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Kiadaliri A, Dell'Isola A, Turkiewicz A, Englund M. Rheumatic and Musculoskeletal Diseases and Risk of Dementia: A Nested Case-Control Study. ACR Open Rheumatol 2024; 6:504-510. [PMID: 39136131 PMCID: PMC11319920 DOI: 10.1002/acr2.11705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 04/04/2024] [Accepted: 05/28/2024] [Indexed: 08/15/2024] Open
Abstract
OBJECTIVE To investigate the associations between rheumatic and musculoskeletal diseases (RMDs) and incident dementia using population register-based data. METHODS This nested case-control study was conducted based on a cohort of residents in the Skåne region, Sweden, aged 50 years and older in 2009 without doctor-diagnosed dementia during 1998 to 2009 (n = 402,825). Individuals with a new main diagnosis of dementia during 2010 to 2019 were identified as incident patients with dementia (n = 22,131). Controls without diagnosed dementia were randomly matched 1:1 by sex, age, and Elixhauser comorbidity index using incidence density sampling. Separate conditional logistic regression analyses adjusted for confounders were fitted for the following RMDs, diagnosed at least 2 years before dementia diagnosis as exposure: gout, osteoarthritis, rheumatoid arthritis, spondyloarthropathies (SpA), and systemic connective tissue disorders. Subgroup analyses by dementia subtype, sex, age, comorbidity, and RMDs/dementia identification were conducted. RESULTS Although gout (adjusted rate ratio 0.88; 95% confidence interval 0.79-0.97), osteoarthritis (0.92; 0.88-0.96), and systemic connective tissue disorders (0.91; 0.83-0.99) were associated with decreased risk of dementia, the associations for rheumatoid arthritis (1.05; 0.92-1.19) and SpA (1.17; 0.94-1.45) were inconclusive. The associations between RMDs and incident dementia were similar across sex, age, and comorbidity subgroups with a few exceptions (eg, an adjusted rate ratio of 0.99 [95% confidence interval 0.71-1.39] in males vs 1.31 [0.99-1.74] in female patients for SpA). CONCLUSION Persons with diagnosed RMDs seem to have comparable or slightly lower risks of developing dementia compared with those without known RMD.
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Ding Q, Lamberts J, Konieczny AM, Bringedahl TB, Torres Garcia KY. Association of Autoimmune Disorders and Disease-modifying Antirheumatic Drugs: (DMARDs) with the Risk of Alzheimer's and/or Dementia: A Population Study Using Medicare Beneficiary Data. Curr Alzheimer Res 2023; 20:725-737. [PMID: 38288824 DOI: 10.2174/0115672050289966240110041616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 12/26/2023] [Accepted: 01/02/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVES Alzheimer's disease (AD) and/or dementia is a prevalent neurocognitive disorder primarily affecting individuals over the age of 65. Identifying specific causes of AD and/or dementia can be challenging, with emerging evidence suggesting a potential association with autoimmune inflammatory conditions such as rheumatoid arthritis (RA). This study aimed to assess the prevalence rate of AD and/or dementia among Medicare beneficiaries reporting an autoimmune disorder. Additionally, this study sought to identify the comparative prevalence of AD and/or dementia in patients with an autoimmune disorder who were using disease-modifying antirheumatic drugs (DMARDs) compared to those not using DMARDs. METHODS Cross-sectional secondary data analyses were conducted on Medicare Current Beneficiary Survey (MCBS) data from 2017 and 2018. The MCBS data consists of a nationally representative sample of the Medicare population, a population that is largely 65 and older, and provides de-identified patient information. Patients from this dataset with a self-reported autoimmune disorder were included in the analyses. Descriptive analyses were conducted on demographic variables, chronic conditions, and medication use. The prevalence of AD and/or dementia was compared between patients with and without an autoimmune disorder. A backward stepwise selection regression was used to identify the risk factors associated with the prevalence of AD and/or dementia. RESULTS The study included 18,929 Medicare beneficiaries, with 4,405 identified as having one autoimmune disorder. The prevalence of AD and/or dementia was significantly higher in patients with an autoimmune disorder. The multivariate regression showed that RA was significantly associated with a higher risk of AD and/or dementia. Other demographic factors, including advanced age, African-American or Hispanic ethnicity, low body mass index, and chronic conditions of ischemic heart disease, history of myocardial infarction, history of stroke, depression, mental health disorder(s), and traumatic brain injury also showed statistically significant associations with AD and/or dementia. Patients using DMARDs demonstrated a reduced likelihood of having AD and/or dementia, compared to patients not using DMARDs. CONCLUSION This study provides evidence of an association between RA and increased risk of AD and/or dementia. The findings suggest that DMARD use may have a protective effect against the development of AD and/or dementia in patients with an autoimmune disorder.
