life Sciences (M.-r.J.), College of Health and Life Sciences, Brunel University London, United Kingdom
| | - Paul Elliott
- From the Department of Epidemiology and Biostatistics (J.H., B.S., V.K., D.G., V.Z., S.P., P.E., K.K.T., M.-r.J., A.D.), School of Public Health, Imperial College London, United Kingdom; Singapore Institute for Clinical Sciences (SICS) (J.H.), Agency for Science, Technology and Research (A*STAR); Center for Life Course Health Research (V.K., S.P., J.A., S.K.-K., M.-r.J.), Faculty of Medicine, Research Unit of Mathematical Sciences (V.K.), University of Oulu, Finland; The Stanley Center for Psychiatric Research (A.A.-O.), Broad Institute of MIT and Harvard, Cambridge, MA; Analytical and Translational Genetics Unit (A.A.-O.), Massachusetts General Hospital, Boston; Institute for Molecular Medicine Finland (A.A.-O.), University of Helsinki; Research Unit of Biomedicine (K.-H.H.), Medical Research Center (MRC), University of Oulu, University Hospital, Finland; Department of Gastroenterology and Metabolism (K.-H.H.), Poznan University of Medical Sciences, Poland; Unit of Primary Care (S.K.-K., M.-r.J.), Oulu University Hospital; Healthcare and Social Services of Selänne (S.K.-K., I.T.), Pyhäjärvi, Finland and City of Oulu; MediCity and Institute of Biomedicine (M.S., S.J.), University of Turku; Department of Clinical Chemistry (T.L.), Fimlab Laboratories, and Finnish Cardiovascular Research Center, Tampere, Faculty of Medicine and Health Technology, Tampere University; Finnish Institute for Health and Welfare (V.S.), Helsinki; Research Centre of Applied and Preventive Cardiovascular Medicine (O.T.R.), University of Turku; Department of Clinical Physiology and Nuclear Medicine (O.T.R.), Turku University Hospital; Centre for Population Health Research (O.T.R.), University of Turku and Turku University Hospital, Finland; Department of Brain Sciences (P.M.M.), Faculty of Medicine, Imperial College London; UK Dementia Research Institute at Imperial College London (P.M.M., P.E.); MRC Centre for Environment and Health (P.E., M.-r.J.), School of Public Health, Imperial College London, United Kingdom; Department of Hygiene and Epidemiology (K.K.T.), University of Ioannina Medical School, Greece; Biocenter Oulu (M.-r.J.), University of Oulu, Finland; and Department of Life Sciences (M.-r.J.), College of Health and Life Sciences, Brunel University London, United Kingdom
| | - Konstantinos K Tsilidis
- From the Department of Epidemiology and Biostatistics (J.H., B.S., V.K., D.G., V.Z., S.P., P.E., K.K.T., M.-r.J., A.D.), School of Public Health, Imperial College London, United Kingdom; Singapore Institute for Clinical Sciences (SICS) (J.H.), Agency for Science, Technology and Research (A*STAR); Center for Life Course Health Research (V.K., S.P., J.A., S.K.-K., M.-r.J.), Faculty of Medicine, Research Unit of Mathematical Sciences (V.K.), University of Oulu, Finland; The Stanley Center for Psychiatric Research (A.A.-O.), Broad Institute of MIT and Harvard, Cambridge, MA; Analytical and Translational Genetics Unit (A.A.-O.), Massachusetts General Hospital, Boston; Institute for Molecular Medicine Finland (A.A.-O.), University of Helsinki; Research Unit of Biomedicine (K.-H.H.), Medical Research Center (MRC), University of Oulu, University Hospital, Finland; Department of Gastroenterology and Metabolism (K.-H.H.), Poznan University of Medical Sciences, Poland; Unit of Primary Care (S.K.-K., M.-r.J.), Oulu University Hospital; Healthcare and Social Services of Selänne (S.K.-K., I.T.), Pyhäjärvi, Finland and City of Oulu; MediCity and Institute of Biomedicine (M.S., S.J.), University of Turku; Department of Clinical Chemistry (T.L.), Fimlab Laboratories, and Finnish Cardiovascular Research Center, Tampere, Faculty of Medicine and Health Technology, Tampere University; Finnish Institute for Health and Welfare (V.S.), Helsinki; Research Centre of Applied and Preventive Cardiovascular Medicine (O.T.R.), University of Turku; Department of Clinical Physiology and Nuclear Medicine (O.T.R.), Turku University Hospital; Centre for Population Health Research (O.T.R.), University of Turku and Turku University Hospital, Finland; Department of Brain Sciences (P.M.M.), Faculty of Medicine, Imperial College London; UK Dementia Research Institute at Imperial College London (P.M.M., P.E.); MRC Centre for Environment and Health (P.E., M.-r.J.), School of Public Health, Imperial College London, United Kingdom; Department of Hygiene and Epidemiology (K.K.T.), University of Ioannina Medical School, Greece; Biocenter Oulu (M.-r.J.), University of Oulu, Finland; and Department of Life Sciences (M.-r.J.), College of Health and Life Sciences, Brunel University London, United Kingdom
| | - Marjo-Riitta Jarvelin
- From the Department of Epidemiology and Biostatistics (J.H., B.S., V.K., D.G., V.Z., S.P., P.E., K.K.T., M.-r.J., A.D.), School of Public Health, Imperial College London, United Kingdom; Singapore Institute for Clinical Sciences (SICS) (J.H.), Agency for Science, Technology and Research (A*STAR); Center for Life Course Health Research (V.K., S.P., J.A., S.K.-K., M.-r.J.), Faculty of Medicine, Research Unit of Mathematical Sciences (V.K.), University of Oulu, Finland; The Stanley Center for Psychiatric Research (A.A.-O.), Broad Institute of MIT and Harvard, Cambridge, MA; Analytical and Translational Genetics Unit (A.A.-O.), Massachusetts General Hospital, Boston; Institute for Molecular Medicine Finland (A.A.-O.), University of Helsinki; Research Unit of Biomedicine (K.-H.H.), Medical Research Center (MRC), University of Oulu, University Hospital, Finland; Department of Gastroenterology and Metabolism (K.-H.H.), Poznan University of Medical Sciences, Poland; Unit of Primary Care (S.K.-K., M.-r.J.), Oulu University Hospital; Healthcare and Social Services of Selänne (S.K.-K., I.T.), Pyhäjärvi, Finland and City of Oulu; MediCity and Institute of Biomedicine (M.S., S.J.), University of Turku; Department of Clinical Chemistry (T.L.), Fimlab Laboratories, and Finnish Cardiovascular Research Center, Tampere, Faculty of Medicine and Health Technology, Tampere University; Finnish Institute for Health and Welfare (V.S.), Helsinki; Research Centre of Applied and Preventive Cardiovascular Medicine (O.T.R.), University of Turku; Department of Clinical Physiology and Nuclear Medicine (O.T.R.), Turku University Hospital; Centre for Population Health Research (O.T.R.), University of Turku and Turku University Hospital, Finland; Department of Brain Sciences (P.M.M.), Faculty of Medicine, Imperial College London; UK Dementia Research Institute at Imperial College London (P.M.M., P.E.); MRC Centre for Environment and Health (P.E., M.-r.J.), School of Public Health, Imperial College London, United Kingdom; Department of Hygiene and Epidemiology (K.K.T.), University of Ioannina Medical School, Greece; Biocenter Oulu (M.-r.J.), University of Oulu, Finland; and Department of Life Sciences (M.-r.J.), College of Health and Life Sciences, Brunel University London, United Kingdom
| | - Ioanna Tzoulaki
- From the Department of Epidemiology and Biostatistics (J.H., B.S., V.K., D.G., V.Z., S.P., P.E., K.K.T., M.-r.J., A.D.), School of Public Health, Imperial College London, United Kingdom; Singapore Institute for Clinical Sciences (SICS) (J.H.), Agency for Science, Technology and Research (A*STAR); Center for Life Course Health Research (V.K., S.P., J.A., S.K.-K., M.-r.J.), Faculty of Medicine, Research Unit of Mathematical Sciences (V.K.), University of Oulu, Finland; The Stanley Center for Psychiatric Research (A.A.-O.), Broad Institute of MIT and Harvard, Cambridge, MA; Analytical and Translational Genetics Unit (A.A.-O.), Massachusetts General Hospital, Boston; Institute for Molecular Medicine Finland (A.A.-O.), University of Helsinki; Research Unit of Biomedicine (K.-H.H.), Medical Research Center (MRC), University of Oulu, University Hospital, Finland; Department of Gastroenterology and Metabolism (K.-H.H.), Poznan University of Medical Sciences, Poland; Unit of Primary Care (S.K.-K., M.-r.J.), Oulu University Hospital; Healthcare and Social Services of Selänne (S.K.-K., I.T.), Pyhäjärvi, Finland and City of Oulu; MediCity and Institute of Biomedicine (M.S., S.J.), University of Turku; Department of Clinical Chemistry (T.L.), Fimlab Laboratories, and Finnish Cardiovascular Research Center, Tampere, Faculty of Medicine and Health Technology, Tampere University; Finnish Institute for Health and Welfare (V.S.), Helsinki; Research Centre of Applied and Preventive Cardiovascular Medicine (O.T.R.), University of Turku; Department of Clinical Physiology and Nuclear Medicine (O.T.R.), Turku University Hospital; Centre for Population Health Research (O.T.R.), University of Turku and Turku University Hospital, Finland; Department of Brain Sciences (P.M.M.), Faculty of Medicine, Imperial College London; UK Dementia Research Institute at Imperial College London (P.M.M., P.E.); MRC Centre for Environment and Health (P.E., M.-r.J.), School of Public Health, Imperial College London, United Kingdom; Department of Hygiene and Epidemiology (K.K.T.), University of Ioannina Medical School, Greece; Biocenter Oulu (M.-r.J.), University of Oulu, Finland; and Department of Life Sciences (M.-r.J.), College of Health and Life Sciences, Brunel University London, United Kingdom
