Risk of dementia associated with psychotic disorders in later life: the health in men study (HIMS)

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: Recent research has identified several potentially modifiable risk factors for dementia, including mental disorders. Psychotic disorders, such as schizophrenia and delusional disorder, have also been associated with increased risk of cognitive impairment and dementia, but currently available data difficult to generalise because of bias and confounding. We designed the present study to investigate if the presence of a psychotic disorder increased the risk of incident dementia in later life. Methods: Prospective cohort study of a community-representative sample of 37 770 men aged 65–85 years who were free of dementia at study entry. They were followed for up to 17.7 years using electronic health records. Clinical diagnoses followed the International Classification of Diseases guidelines. As psychotic disorders increase mortality, we considered death a competing risk. Results: A total of 8068 (21.4%) men developed dementia and 23 999 (63.5%) died during follow up. The sub-hazard ratio of dementia associated with a psychotic disorder was 2.67 (95% CI 2.30–3.09), after statistical adjustments for age and prevalent cardiovascular, respiratory, gastrointestinal and renal diseases, cancer, as well as hearing loss, depressive and bipolar disorders, and alcohol use disorder. The association between psychotic disorder and dementia risk varied slightly according to the duration of the psychotic disorder (highest for those with the shortest illness duration), but not the age of onset. No information about the use of antipsychotics was available. Conclusion: Older men with a psychotic disorder have nearly three times greater risk of developing dementia than those without psychosis. The pathways linking psychotic disorders to dementia remain unclear but may involve mechanisms other than those associated with Alzheimer's disease and other common dementia syndromes.

Original languageEnglish
Pages (from-to)232-242
Number of pages11
JournalPsychological Medicine
Volume49
Issue number2
Early online date22 Mar 2018
DOIs
Publication statusPublished - Jan 2019

Fingerprint

Men's Health
Psychotic Disorders
Dementia
Hearing Disorders
Paranoid Schizophrenia
Electronic Health Records
Gastrointestinal Diseases
Kidney Neoplasms
International Classification of Diseases
Depressive Disorder
Bipolar Disorder
Hearing Loss
Age of Onset
Mental Disorders
Antipsychotic Agents
Schizophrenia
Alzheimer Disease
Cohort Studies
Alcohols
Prospective Studies

Cite this

@article{29054b6d2ba945ed95e551689648df6e,
title = "Risk of dementia associated with psychotic disorders in later life: the health in men study (HIMS)",
abstract = "Background: Recent research has identified several potentially modifiable risk factors for dementia, including mental disorders. Psychotic disorders, such as schizophrenia and delusional disorder, have also been associated with increased risk of cognitive impairment and dementia, but currently available data difficult to generalise because of bias and confounding. We designed the present study to investigate if the presence of a psychotic disorder increased the risk of incident dementia in later life. Methods: Prospective cohort study of a community-representative sample of 37 770 men aged 65–85 years who were free of dementia at study entry. They were followed for up to 17.7 years using electronic health records. Clinical diagnoses followed the International Classification of Diseases guidelines. As psychotic disorders increase mortality, we considered death a competing risk. Results: A total of 8068 (21.4{\%}) men developed dementia and 23 999 (63.5{\%}) died during follow up. The sub-hazard ratio of dementia associated with a psychotic disorder was 2.67 (95{\%} CI 2.30–3.09), after statistical adjustments for age and prevalent cardiovascular, respiratory, gastrointestinal and renal diseases, cancer, as well as hearing loss, depressive and bipolar disorders, and alcohol use disorder. The association between psychotic disorder and dementia risk varied slightly according to the duration of the psychotic disorder (highest for those with the shortest illness duration), but not the age of onset. No information about the use of antipsychotics was available. Conclusion: Older men with a psychotic disorder have nearly three times greater risk of developing dementia than those without psychosis. The pathways linking psychotic disorders to dementia remain unclear but may involve mechanisms other than those associated with Alzheimer's disease and other common dementia syndromes.",
keywords = "Cohort study, delusional disorder, dementia, epidemiology, men's health, neurocognitive disorder, paraphrenia, psychotic disorder, schizophrenia",
author = "Almeida, {Osvaldo P.} and Ford, {Andrew H.} and Hankey, {Graeme J.} and Yeap, {Bu B.} and Jonathan Golledge and Leon Flicker",
year = "2019",
month = "1",
doi = "10.1017/S003329171800065X",
language = "English",
volume = "49",
pages = "232--242",
journal = "Psychological Medicine.",
issn = "0033-2917",
publisher = "Cambridge University Press",
number = "2",

}

TY - JOUR

T1 - Risk of dementia associated with psychotic disorders in later life

T2 - the health in men study (HIMS)

AU - Almeida, Osvaldo P.