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Affiliation(s)
- Qian Ding
- Ferris State University College of Pharmacy, 220 Ferris Drive, Big Rapids, MI 49307, USA
| | - Jennifer Lamberts
- Ferris State University College of Pharmacy, 220 Ferris Drive, Big Rapids, MI 49307, USA
| | - Alison M Konieczny
- Ferris Library for Information, Technology, and Education, Big Rapids, MI 49307, USA
| | - Tyler B Bringedahl
- Trinity Health Muskegon, 1500 East Sherman Blvd., Muskegon, MI 49444, USA
| | - Kiara Y Torres Garcia
- St. Joseph Health System Family Medicine Center, 611 E Douglas Rd., Mishawaka, IN 46545, USA
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Kleinert S, Schuch F, Rapp P, Ronneberger M, Wendler J, Sternad P, Popp F, Bartz-Bazzanella P, von der Decken C, Karberg K, Gauler G, Wurth P, Späthling-Mestekemper S, Kuhn C, Englbrecht M, Vorbrüggen W, Adler G, Welcker M. Impairment in cognitive function in patients with axial spondyloarthritis and psoriatic arthritis. Rheumatol Int 2023; 43:89-97. [PMID: 36441274 DOI: 10.1007/s00296-022-05248-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 11/09/2022] [Indexed: 11/29/2022]
Abstract
Spondyloarthritis may contribute to deficits in cognition. The objective of this study was to compare cognitive abilities in patients with axial spondyloarthritis (axSpA) or psoriatic arthritis (PsA) with matched reference groups. This investigator-initiated, cross-sectional, exploratory study of adults with axSpA or PsA was conducted at two German rheumatology centres (November 2018-September 2019). All data on patient and disease characteristics and cognitive abilities were collected at a single visit. Cognitive function was assessed by the previously validated Memory and Attention Test subscores of selective attention, episodic working memory, and episodic short-term memory and compared with subscores from healthy age-, sex-, and education-matched reference subjects. The mean patient age was 51.1 and 55.8 years in the axSpA (n = 101) and PsA (n = 117) groups, respectively, and mean symptom duration was 13.7 and 10.3 years. Compared with matched reference subjects, axSpA and PsA patients showed significant impairments in selective attention (mean difference of -6.5 and -4.5, respectively, on a 45-point scale; P < 0.001 for both) and no significant differences in episodic working memory. The PsA cohort, but not the axSpA cohort, had significantly better episodic short-term memory subscores compared with matched reference subjects (mean change of 2.0 on a 15-point scale; P < 0.001). Explorative subgroup analyses were unable to identify factors influencing cognitive changes, including disease activity, pain, and function, but may have been underpowered. We conclude that impairments in selective attention may impact the ability of axSpA and PsA patients to process information. These findings warrant additional studies, including longitudinal analyses, in patients with spondyloarthritis.
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Affiliation(s)
- Stefan Kleinert
- Praxisgemeinschaft Rheumatologie-Nephrologie (PGRN), Möhrendorferstr 1C, Erlangen, Germany.