| | - Abbas Dehghan
- From the Department of Epidemiology and Biostatistics (J.H., B.S., V.K., D.G., V.Z., S.P., P.E., K.K.T., M.-r.J., A.D.), School of Public Health, Imperial College London, United Kingdom; Singapore Institute for Clinical Sciences (SICS) (J.H.), Agency for Science, Technology and Research (A*STAR); Center for Life Course Health Research (V.K., S.P., J.A., S.K.-K., M.-r.J.), Faculty of Medicine, Research Unit of Mathematical Sciences (V.K.), University of Oulu, Finland; The Stanley Center for Psychiatric Research (A.A.-O.), Broad Institute of MIT and Harvard, Cambridge, MA; Analytical and Translational Genetics Unit (A.A.-O.), Massachusetts General Hospital, Boston; Institute for Molecular Medicine Finland (A.A.-O.), University of Helsinki; Research Unit of Biomedicine (K.-H.H.), Medical Research Center (MRC), University of Oulu, University Hospital, Finland; Department of Gastroenterology and Metabolism (K.-H.H.), Poznan University of Medical Sciences, Poland; Unit of Primary Care (S.K.-K., M.-r.J.), Oulu University Hospital; Healthcare and Social Services of Selänne (S.K.-K., I.T.), Pyhäjärvi, Finland and City of Oulu; MediCity and Institute of Biomedicine (M.S., S.J.), University of Turku; Department of Clinical Chemistry (T.L.), Fimlab Laboratories, and Finnish Cardiovascular Research Center, Tampere, Faculty of Medicine and Health Technology, Tampere University; Finnish Institute for Health and Welfare (V.S.), Helsinki; Research Centre of Applied and Preventive Cardiovascular Medicine (O.T.R.), University of Turku; Department of Clinical Physiology and Nuclear Medicine (O.T.R.), Turku University Hospital; Centre for Population Health Research (O.T.R.), University of Turku and Turku University Hospital, Finland; Department of Brain Sciences (P.M.M.), Faculty of Medicine, Imperial College London; UK Dementia Research Institute at Imperial College London (P.M.M., P.E.); MRC Centre for Environment and Health (P.E., M.-r.J.), School of Public Health, Imperial College London, United Kingdom; Department of Hygiene and Epidemiology (K.K.T.), University of Ioannina Medical School, Greece; Biocenter Oulu (M.-r.J.), University of Oulu, Finland; and Department of Life Sciences (M.-r.J.), College of Health and Life Sciences, Brunel University London, United Kingdom.
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12
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Yin GS, van der Heide F, Littlejohns TJ, Kuźma E, Hayat S, Brayne C, Foster PJ, Luben R, Khawaja AP. Association Between Retinal Nerve Fiber Layer Thickness and Incident Dementia in the European Prospective Investigation into Cancer in Norfolk Cohort. J Alzheimers Dis 2023; 95:691-702. [PMID: 37574729 DOI: 10.3233/jad-230073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
BACKGROUND Retinal nerve fiber layer (RNFL) thickness may reflect cerebral status. OBJECTIVE This study assessed the relationship between RNFL thickness and incident all-cause dementia in the European Prospective Investigation into Cancer in Norfolk (EPIC-Norfolk) Eye Study. METHODS Glaucoma detection with variable corneal compensation (GDx-VCC) and Heidelberg Retinal Tomograph II (HRT II) derived global mean RNFL thickness from dementia-free participants at baseline within the EPIC-Norfolk Eye Study were analyzed. Incident dementia was identified through linkage to electronic medical records. Cox proportional hazard mixed-effects regression models adjusted for key confounders were used to examine the associations between RNFL thickness and incident dementia in four separate models. RESULTS 6,239 participants were included with 322 cases of incident dementia and mean age of 67.5-years old, with 49.7% women (median follow-up 13.2-years, interquartile range (11.7 to 14.6 years). Greater RNFL thickness (GDx-VCC) was not significantly associated with a lower risk of incident dementia in the full adjusted model [HR per quartile increase 0.95; 95% CI 0.82-1.10]. Similarly, RNFL thickness assessed with HRT II was also not associated with incident dementia in any model (full adjusted model; HR per quartile increase: 1.06; [95% CI 0.93-1.19]. Gender did not modify any associations under study. CONCLUSION GDx-VCC and HRT II derived RNFL thickness are unlikely to be useful predictors of incident dementia. Higher resolution optical imaging technologies may clarify whether there are useful relationships between neuro-retinal morphology and brain measures.
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Affiliation(s)
- Grace S Yin
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Frank van der Heide
- Cardiovascular Research Institute Maastricht School for Cardiovascular Diseases, Maastricht University, the Netherlands
- Department of Internal Medicine, Maastricht University Medical Center, the Netherlands
| | | | - Elżbieta Kuźma
- Albertinen-Haus Centre for Geriatrics and Gerontology, University of Hamburg, Hamburg, Germany
| | - Shabina Hayat
- Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, England, UK
| | - Carol Brayne
- Cambridge Public Health, University of Cambridge, Cambridge, UK
| | - Paul J Foster
- NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK
| | - Robert Luben
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
- NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK
| | - Anthony P Khawaja
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
- NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK
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13
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Chung S, Providencia R, Sofat R, Pujades‐Rodriguez M, Torralbo A, Fatemifar G, Fitzpatrick NK, Taylor J, Li K, Dale C, Rossor M, Acosta‐Mena D, Whittaker J, Denaxas S. Incidence, morbidity, mortality and disparities in dementia: A population linked electronic health records study of 4.3 million individuals. Alzheimers Dement 2023; 19:123-135. [PMID: 35290719 PMCID: PMC10078672 DOI: 10.1002/alz.12635] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 11/08/2021] [Accepted: 01/30/2022] [Indexed: 01/18/2023]
Abstract
INTRODUCTION We report dementia incidence, comorbidities, reasons for health-care visits, mortality, causes of death, and examined dementia patterns by relative deprivation in the UK. METHOD A longitudinal cohort analysis of linked electronic health records from 4.3 million people in the UK was conducted to investigate dementia incidence and mortality. Reasons for hospitalization and causes of death were compared in individuals with and without dementia. RESULTS From 1998 to 2016 we observed 145,319 (3.1%) individuals with incident dementia. Repeated hospitalizations among senior adults for infection, unknown morbidity, and multiple primary care visits for chronic pain were observed prior to dementia diagnosis. Multiple long-term conditions are present in half of the individuals at the time of diagnosis. Individuals living in high deprivation areas had higher dementia incidence and high fatality. DISCUSSION There is a considerable disparity of dementia that informs priorities of prevention and provision of patient care.