AU - Ford, Andrew H.

AU - Hankey, Graeme J.

AU - Yeap, Bu B.

AU - Golledge, Jonathan

AU - Flicker, Leon

PY - 2019/1

Y1 - 2019/1

N2 - Background: Recent research has identified several potentially modifiable risk factors for dementia, including mental disorders. Psychotic disorders, such as schizophrenia and delusional disorder, have also been associated with increased risk of cognitive impairment and dementia, but currently available data difficult to generalise because of bias and confounding. We designed the present study to investigate if the presence of a psychotic disorder increased the risk of incident dementia in later life. Methods: Prospective cohort study of a community-representative sample of 37 770 men aged 65–85 years who were free of dementia at study entry. They were followed for up to 17.7 years using electronic health records. Clinical diagnoses followed the International Classification of Diseases guidelines. As psychotic disorders increase mortality, we considered death a competing risk. Results: A total of 8068 (21.4%) men developed dementia and 23 999 (63.5%) died during follow up. The sub-hazard ratio of dementia associated with a psychotic disorder was 2.67 (95% CI 2.30–3.09), after statistical adjustments for age and prevalent cardiovascular, respiratory, gastrointestinal and renal diseases, cancer, as well as hearing loss, depressive and bipolar disorders, and alcohol use disorder. The association between psychotic disorder and dementia risk varied slightly according to the duration of the psychotic disorder (highest for those with the shortest illness duration), but not the age of onset. No information about the use of antipsychotics was available. Conclusion: Older men with a psychotic disorder have nearly three times greater risk of developing dementia than those without psychosis. The pathways linking psychotic disorders to dementia remain unclear but may involve mechanisms other than those associated with Alzheimer's disease and other common dementia syndromes.

AB - Background: Recent research has identified several potentially modifiable risk factors for dementia, including mental disorders. Psychotic disorders, such as schizophrenia and delusional disorder, have also been associated with increased risk of cognitive impairment and dementia, but currently available data difficult to generalise because of bias and confounding. We designed the present study to investigate if the presence of a psychotic disorder increased the risk of incident dementia in later life. Methods: Prospective cohort study of a community-representative sample of 37 770 men aged 65–85 years who were free of dementia at study entry. They were followed for up to 17.7 years using electronic health records. Clinical diagnoses followed the International Classification of Diseases guidelines. As psychotic disorders increase mortality, we considered death a competing risk. Results: A total of 8068 (21.4%) men developed dementia and 23 999 (63.5%) died during follow up. The sub-hazard ratio of dementia associated with a psychotic disorder was 2.67 (95% CI 2.30–3.09), after statistical adjustments for age and prevalent cardiovascular, respiratory, gastrointestinal and renal diseases, cancer, as well as hearing loss, depressive and bipolar disorders, and alcohol use disorder. The association between psychotic disorder and dementia risk varied slightly according to the duration of the psychotic disorder (highest for those with the shortest illness duration), but not the age of onset. No information about the use of antipsychotics was available. Conclusion: Older men with a psychotic disorder have nearly three times greater risk of developing dementia than those without psychosis. The pathways linking psychotic disorders to dementia remain unclear but may involve mechanisms other than those associated with Alzheimer's disease and other common dementia syndromes.

KW - Cohort study

KW - delusional disorder

KW - dementia

KW - epidemiology

KW - men's health

KW - neurocognitive disorder

KW - paraphrenia

KW - psychotic disorder

KW - schizophrenia

UR - http://www.scopus.com/inward/record.url?scp=85044341517&partnerID=8YFLogxK

U2 - 10.1017/S003329171800065X

DO - 10.1017/S003329171800065X

M3 - Article

VL - 49

SP - 232

EP - 242

JO - Psychological Medicine.

JF - Psychological Medicine.

SN - 0033-2917

IS - 2

ER -