Risk of Dementia Among Patients With Asthma: A Nationwide Longitudinal Study

doi:10.1016/j.jamda.2014.06.003

Journal of the American Medical Directors Association

Volume 15, Issue 10, October 2014, Pages 763-767

https://doi.org/10.1016/j.jamda.2014.06.003 Get rights and content

Abstract

Background

Previous studies have suggested an association between asthma and dementia, but the results are still inconsistent.

Methods

Using the Taiwan National Health Insurance Database, we enrolled 11,030 participants aged more than 45 years with asthma and 44,120 (1:4) age-/sex-matched controls between 1998 and 2008, and followed them to the end of 2011. Cases of any dementia or Alzheimer's disease that developed during the follow-up period were identified.

Results

Asthma was associated with an increased risk of developing any dementia [hazard ratio (HR): 2.17, 95% confidence interval (CI): 1.87–2.52] and Alzheimer's disease (HR: 2.62, 95% CI: 1.71–4.02). Stratified by age, both asthma in midlife (>45 years and <65 years) and in late life (≥65 years) was associated with a greater likelihood of any dementia (HR: 2.48, 95% CI: 1.80–3.41; HR: 2.06, 95% CI: 1.74–2.44).

Discussion

Asthma in midlife and in late life increased the risk of developing any dementia and Alzheimer's disease. The underlying mechanisms between asthma and dementia require further investigation.

Section snippets

Data Source

The Taiwan National Health Insurance (NHI) program was implemented in 1995 and offers comprehensive medical coverage to all residents of Taiwan. The NHI program covered both primary-level and secondary-level health care of all insured participants. National Health Research Institute is in charge of the entire insurance claims database, namely, the NHIRD, which consists of healthcare data from >97% of the entire Taiwan population (http://www.nhi.gov.tw/). The National Health Research Institute

Results

In all, 11,030 patients with asthma and 44,120 age-/sex-matched controls were included in our study, with an average age of 60.88 ± 10.39 years and a female predominance (58.3%), and with a mean follow-up of 8.00 ± 3.04 years. Patients with asthma had higher incidence rates of developing any dementia (6.79 vs 3.08/1000 person-years, P < .001) and Alzheimer's disease (0.87 vs 0.33/1000 person-years), with an earlier age of diagnoses of dementia (75.63 ± 8.30 vs 78.94 ± 7.64 years, P < .001) and

Discussion

Our results supported the study hypothesis that asthma in both midlife and late life was an independent risk factor for developing dementia after adjusting for demographic data, other allergic diseases, medical comorbidities, use of inhaled steroid, and health system utilization. Only asthma in late life, however, was associated with the increased risk of Alzheimer's disorder.

From the clinical perspective, Jelicic et al¹¹ assessed the cognitive function of a sample of community-dwelling elderly

Acknowledgments

The authors thank Mr I-Fan Hu for his friendship and support. The authors also thank Dr MHC, Dr TPS, and Dr YMB, who designed the study, and wrote the protocol and manuscripts, Dr YMB, Dr TPS, Dr CTL, Dr CFT, Dr WCL, and Prof TLP who assisted with the preparation and proof-reading of the manuscript, and Dr YMB, Dr TJC, and Ms WHC, who provided the advices on statistical analysis.

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Citation Excerpt :
Furthermore, they reported an inverse association between PROMIS Cognitive Function T-scores and patient-reported global AD severity and suggested that clinicians should regularly monitor the cognitive functions of patients with AD.8 However, the association between AD and subsequent neurodegenerative disorders, particularly dementia, remains unknown and has not been explored, even though previous studies have suggested a relationship of other atopic diseases, particularly asthma, with an increased risk of subsequent dementia.9,10 In this study, we used the Taiwan National Health Insurance Research Database (NHIRD) with a large sample size and a longitudinal follow-up study design to investigate the temporal association between AD and dementia, including Alzheimer's disease and vascular dementia.
Retrospective studies have suggested that patients with dementia have higher prevalence of atopic dermatitis (AD) than those without dementia. However, the temporal association of AD with subsequent dementia remains unknown.
To assess the temporal association of AD with subsequent dementia.
We included data of patients with AD aged 45 years and older (n = 1059) and 1:10 age, sex, residence, income, and dementia-related comorbidity–matched controls (n = 10,590) from the Taiwan National Health Insurance Research Database and reviewed their subsequent dementia development from the enrollment date to the end of 2013.
After adjustments for dementia-related comorbidities, patients with AD were found to be more likely to develop any dementia (hazard ratio [HR], 2.02; 95% confidence interval [CI], 1.24-3.29), particularly Alzheimer's disease (HR, 3.74; 95% CI, 1.17-11.97), during the follow-up period than those in the control group. Moderate-to-severe AD was associated with a high subsequent dementia risk (HR, 4.64; 95% CI, 2.58-8.33). Sensitivity analyses with the exclusion of the first 3 (HR, 2.20; 95% CI, 1.28-3.80) or 5 (HR, 2.05; 95% CI, 1.08-3.89) years of observation revealed consistent findings.
AD may be an independent risk factor for new-onset dementia. Clinicians may monitor the trajectory of neurocognitive function among elderly patients with AD. Additional studies elucidating the pathomechanisms between AD and subsequent dementia are warranted.

View all citing articles on Scopus

: The authors declare no conflicts of interest.

: The study was supported by a grant from Taipei Veterans General Hospital (V103E10-001).

: All authors have no financial relationships relevant to this article to disclose.

View full text

Original StudyRisk of Dementia Among Patients With Asthma: A Nationwide Longitudinal Study

Abstract

Background

Methods

Results

Discussion

Section snippets

Data Source

Results

Discussion

Acknowledgments

Lancet

Lancet

Lancet

Lancet

Neuron

Lancet

Neurobiol Aging

Trends Endocrinol Metab

J Affect Disord

J Am Med Dir Assoc

Brain Res Mol Brain Res

Exp Cell Res

Neurobiol Aging

New insights into the dementia epidemic

N Engl J Med

Confronting Alzheimer's disease

N Engl J Med

Is neuroinflammation involved in the development of dementia in patients with Parkinson's disease?

Intern Med

Asthma, eczema, rhinitis and the risk for dementia

Dementia Geriatr Cogn Disord

Original Study
Risk of Dementia Among Patients With Asthma: A Nationwide Longitudinal Study