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Affiliation(s)
- Sheng‐Chia Chung
- Department of Health InformaticsHealth Data Research UKLondonUK
- Department of Health InformaticsUniversity College LondonLondonUK
| | | | - Reecha Sofat
- Department of Health InformaticsHealth Data Research UKLondonUK
| | | | - Ana Torralbo
- Department of Health InformaticsHealth Data Research UKLondonUK
- Department of Health InformaticsUniversity College LondonLondonUK
| | - Ghazaleh Fatemifar
- Department of Health InformaticsHealth Data Research UKLondonUK
- Department of Health InformaticsUniversity College LondonLondonUK
| | - Natalie K. Fitzpatrick
- Department of Health InformaticsHealth Data Research UKLondonUK
- Department of Health InformaticsUniversity College LondonLondonUK
| | - Julie Taylor
- Department of Health InformaticsHealth Data Research UKLondonUK
| | - Ken Li
- Department of Health InformaticsHealth Data Research UKLondonUK
| | - Caroline Dale
- Department of Health InformaticsHealth Data Research UKLondonUK
| | - Martin Rossor
- Department of NeurodegenerationUCL Institute of NeurologyLondonUK
| | | | | | - Spiros Denaxas
- Department of Health InformaticsHealth Data Research UKLondonUK
- Department of Health InformaticsUniversity College LondonLondonUK
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14
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Beerten SG, Helsen A, De Lepeleire J, Waldorff FB, Vaes B. Trends in prevalence and incidence of registered dementia and trends in multimorbidity among patients with dementia in general practice in Flanders, Belgium, 2000-2021: a registry-based, retrospective, longitudinal cohort study. BMJ Open 2022; 12:e063891. [PMID: 36323468 PMCID: PMC9639092 DOI: 10.1136/bmjopen-2022-063891] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVES With the ageing of our population, it seems plausible that the prevalence of both dementia and multimorbidity will increase in the following decades. The aim of this study is to examine the trends in prevalence and incidence of registered dementia and trends in multimorbidity in patients with dementia in general practice in Flanders. DESIGN Retrospective, longitudinal cohort study. SETTING Primary care practices across Flanders, Belgium. PARTICIPANTS Patients included in the Intego database. METHODS Data were collected from the Intego database, a Belgian general practice registration network, from 1 January 2000 to 31 December 2021. Joinpoint regression, the Cochran-Armitage test and Jonckheere-Terpstra test were used for the trend analysis. RESULTS Data from 149 492 unique patients aged 65 years and older were available. From 2000 to 2021, 3835 incident cases of dementia were found. The age-adjusted prevalence of registered dementia significantly increased during this study period, from 1.19% to 2.43% (average annual percentage change (AAPC) 3.3; 95% CI 2.7 to 4.0). Incidence increased from 3.68 to 5.86 per 1000 patient years overall (AAPC 1.8, 95% CI -2.0 to 5.7), but declined in recent years (annual percentage change -8.1, 95% CI -14.8 to -0.8). Almost three-quarters of the patients with dementia (74.8%) suffered from multimorbidity (three or more comorbidities) and this increased significantly during the study period (p=0.0031). By 2021, 86.7% and 74.8% of the patients with dementia suffered from two or more or three or more chronic conditions, respectively. Hypertension (47.9%), osteoarthritis (29.7%) and lipid metabolism disorders (25.7%) were the most prevalent conditions. CONCLUSIONS The prevalence of registered dementia doubled over a 22-year time period, mirroring the increasing health burden by this disease globally. Furthermore, three-quarters of the patients with dementia suffered from multimorbidity, underlining the urgent need to implement comorbidity management and patient-centred care in dementia.
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Affiliation(s)
| | - Antje Helsen
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Jan De Lepeleire
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Frans Boch Waldorff
- Department of Public Health, Research Unit for General Practice and Section of General Practice, University of Copenhagen, Copenhagen, Denmark
| | - Bert Vaes
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
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15
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Bacigalupo I, Lombardo FL, Bargagli AM, Cascini S, Agabiti N, Davoli M, Scalmana S, Palma AD, Greco A, Rinaldi M, Giordana R, Imperiale D, Secreto P, Golini N, Gnavi R, Lovaldi F, Biagini CA, Gualdani E, Francesconi P, Magliocchetti N, Fiandra TD, Vanacore N. Identification of dementia and MCI cases in health information systems: An Italian validation study. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2022; 8:e12327. [PMID: 36320346 PMCID: PMC9617569 DOI: 10.1002/trc2.12327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 06/03/2022] [Accepted: 06/10/2022] [Indexed: 11/06/2022]
Abstract
Introduction The identification of dementia cases through routinely collected health data represents an easily accessible and inexpensive method to estimate the prevalence of dementia. In Italy, a project aimed at the validation of an algorithm was conducted. Methods The project included cases (patients with dementia or mild cognitive impairment [MCI]) recruited in centers for cognitive disorders and dementias and controls recruited in outpatient units of geriatrics and neurology. The algorithm based on pharmaceutical prescriptions, hospital discharge records, residential long‐term care records, and information on exemption from health‐care co‐payment, was applied to the validation population. Results The main analysis was conducted on 1110 cases and 1114 controls. The sensitivity, specificity, and positive and negative predictive values in discerning cases of dementia were 74.5%, 96.0%, 94.9%, and 79.1%, respectively, whereas in detecting cases of MCI these values were 29.7%, 97.5%, 92.2%, and 58.1%, respectively. The variables associated with misclassification of cases were also identified. Discussion This study provided a validated algorithm, based on administrative data, which can be used to identify cases with dementia and, with lower sensitivity, also early onset dementia but not cases with MCI.
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Affiliation(s)
- Ilaria Bacigalupo
- National Center for Disease Prevention and Health PromotionItalian NationalInstitute of HealthRomeItaly
| | - Flavia L. Lombardo
- National Center for Disease Prevention and Health PromotionItalian NationalInstitute of HealthRomeItaly
| | | | - Silvia Cascini
- Department of EpidemiologyLazio Regional Health ServiceRomeItaly
| | - Nera Agabiti
- Department of EpidemiologyLazio Regional Health ServiceRomeItaly
| | - Marina Davoli
- Department of EpidemiologyLazio Regional Health ServiceRomeItaly
| | | | | | | | | | | | | | - Piero Secreto
- Geriatric unitLocal Health Authority TO3Piemonte RegionTurinItaly
| | - Natalia Golini
- Epidemiology UnitLocal Health Authority TO3Piemonte RegionGrugliascoItaly
| | - Roberto Gnavi
- Epidemiology UnitLocal Health Authority TO3Piemonte RegionGrugliascoItaly
| | | | | | - Elisa Gualdani
- Epidemiology UnitToscana Regional Health AgencyFlorenceItaly
| | | | | | - Teresa Di Fiandra
- General Directorate for Health PreventionMinistry of HealthRomeItaly
| | - Nicola Vanacore
- National Center for Disease Prevention and Health PromotionItalian NationalInstitute of HealthRomeItaly
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16
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Lee SI, Cooper J, Fenton A, Subramanian A, Taverner T, Gokhale KM, Phillips K, Patel M, Harper L, Thomas GN, Nirantharakumar K. Decreased renal function is associated with incident dementia: An IMRD-THIN retrospective cohort study in the UK. Alzheimers Dement 2022; 18:1943-1956. [PMID: 34978143 DOI: 10.1002/alz.12539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 08/26/2021] [Accepted: 10/25/2021] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Decreased renal function is a potential risk factor for dementia. METHODS This retrospective cohort study of 2.8 million adults aged ≥50 years used the IMRD-THIN database, representative of UK primary care, from January 1, 1995 to February 24, 2020. The associations between estimated glomerular filtration rate (eGFR) and urine albumin creatinine ratio (ACR) with incident all-cause dementia were analyzed using Cox regression. RESULTS In the eGFR cohort (n = 2,797,384), worsening renal dysfunction was associated with increased hazard of all-cause dementia, with greatest hazard at eGFR 15-30 ml/min/1.73min2 (hazard ratio [HR] 1.26, 95% confidence interval [CI] 1.19-1.33). In the ACR cohort (n = 641,912), the hazard of dementia increased from ACR 3-30 mg/mmol (HR 1.13, 95% CI 1.10-1.15) to ACR > 30 mg/mmol (HR 1.25, 95% CI 1.18-1.33). DISCUSSION Worsening eGFR and albuminuria have graded associations with the risk of dementia, which may have significant implications for the care of patients with kidney disease.