- Universitätsklinik Würzburg, Med. Klinik 3, Rheumatologie/Klinische Immunologie, Würzburg, Germany.
| | - Florian Schuch
- Praxisgemeinschaft Rheumatologie-Nephrologie (PGRN), Möhrendorferstr 1C, Erlangen, Germany
| | - Praxedis Rapp
- Praxisgemeinschaft Rheumatologie-Nephrologie (PGRN), Möhrendorferstr 1C, Erlangen, Germany
| | - Monika Ronneberger
- Praxisgemeinschaft Rheumatologie-Nephrologie (PGRN), Möhrendorferstr 1C, Erlangen, Germany
| | - Joerg Wendler
- Praxisgemeinschaft Rheumatologie-Nephrologie (PGRN), Möhrendorferstr 1C, Erlangen, Germany
| | - Patrizia Sternad
- Medizinisches Versorgungszentrum für Rheumatologie Dr. M. Welcker GmbH, Planeg, Germany
| | - Florian Popp
- Medizinisches Versorgungszentrum für Rheumatologie Dr. M. Welcker GmbH, Planeg, Germany
| | | | | | - Kirsten Karberg
- Praxis Für Rheumatologie und Innere Medizin, Berlin, Germany
| | - Georg Gauler
- Rheumatologische Schwerpunktpraxis, Osnabrück, Germany
| | - Patrick Wurth
- Rheumatologische Schwerpunktpraxis, Osnabrück, Germany
| | | | | | | | | | - Georg Adler
- Institut für Studien zur Psychischen Gesundheit (ISPG), Mannheim, Germany
| | - Martin Welcker
- Medizinisches Versorgungszentrum für Rheumatologie Dr. M. Welcker GmbH, Planeg, Germany
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Booth MJ, Kobayashi LC, Janevic MR, Clauw D, Piette JD. No increased risk of Alzheimer's disease among people with immune-mediated inflammatory diseases: findings from a longitudinal cohort study of U.S. older adults. BMC Rheumatol 2021; 5:48. [PMID: 34763722 PMCID: PMC8588609 DOI: 10.1186/s41927-021-00219-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 07/14/2021] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE Immune-mediated inflammatory diseases (IMID) are characterized by systemic inflammation affecting the joints and bodily organs. Studies examining the association between individual IMIDs and the risk of Alzheimer's disease (AD) have yielded inconsistent findings. This study examines AD risk across a group of IMIDs in a large population-based sample of older adults. METHODS Data on a national sample of US adults over age 50 was drawn from the Health and Retirement Study (HRS) and linked Medicare claims from 2006 to 2014. IMIDs include rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, Crohn's disease, ulcerative colitis, and related conditions. We identified IMIDs from 2006 to 2009 Medicare claims using International Classification of Diseases (ICD9-CM) codes. The date of incident AD was derived from Chronic Conditions Warehouse (CCW) identifiers. We examined the risk of AD from 2009 to 2014 using Cox proportional hazards models, both unadjusted and adjusted for age, gender, education, race, and the genetic risk factor APOE-e4. RESULTS One hundred seventy-one (6.02%) of the 2842 total HRS respondents with Medicare coverage and genetic data were classified with IMIDs. Over the subsequent 6 years, 9.36% of IMID patients developed AD compared to 8.57% of controls (unadjusted hazard ratio (HR): 1.09, 95% CI .66-1.81, p = 0.74). Adjusted HR 1.27 (95% CI 0.76-2.12, p = 0.35). Age (HR for 10-year increment 3.56, p < .001), less than high school education (HR 1.70, p = .007), and APOE-e4 (HR 2.61, p < .001 for one or two copies), were also statistically significant predictors of AD. CONCLUSION HRS respondents with common IMIDs do not have increased risk of Alzheimer's disease over a 6-year period.
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Affiliation(s)
- Michael J Booth
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48130, USA.
| | - Lindsay C Kobayashi
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Mary R Janevic
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48130, USA
| | - Daniel Clauw
- Department of Anesthesiology, Rheumatology, Psychiatry, Michigan Medicine, Ann Arbor, MI, USA
| | - John D Piette
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48130, USA
- Department of Veterans Affairs Center for Clinical Management Research, Ann Arbor, MI, USA
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