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Affiliation(s)
- Siang Ing Lee
- Institute of Applied Health Sciences, University of Birmingham, Birmingham, UK
| | - Jennifer Cooper
- Institute of Applied Health Sciences, University of Birmingham, Birmingham, UK
| | - Anthony Fenton
- Institute of Applied Health Sciences, University of Birmingham, Birmingham, UK
| | | | - Tom Taverner
- Institute of Applied Health Sciences, University of Birmingham, Birmingham, UK
| | - Krishna M Gokhale
- Institute of Applied Health Sciences, University of Birmingham, Birmingham, UK
| | - Katherine Phillips
- Institute of Applied Health Sciences, University of Birmingham, Birmingham, UK
| | - Mitesh Patel
- Institute of Applied Health Sciences, University of Birmingham, Birmingham, UK
| | - Lorraine Harper
- Institute of Clinical Sciences, Centre for Translational Inflammation Research, University of Birmingham Research Laboratories, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - G Neil Thomas
- Institute of Applied Health Sciences, University of Birmingham, Birmingham, UK
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Bell G, Baou CE, Saunders R, Buckman JEJ, Charlesworth G, Richards M, Brown B, Nurock S, Michael S, Ware P, Aguirre E, Rio M, Cooper C, Pilling S, John A, Stott J. Effectiveness of primary care psychological therapy services for the treatment of depression and anxiety in people living with dementia: Evidence from national healthcare records in England. EClinicalMedicine 2022; 52:101692. [PMID: 36313148 PMCID: PMC9596302 DOI: 10.1016/j.eclinm.2022.101692] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/22/2022] [Accepted: 09/22/2022] [Indexed: 11/06/2022] Open
Abstract
Background Depression and anxiety are common and deleterious in people living with dementia (PLWD). It is currently unknown whether routinely provided psychological therapy can help reduce these symptoms in PLWD. This study aimed to investigate improvements in depression and anxiety symptoms over the course of therapy offered in primary care psychological therapy services in PLWD and to compare outcomes to people without dementia. Methods National data from Improving Access to Psychological Therapies services (IAPT) across England linked with Hospital Episode Statistics data, the Mental Health Services Dataset, and HES-ONS mortality data were used to identify 1,549 PLWD who completed a course of psychological treatment in IAPT between 2012-2019 and a propensity score matched control group without identified dementia. Outcome measures included pre-post intervention changes in depression (PHQ-9) and anxiety (GAD-7) symptoms and therapy outcomes (reliable improvement, recovery, deterioration). Findings Symptoms of depression (t(1548)=31·05, p<·001) and anxiety (t(1548)=30·31, p<·001) improved in PLWD over the course of psychological therapy with large effect sizes (depression: d=-0·83; anxiety: d=-0·80). However, PLWD were less likely to reliably improve (OR=·75, 95%CI[·63,·88], p<·001) or recover (OR=·75, 95%CI[·64,·88], p=·001), and more likely to deteriorate (OR=1·35, 95%CI[1·03,1·78], p=·029) than a matched control sample without dementia. Interpretation Psychological therapy may be beneficial for PLWD with depression or anxiety, but it is currently not as effective as for people without dementia. More research is needed to improve access to psychological therapies and to understand this discrepancy and how therapies can be adapted to further improve outcomes. Funding This work was supported by the Alzheimer's Society.
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Affiliation(s)
- Georgia Bell
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
| | - Celine El Baou
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
| | - Rob Saunders
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
| | - Joshua E. J Buckman
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
- iCope – Camden & Islington NHS Foundation Trust, St Pancras Hospital, London, UK
| | - Georgina Charlesworth
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
- North East London NHS Foundation Trust (NELFT), London, UK
| | - Marcus Richards
- MRC Unit for Lifelong Health and Ageing at UCL, UCL, London, UK
| | - Barbara Brown
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
| | - Shirley Nurock
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
| | - Stuart Michael
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
| | - Paul Ware
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
| | - Elisa Aguirre
- North East London NHS Foundation Trust (NELFT), London, UK
| | - Miguel Rio
- Department of Electronic and Electrical Engineering, UCL, London, UK
| | - Claudia Cooper
- Centre for Psychiatry and Mental Health, Wolfson Institute for Population Health, Queen Mary University of London, London, UK
- East London NHS Foundation Trust, London, UK
| | - Stephen Pilling
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
- Camden & Islington NHS Foundation Trust, St Pancras Hospital, London, UK
| | - Amber John
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
| | - Joshua Stott
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
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18
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Hallam B, Petersen I, Cooper C, Avgerinou C, Walters K. Time Trends in Incidence of Reported Memory Concerns and Cognitive Decline: A Cohort Study in UK Primary Care. Clin Epidemiol 2022; 14:395-408. [PMID: 35359800 PMCID: PMC8961006 DOI: 10.2147/clep.s350396] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 02/11/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Brendan Hallam
- UCL Research Department of Primary Care & Population Health, University College London, London, UK
- Correspondence: Brendan Hallam, UCL Research Department of Primary Care & Population Health, University College London, London, UK, Email
| | - Irene Petersen
- UCL Research Department of Primary Care & Population Health, University College London, London, UK
| | - Claudia Cooper
- Division of Psychiatry, University College London, London, UK
| | - Christina Avgerinou
- UCL Research Department of Primary Care & Population Health, University College London, London, UK
| | - Kate Walters
- UCL Research Department of Primary Care & Population Health, University College London, London, UK
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Warren-Gash C, Williamson E, Shiekh SI, Borjas-Howard J, Pearce N, Breuer JM, Smeeth L. No evidence that herpes zoster is associated with increased risk of dementia diagnosis. Ann Clin Transl Neurol 2022; 9:363-374. [PMID: 35170873 PMCID: PMC8935278 DOI: 10.1002/acn3.51525] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/01/2022] [Accepted: 02/04/2022] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE To investigate whether herpes zoster (HZ) was associated with subsequent increased risk of dementia diagnosis. METHODS We conducted a historical cohort study using primary care electronic health records from the Clinical Practice Research Datalink in the United Kingdom. Individuals with incident HZ aged ≥40 years from 2000 to 2017 were matched with up to four individuals without HZ by age, sex, primary care practise and calendar time. The primary outcome was a new diagnosis of all-cause dementia. We used the Cox proportional hazards regression adjusting for demographic, lifestyle and clinical confounders to assess any association between HZ and dementia. We investigated interactions with sex, frailty index and antiviral treatment and conducted various sensitivity analyses. RESULTS The cohort comprised 177,144 individuals with HZ and 706,901 matched unexposed individuals (median age 65 years (IQR 55.1-75.0), 40% male) followed for a median duration of 4.6 years (IQR 2.0-8.1). In total, 26,585 (3%) patients had an incident dementia diagnosis recorded and 113,056 patients died (12.8%). HZ was associated with a small reduction in dementia diagnosis (adjusted HR 0.92 (95% CI 0.89-0.95)), occurring predominantly in frail individuals and females. For patients who were fit (578,115, 65%), no association was seen (adjusted HR 0.97, 95% CI 0.92-1.02). There was no association between HZ and a composite outcome of dementia or death (adjusted HR 1.00, 95% CI 0.99-1.02). Dementia risk did not vary by prescription of antiviral agents. Sensitivity analyses showed consistent results. INTERPRETATION HZ was not associated with increased dementia diagnosis in a UK primary care-based cohort.
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Affiliation(s)
- Charlotte Warren-Gash
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT
| | - Elizabeth Williamson
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT
| | - Suhail I Shiekh
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT
| | - James Borjas-Howard
- Department of Haematology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Neil Pearce
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT.,Department of Medical Statistics, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT
| | - Judith M Breuer
- Institute of Child Health, University College London, Gower Street, London, WC1E 6BT
| | - Liam Smeeth
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT
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Cadogan SL, Powell E, Wing K, Wong AY, Smeeth L, Warren-Gash C. Anticoagulant prescribing for atrial fibrillation and risk of incident dementia. Heart 2021; 107:1898-1904. [PMID: 34645643 PMCID: PMC8600601 DOI: 10.1136/heartjnl-2021-319672] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 09/23/2021] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE The aim of this study was to investigate the association between oral anticoagulant type (direct oral anticoagulants (DOACs) vs vitamin K antagonists (VKAs)) and incident dementia or mild cognitive impairment (MCI) among patients with newly diagnosed atrial fibrillation (AF). METHODS Using linked electronic health record (EHR) data from the Clinical Practice Research Datalink in the UK, we conducted a historical cohort study among first-time oral anticoagulant users with incident non-valvular AF diagnosed from 2012 to 2018. We compared the incidence of (1) clinically coded dementia and (2) MCI between patients prescribed VKAs and DOACs using Cox proportional hazards regression models, with age as the underlying timescale, accounting for calendar time and time on treatment, sociodemographic and lifestyle factors, clinical comorbidities and medications. RESULTS Of 39 200 first-time oral anticoagulant users (44.6% female, median age 76 years, IQR 68-83), 20 687 (53%) were prescribed a VKA and 18 513 (47%) a DOAC at baseline. Overall, 1258 patients (3.2%) had GP-recorded incident dementia, incidence rate 16.5 per 1000 person-years. DOAC treatment for AF was associated with a 16% reduction in dementia diagnosis compared with VKA treatment in the whole cohort (adjusted HR 0.84, 95% CI: 0.73 to 0.98) and with a 26% reduction in incident MCI (adjusted HR 0.74, 95% CI: 0.65 to 0.84). Findings were similar across various sensitivity analyses. CONCLUSIONS Incident EHR-recorded dementia and MCI were less common among patients prescribed DOACs for new AF compared with those prescribed VKAs.
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Affiliation(s)
- Sharon Louise Cadogan
- Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Emma Powell
- Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Kevin Wing
- Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Angel Yun Wong
- Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Liam Smeeth
- Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Charlotte Warren-Gash
- Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
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21
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Davis KAS, Mueller C, Ashworth M, Broadbent M, Jewel A, Molokhia M, Perera G, Stewart RJ. What gets recorded, counts: dementia recording in primary care compared with a specialist database. Age Ageing 2021; 50:2206-2213. [PMID: 34417796 PMCID: PMC8581382 DOI: 10.1093/ageing/afab164] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 06/21/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND databases of electronic health records are powerful tools for dementia research, but data can be influenced by incomplete recording. We examined whether people with dementia recorded in a specialist database (from a mental health and dementia care service) differ from those recorded in primary care. METHODS a retrospective cohort study of the population covered by Lambeth DataNet (primary care electronic records) between 2007 and 2019. Documentation of dementia diagnosis in primary care coded data and linked records in a specialist database (Clinical Records Interactive Search) were compared. RESULTS 3,859 people had dementia documented in primary care codes and 4,266 in the specialist database, with 2,886/5,239 (55%) documented in both sources. Overall, 55% were labelled as having Alzheimer's dementia and 29% were prescribed dementia medication, but these proportions were significantly higher in those documented in both sources. The cohort identified from the specialist database were less likely to live in a care home (prevalence ratio 0.73, 95% confidence interval 0.63-0.85), have multimorbidity (0.87, 0.77-0.98) or consult frequently (0.91, 0.88-0.95) than those identified through primary care codes, although mortality did not differ (0.98, 0.91-1.06). DISCUSSION there is under-recording of dementia diagnoses in both primary care and specialist databases. This has implications for clinical care and for generalizability of research. Our results suggest that using a mental health database may under-represent those patients who have more frailty, reflecting differential referral to mental health services, and demonstrating how the patient pathways are an important consideration when undertaking database studies.
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Affiliation(s)
- Katrina A S Davis
- King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Christoph Mueller
- King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Mark Ashworth
- King's College London Population Health Sciences, London, UK
| | | | - Amelia Jewel
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Mariam Molokhia
- King's College London Population Health Sciences, London, UK
| | - Gayan Perera
- King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Robert J Stewart
- King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
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22
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Bullock L, Bedson J, Chen Y, Chew-Graham CA, Campbell P. Comparative differences in musculoskeletal pain consultation and analgesic prescription for people with dementia: a UK-wide matched cohort study. Pain 2021; 162:2613-2620. [PMID: 33902094 DOI: 10.1097/j.pain.0000000000002257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 02/15/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT Painful musculoskeletal conditions are common in older adults; however, pain identification, assessment, and management are reported to be suboptimal for people with dementia. Adequate pain management is an integral aspect of care for people with dementia to prevent or delay negative outcomes, such as behavioural and psychological changes, emergency department attendance, and premature nursing home admission. This study aims to examine musculoskeletal consultations and analgesic prescriptions for people with dementia compared with those for people without dementia. A dementia cohort (n = 36,582) and matched cohort were identified in the Clinical Practice Research Datalink (a UK-wide primary care database). Period prevalence for musculoskeletal consultations and analgesic prescriptions was described, and logistic regression applied to estimate associations between dementia and musculoskeletal consultation or analgesic prescription from the time of dementia diagnosis to 5 years after diagnosis. People with dementia had a consistently (over time) lower prevalence and odds of musculoskeletal consultation and analgesic prescription compared with people without dementia. The evidence suggests that pain management may be suboptimal for people with dementia. These results highlight the need to increase awareness of pain and use better methods of pain assessment, evaluation of treatment response, and acceptable and effective management for people with dementia, in primary care.
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Affiliation(s)
- Laurna Bullock
- School of Medicine, Keele University, Staffordshire, United Kingdom
| | - John Bedson
- School of Medicine, Keele University, Staffordshire, United Kingdom
| | - Ying Chen
- School of Medicine, Keele University, Staffordshire, United Kingdom
- Department of Health and Environmental Sciences, Xi'an Jiaotong Liverpool University, Suzhou, China
| | - Carolyn A Chew-Graham
- School of Medicine, Keele University, Staffordshire, United Kingdom
- Midlands Partnership NHS Foundation Trust, St Georges' Hospital, Stafford, United Kingdom
| | - Paul Campbell
- School of Medicine, Keele University, Staffordshire, United Kingdom
- Midlands Partnership NHS Foundation Trust, St Georges' Hospital, Stafford, United Kingdom
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23
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Weuve J, Bennett EE, Ranker L, Gianattasio KZ, Pedde M, Adar SD, Yanosky JD, Power MC. Exposure to Air Pollution in Relation to Risk of Dementia and Related Outcomes: An Updated Systematic Review of the Epidemiological Literature. ENVIRONMENTAL HEALTH PERSPECTIVES 2021; 129:96001. [PMID: 34558969 PMCID: PMC8462495 DOI: 10.1289/ehp8716] [Citation(s) in RCA: 89] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 08/04/2021] [Accepted: 08/05/2021] [Indexed: 05/02/2023]
Abstract
BACKGROUND Dementia is a devastating neurologic condition that is common in older adults. We previously reviewed the epidemiological evidence examining the hypothesis that long-term exposure to air pollution affects dementia risk. Since then, the evidence base has expanded rapidly. OBJECTIVES With this update, we collectively review new and previously identified epidemiological studies on air pollution and late-life cognitive health, highlighting new developments and critically discussing the merits of the evidence. METHODS Using a registered protocol (PROSPERO 2020 CRD42020152943), we updated our literature review to capture studies published through 31 December 2020, extracted data, and conducted a bias assessment. RESULTS We identified 66 papers (49 new) for inclusion in this review. Cognitive level remained the most commonly considered outcome, and particulate matter (PM) remained the most commonly considered air pollutant. Since our prior review, exposure estimation methods in this research have improved, and more papers have looked at cognitive change, neuroimaging, and incident cognitive impairment/dementia, though methodological concerns remain common. Many studies continue to rely on administrative records to ascertain dementia, have high potential for selection bias, and adjust for putative mediating factors in primary models. A subset of 35 studies met strict quality criteria. Although high-quality studies of fine particulate matter with aerodynamic diameter ≤ 2.5 μ m (PM 2.5 ) and cognitive decline generally supported an adverse association, other findings related to PM 2.5 and findings related to particulate matter with aerodynamic diameter ≤ 10 μ m (PM 10 , NO 2 , and NO x ) were inconclusive, and too few papers reported findings with ozone to comment on the likely direction of association. Notably, only a few findings on dementia were included for consideration on the basis of quality criteria. DISCUSSION Strong conclusions remain elusive, although the weight of the evidence suggests an adverse association between PM 2.5 and cognitive decline. However, we note a continued need to confront methodological challenges in this line of research. https://doi.org/10.1289/EHP8716.
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Affiliation(s)
- Jennifer Weuve
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Erin E. Bennett
- Department of Epidemiology, The George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Lynsie Ranker
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Kan Z. Gianattasio
- Department of Epidemiology, The George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Meredith Pedde
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Sara D. Adar
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Jeff D. Yanosky
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Melinda C. Power
- Department of Epidemiology, The George Washington University Milken Institute School of Public Health, Washington, DC, USA
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24
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Ahmad S, Carey IM, Harris T, Cook DG, DeWilde S, Strachan DP. The rising tide of dementia deaths: triangulation of data from three routine data sources using the Clinical Practice Research Datalink. BMC Geriatr 2021; 21:375. [PMID: 34154546 PMCID: PMC8218386 DOI: 10.1186/s12877-021-02306-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 05/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dementia is currently the leading certified underlying cause of death in England. We assess how dementia recording on Office for National Statistics death certificates (ONS) corresponded to recording in general practice records (GP) and Hospital Episode Statistics (HES). METHODS Retrospective study of deaths (2001-15) in 153 English General Practices contributing to the Clinical Practice Research Datalink, with linked ONS and HES records. RESULTS Of 207,068 total deaths from any cause, 19,627 mentioned dementia on the death certificate with 10,253 as underlying cause; steady increases occurred from 2001 to 2015 (any mention 5.3 to 15.4 %, underlying cause 2.7 to 10 %). Including all data sources, recording of any dementia increased from 13.2 to 28.6 %. In 2015, only 53.8 % of people dying with dementia had dementia recorded on their death certificates. Among deaths mentioning dementia on the death certificate, the recording of a prior diagnosis of dementia in GP and HES rose markedly over the same period. In 2001, only 76.3 % had a prior diagnosis in GP and/or HES records; by 2015 this had risen to 95.7 %. However, over the same period the percentage of all deaths with dementia recorded in GP or HES but not mentioned on the death certificate rose from 7.9 to 13.3 %. CONCLUSIONS Dementia recording in all data sources increased between 2001 and 2015. By 2015 the vast majority of deaths mentioning dementia had supporting evidence in primary and/or secondary care. However, death certificates were still providing an inadequate picture of the number of people dying with dementia.
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Affiliation(s)
- Shaleen Ahmad
- Population Health Research Institute, St George's University of London, Cranmer Terrace, SW17 0RE, London, United Kingdom
| | - Iain M Carey
- Population Health Research Institute, St George's University of London, Cranmer Terrace, SW17 0RE, London, United Kingdom.
| | - Tess Harris
- Population Health Research Institute, St George's University of London, Cranmer Terrace, SW17 0RE, London, United Kingdom
| | - Derek G Cook
- Population Health Research Institute, St George's University of London, Cranmer Terrace, SW17 0RE, London, United Kingdom
| | - Stephen DeWilde
- Population Health Research Institute, St George's University of London, Cranmer Terrace, SW17 0RE, London, United Kingdom
| | - David P Strachan
- Population Health Research Institute, St George's University of London, Cranmer Terrace, SW17 0RE, London, United Kingdom
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25
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Douros A, Santella C, Dell'Aniello S, Azoulay L, Renoux C, Suissa S, Brassard P. Infectious Disease Burden and the Risk of Alzheimer's Disease: A Population-Based Study. J Alzheimers Dis 2021; 81:329-338. [PMID: 33780369 DOI: 10.3233/jad-201534] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Previous studies suggested a link between various infectious pathogens and the development of Alzheimer's disease (AD), posing the question whether infectious disease could present a novel modifiable risk factor. OBJECTIVE To assess whether infectious disease burden due to clinically apparent infections is associated with an increased risk of AD. METHODS We conducted a population-based nested case-control study using the United Kingdom Clinical Practice Research Datalink. We included all dementia-free subjects ≥50 years of age enrolling in the database between January 1988 and December 2017. Each case of AD identified during follow-up was matched with up to 40 controls. Conditional logistic regression estimated adjusted odds ratios (ORs) with 95% confidence intervals (CIs) of AD associated with ≥1 infection diagnosed > 2 years before the index date compared with no infection during the study period. We further stratified by time since first infection and cumulative number of infections. RESULTS The cohort included overall 4,262,092 individuals (mean age at cohort entry 60.4 years; 52% female). During a median follow-up of 10.5 years, 40,455 cases of AD were matched to 1,610,502 controls. Compared with having no burden of infectious disease, having a burden of infectious disease was associated with an increase in the risk of AD (OR, 1.05; 95% CI, 1.02 to 1.08). The risk increased with longer time since first infection, peaking after 12-30 years (OR, 1.11; 95% CI, 1.05-1.17). The risk did not increase with cumulative number of infections. CONCLUSION The overall risk of AD associated with infectious disease burden was small but increased gradually with longer time since first infection.
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Affiliation(s)
- Antonios Douros
- Department of Medicine, McGill University, Montreal, QC, Canada.,Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada.,Centre for Clinical Epidemiology, Lady Davis Institute, Montreal, QC, Canada.,Institute of Clinical Pharmacology and Toxicology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Christina Santella
- Centre for Clinical Epidemiology, Lady Davis Institute, Montreal, QC, Canada
| | - Sophie Dell'Aniello
- Centre for Clinical Epidemiology, Lady Davis Institute, Montreal, QC, Canada
| | - Laurent Azoulay
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada.,Centre for Clinical Epidemiology, Lady Davis Institute, Montreal, QC, Canada.,Gerald Bronfman Department of Oncology, McGill University, Montreal, QC, Canada
| | - Christel Renoux
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada.,Centre for Clinical Epidemiology, Lady Davis Institute, Montreal, QC, Canada.,Department of Neurology and Neurosurgery, McGill University, Montreal, Québec, Canada
| | - Samy Suissa
- Department of Medicine, McGill University, Montreal, QC, Canada.,Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada.,Centre for Clinical Epidemiology, Lady Davis Institute, Montreal, QC, Canada
| | - Paul Brassard
- Department of Medicine, McGill University, Montreal, QC, Canada.,Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada.,Centre for Clinical Epidemiology, Lady Davis Institute, Montreal, QC, Canada
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26
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Peppa M, Minassian C, Mangtani P, Thomas SL. The identification and validity of congenital malformation diagnoses in UK electronic health records: A systematic review. Pharmacoepidemiol Drug Saf 2021; 30:875-898. [PMID: 33881794 DOI: 10.1002/pds.5251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 04/15/2021] [Indexed: 11/09/2022]
Abstract
PURPOSE To describe the methods used to identify and validate congenital malformation diagnoses recorded in UK electronic health records, and the results of validation studies. METHODS Medline and Embase were searched for publications between 1987 and 2019 that involved identifying congenital malformations from UK electronic health records using diagnostic codes. The methods and code-lists used to identify congenital malformations, and the methods and results of validations, were examined. RESULTS We retrieved 54 eligible studies; 36 identified congenital malformations from primary care data and 18 from secondary care data alone or in combination with birth and/or death records. Identification in secondary care data relied on codes from the 'Q' chapter for congenital malformations in ICD-10. In contrast, studies using primary care data frequently used additional codes outside of the 'P' chapter for congenital malformation diagnoses in Read, although the exact codes used were not always clear. Eight studies validated diagnoses identified in primary care data. The positive predictive value was highest (80%-100%) for congenital malformations overall, major malformations, and heart defects although the validity of the reference standard used was often uncertain. It was lowest for neural tube defects (71%) and developmental hip dysplasia (56%). CONCLUSIONS Studies identifying congenital malformations from primary care data provided limited details about the methods used. The few validation studies were limited to diagnoses recorded in primary care. Further assessments of all measures of validity in both data sources and of other malformation subgroups are needed, using robust reference standards and adhering to reporting guidelines.
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Affiliation(s)
- Maria Peppa
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Caroline Minassian
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Punam Mangtani
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Sara L Thomas
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
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27
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Rathod-Mistry T, Marshall M, Campbell P, Bailey J, Chew-Graham CA, Croft P, Frisher M, Hayward R, Negi R, Robinson L, Singh S, Sumathipala A, Thein N, Walters K, Weich S, Jordan KP. Indicators of dementia disease progression in primary care: An electronic health record cohort study. Eur J Neurol 2021; 28:1499-1510. [PMID: 33378599 DOI: 10.1111/ene.14710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 12/17/2020] [Accepted: 12/20/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND PURPOSE The objectives were to assess the feasibility and validity of using markers of dementia-related health as indicators of dementia progression in primary care, by assessing the frequency with which they are recorded and by testing the hypothesis that they are associated with recognised outcomes of dementia. The markers, in 13 domains, were derived previously through literature review, expert consensus, and analysis of regional primary care records. METHODS The study population consisted of patients with a recorded dementia diagnosis in the Clinical Practice Research Datalink, a UK primary care database linked to secondary care records. Incidence of recorded domains in the 36 months after diagnosis was determined. Associations of recording of domains with future hospital admission, palliative care, and mortality were derived. RESULTS There were 30,463 people with diagnosed dementia. Incidence of domains ranged from 469/1000 person-years (Increased Multimorbidity) to 11/1000 (Home Pressures). An increasing number of domains in which a new marker was recorded in the first year after diagnosis was associated with hospital admission (hazard ratio for ≥4 domains vs. no domains = 1.24; 95% confidence interval = 1.15-1.33), palliative care (1.87; 1.62-2.15), and mortality (1.57; 1.47-1.67). Individual domains were associated with outcomes with varying strengths of association. CONCLUSIONS Feasibility and validity of potential indicators of progression of dementia derived from primary care records are supported by their frequency of recording and associations with recognised outcomes. Further research should assess whether these markers can help identify patients with poorer prognosis to improve outcomes through stratified care and targeted support.
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Affiliation(s)
| | | | - Paul Campbell
- School of Medicine, Keele University, Keele, UK.,Midlands Partnership NHS Foundation Trust, Stafford, UK
| | | | - Carolyn A Chew-Graham
- School of Medicine, Keele University, Keele, UK.,Midlands Partnership NHS Foundation Trust, Stafford, UK
| | - Peter Croft
- School of Medicine, Keele University, Keele, UK
| | - Martin Frisher
- School of Pharmacy and Bioengineering, Keele University, Keele, UK
| | | | - Rashi Negi
- Midlands Partnership NHS Foundation Trust, Stafford, UK
| | - Louise Robinson
- Institute of Health and Society and Newcastle University Institute for Ageing, Newcastle Upon Tyne, UK
| | - Swaran Singh
- Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
| | - Athula Sumathipala
- School of Medicine, Keele University, Keele, UK.,Midlands Partnership NHS Foundation Trust, Stafford, UK
| | - Nwe Thein
- Midlands Partnership NHS Foundation Trust, Stafford, UK
| | - Kate Walters
- Research Department of Primary Care & Population Health, University College London, London, UK
| | - Scott Weich
- Mental Health Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Kelvin P Jordan
- School of Medicine, Keele University, Keele, UK.,Centre for Prognosis Research, Keele University, Keele, UK
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28
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Cao Z, Xu C, Yang H, Li S, Xu F, Zhang Y, Wang Y. Associations of BMI and Serum Urate with Developing Dementia: A Prospective Cohort Study. J Clin Endocrinol Metab 2020; 105:5904455. [PMID: 32918088 DOI: 10.1210/clinem/dgaa638] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 09/09/2020] [Indexed: 01/15/2023]
Abstract
CONTEXT Recent studies have suggested that a higher body mass index (BMI) and serum urate levels were associated with a lower risk of developing dementia. However, these reverse relationships remain controversial, and whether serum urate and BMI confound each other is not well established. OBJECTIVES To investigate the independent associations of BMI and urate, as well as their interaction with the risk of developing dementia. DESIGN AND SETTINGS We analyzed a cohort of 502 528 individuals derived from the UK Biobank that included people aged 37-73 years for whom BMI and urate were recorded between 2006 and 2010. Dementia was ascertained at follow-up using electronic health records. RESULTS During a median of 8.1 years of follow-up, a total of 2138 participants developed dementia. People who were underweight had an increased risk of dementia (hazard ratio [HR] = 1.91, 95% confidence interval [CI]: 1.24-2.97) compared with people of a healthy weight. However, the risk of dementia continued to fall as weight increased, as those who were overweight and obese were 19% (HR = 0.81, 95%: 0.73-0.90) and 22% (HR = 0.78, 95% CI: 0.68-0.88) were less likely to develop dementia than people of a healthy weight. People in the highest quintile of urate were also associated with a 25% (HR = 0.75, 95% CI: 0.64-0.87) reduction in the risk of developing dementia compared with those who were in the lowest quintile. There was a significant multiplicative interaction between BMI and urate in relation to dementia (P for interaction = 0.004), and obesity strengthens the protective effect of serum urate on the risk of dementia. CONCLUSION Both BMI and urate are independent predictors of dementia, and there are inverse monotonic and dose-response associations of BMI and urate with dementia.
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Affiliation(s)
- Zhi Cao
- School of Public Health, Tianjin Medical University, Tianjin, China
| | - Chenjie Xu
- School of Public Health, Tianjin Medical University, Tianjin, China
| | - Hongxi Yang
- School of Public Health, Tianjin Medical University, Tianjin, China
| | - Shu Li
- School of Public Health, Tianjin Medical University, Tianjin, China
| | - Fusheng Xu
- School of Public Health, Tianjin Medical University, Tianjin, China
| | - Yuan Zhang
- School of Public Health, Tianjin Medical University, Tianjin, China
| | - Yaogang Wang
- School of Public Health, Tianjin Medical University, Tianjin, China
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29
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Power MC, Gianattasio KZ, Ciarleglio A. Implications of the Use of Algorithmic Diagnoses or Medicare Claims to Ascertain Dementia. Neuroepidemiology 2020; 54:462-471. [PMID: 33075766 DOI: 10.1159/000510753] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 08/07/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Formal dementia ascertainment with research criteria is resource-intensive, prompting the growing use of alternative approaches. Our objective was to illustrate the potential bias and implications for study conclusions introduced through the use of alternate dementia ascertainment approaches. METHODS We compared dementia prevalence and risk factor associations obtained using criterion-standard dementia diagnoses to those obtained using algorithmic or Medicare-based dementia ascertainment in participants of the baseline visit of the Aging, Demographics, and Memory Study (ADAMS), a Health and Retirement Study (HRS) sub-study. RESULTS Estimates of dementia prevalence derived using algorithmic or Medicare-based ascertainment differ substantially from those obtained using criterion-standard ascertainment. Use of algorithmic or Medicare-based dementia ascertainment can, but does not always, lead to risk factor associations that substantially differ from those obtained using criterion-standard ascertainment. DISCUSSION/CONCLUSIONS Absolute estimates of dementia prevalence should rely on samples with formal dementia ascertainment. The use of multiple algorithms is recommended for risk factor studies when formal dementia ascertainment is not available.
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Affiliation(s)
- Melinda C Power
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia, USA,
| | - Kan Z Gianattasio
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia, USA
| | - Adam Ciarleglio
- Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia, USA
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Davidson J, Banerjee A, Muzambi R, Smeeth L, Warren-Gash C. Validity of Acute Cardiovascular Outcome Diagnoses Recorded in European Electronic Health Records: A Systematic Review. Clin Epidemiol 2020; 12:1095-1111. [PMID: 33116903 PMCID: PMC7569174 DOI: 10.2147/clep.s265619] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 08/06/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Electronic health records are widely used in cardiovascular disease research. We appraised the validity of stroke, acute coronary syndrome and heart failure diagnoses in studies conducted using European electronic health records. METHODS Using a prespecified strategy, we systematically searched seven databases from dates of inception to April 2019. Two reviewers independently completed study selection, followed by partial parallel data extraction and risk of bias assessment. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value estimates were narratively synthesized and heterogeneity between sensitivity and PPV estimates were assessed using I2. RESULTS We identified 81 studies, of which 20 validated heart failure diagnoses, 31 validated acute coronary syndrome diagnoses with 29 specifically recording estimates for myocardial infarction, and 41 validated stroke diagnoses. Few studies reported specificity or negative predictive value estimates. Sensitivity was ≤66% in all but one heart failure study, ≥80% for 91% of myocardial infarction studies, and ≥70% for 73% of stroke studies. PPV was ≥80% in 74% of heart failure, 88% of myocardial infarction, and 70% of stroke studies. PPV by stroke subtype was variable, at ≥80% for 80% of ischaemic stroke but only 44% of haemorrhagic stroke. There was considerable heterogeneity (I2 >75%) between sensitivity and PPV estimates for all diagnoses. CONCLUSION Overall, European electronic health record stroke, acute coronary syndrome and heart failure diagnoses are accurate for use in research, although validity estimates for heart failure and individual stroke subtypes were lower. Where possible, researchers should validate data before use or carefully interpret the results of previous validation studies for their own study purposes.
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Affiliation(s)
- Jennifer Davidson
- Faculty of Epidemiology & Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Amitava Banerjee
- Institute of Health Informatics, University College London, London, UK
| | - Rutendo Muzambi
- Faculty of Epidemiology & Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Liam Smeeth
- Faculty of Epidemiology & Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Charlotte Warren-Gash
- Faculty of Epidemiology & Population Health, London School of Hygiene and Tropical Medicine, London, UK
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Using clinical registries, administrative data and electronic medical records to improve medication safety and effectiveness in dementia. Curr Opin Psychiatry 2020; 33:163-169. [PMID: 31972590 DOI: 10.1097/yco.0000000000000579] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE OF REVIEW Clinical registries, routinely collected administrative data and electronic medical records (EMRs) provide new opportunities to investigate medication safety and effectiveness. This review outlines the strengths and limitations of these data, and highlights recent research related to safe and effective medication use in dementia. RECENT FINDINGS Clinical registries, administrative data and EMRs facilitate observational research among people often excluded from randomized controlled trials (RCTs). Larger sample sizes and longer follow-up times permit research into less common adverse events not apparent in RCTs. The validity of diagnoses recorded in administrative data and EMRs remains variable, although positive predictive values are typically high and sensitivity is low. Dispensing records are a rich source of data for estimating medication exposure. Recent research has investigated medications and prescribing patterns as risk factors for incident dementia, strategies to alleviate behavioural symptoms and the management of comorbidity. Common study protocols and common data models are examples of distributed network approaches increasingly used to conduct large and generalizable multi-database studies across different countries. SUMMARY Greater availability of electronic health data provides important opportunities to address evidence-practice gaps in relation to medication use and safety in people with dementia.
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Ponjoan A, Garre-Olmo J, Blanch J, Fages E, Alves-Cabratosa L, Martí-Lluch R, Comas-Cufí M, Parramon D, García-Gil M, Ramos R. How well can electronic health records from primary care identify Alzheimer's disease cases? Clin Epidemiol 2019; 11:509-518. [PMID: 31456649 PMCID: PMC6620769 DOI: 10.2147/clep.s206770] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 04/24/2019] [Indexed: 12/03/2022] Open
Abstract
Background Electronic health records (EHR) from primary care are emerging in Alzheimer’s disease (AD) research, but their accuracy is a concern. We aimed to validate AD diagnoses from primary care using additional information provided by general practitioners (GPs), and a register of dementias. Patients and methods This retrospective observational study obtained data from the System for the Development of Research in Primary Care (SIDIAP). Three algorithms combined International Statistical Classification of Diseases (ICD-10) and Anatomical Therapeutic Chemical codes to identify AD cases in SIDIAP. GPs evaluated dementia diagnoses by means of an online survey. We linked data from the Register of Dementias of Girona and from SIDIAP. We estimated the positive predictive value (PPV) and sensitivity and provided results stratified by age, sex and severity. Results Using survey data from the GPs, PPV of AD diagnosis was 89.8% (95% CI: 84.7–94.9). Using the dataset linkage, PPV was 74.8 (95% CI: 73.1–76.4) for algorithm A1 (AD diagnoses), and 72.3 (95% CI: 70.7–73.9) for algorithm A3 (diagnosed or treated patients without previous conditions); sensitivity was 71.4 (95% CI: 69.6–73.0) and 83.3 (95% CI: 81.8–84.6) for algorithms A1 (AD diagnoses) and A3, respectively. Stratified results did not differ by age, but PPV and sensitivity estimates decreased amongst men and severe patients, respectively. Conclusions PPV estimates differed depending on the gold standard. The development of algorithms integrating diagnoses and treatment of dementia improved the AD case ascertainment. PPV and sensitivity estimates were high and indicated that AD codes recorded in a large primary care database were sufficiently accurate for research purposes.
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Affiliation(s)
- Anna Ponjoan
- Vascular Health Research Group (ISV-Girona), Jordi Gol Institute for Primary Care Research (IDIAPJGol), Barcelona, Catalonia, Spain.,Universitat Autònoma de Barcelona , Bellaterra, Catalonia, Spain.,Girona Biomedical Research Institute (IDIBGI) , Girona, Catalonia, Spain
| | - Josep Garre-Olmo
- Girona Biomedical Research Institute (IDIBGI) , Girona, Catalonia, Spain
| | - Jordi Blanch
- Vascular Health Research Group (ISV-Girona), Jordi Gol Institute for Primary Care Research (IDIAPJGol), Barcelona, Catalonia, Spain
| | - Ester Fages
- Vascular Health Research Group (ISV-Girona), Jordi Gol Institute for Primary Care Research (IDIAPJGol), Barcelona, Catalonia, Spain.,Primary Care Services, Catalan Health Institute (ICS), Girona, Catalonia, Spain
| | - Lia Alves-Cabratosa
- Vascular Health Research Group (ISV-Girona), Jordi Gol Institute for Primary Care Research (IDIAPJGol), Barcelona, Catalonia, Spain
| | - Ruth Martí-Lluch
- Vascular Health Research Group (ISV-Girona), Jordi Gol Institute for Primary Care Research (IDIAPJGol), Barcelona, Catalonia, Spain.,Universitat Autònoma de Barcelona , Bellaterra, Catalonia, Spain.,Girona Biomedical Research Institute (IDIBGI) , Girona, Catalonia, Spain
| | - Marc Comas-Cufí
- Vascular Health Research Group (ISV-Girona), Jordi Gol Institute for Primary Care Research (IDIAPJGol), Barcelona, Catalonia, Spain
| | - Dídac Parramon
- Vascular Health Research Group (ISV-Girona), Jordi Gol Institute for Primary Care Research (IDIAPJGol), Barcelona, Catalonia, Spain.,Primary Care Services, Catalan Health Institute (ICS), Girona, Catalonia, Spain
| | - María García-Gil
- Vascular Health Research Group (ISV-Girona), Jordi Gol Institute for Primary Care Research (IDIAPJGol), Barcelona, Catalonia, Spain
| | - Rafel Ramos
- Vascular Health Research Group (ISV-Girona), Jordi Gol Institute for Primary Care Research (IDIAPJGol), Barcelona, Catalonia, Spain.,Department of Medical Sciences, School of Medicine, Campus Salut, University of Girona, Girona, Catalonia, Spain
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McGuinness LA, Warren‐Gash C, Moorhouse LR, Thomas SL. The validity of dementia diagnoses in routinely collected electronic health records in the United Kingdom: A systematic review. Pharmacoepidemiol Drug Saf 2019; 28:244-255. [PMID: 30667114 PMCID: PMC6519035 DOI: 10.1002/pds.4669] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 07/23/2018] [Accepted: 09/04/2018] [Indexed: 11/11/2022]
Abstract
PURPOSE The purpose of the study is to assess the validity of codes or algorithms used to identify dementia in UK electronic health record (EHR) primary care and hospitalisation databases. METHODS Relevant studies were identified by searching the MEDLINE/EMBASE databases from inception to June 2018, hand-searching reference lists, and consulting experts. The search strategy included synonyms for "Dementia", "Europe", and "EHR". Studies were included if they validated dementia diagnoses in UK primary care or hospitalisation databases, irrespective of validation method used. The Quality Assessment for Diagnostic Accuracy Studies-2 (QUADAS-2) tool was used to assess risk of bias. RESULTS From 1469 unique records, 14 relevant studies were included. Thirteen validated individual diagnoses against a reference standard, reporting high estimates of validity. Most reported only the positive predictive value (PPV), with estimates ranging between 0.09 and 1.0 and 0.62 and 0.85 in primary care and hospitalisation databases, respectively. One study performed a rate comparison, indicating good generalisability of dementia diagnoses in The Health Improvement Network (THIN) database to the UK population. Studies were of low methodological quality. As studies were not comparable, no summary validity estimates were produced. CONCLUSION While heterogenous across studies, reported validity estimates were generally high. However, the credibility of these estimates is limited by the methodological quality of studies, primarily resulting from insufficient blinding of researchers interpreting the reference test. Inadequate reporting, particularly of the specific codes validated, hindered comparison of estimates across studies. Future validation studies should make use of more robust reference tests, follow established reporting guidelines, and calculate all measures of validity.
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Affiliation(s)
| | - Charlotte Warren‐Gash
- Faculty of Epidemiology and Population HealthLondon School of Hygiene and Tropical MedicineLondonUK
| | - Louisa R. Moorhouse
- Faculty of Epidemiology and Population HealthLondon School of Hygiene and Tropical MedicineLondonUK
| | - Sara L. Thomas
- Faculty of Epidemiology and Population HealthLondon School of Hygiene and Tropical MedicineLondonUK
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