Association between dementia and systemic rheumatic disease: A nationwide population-based study

Hyemi Park; Dong-Hyuk Yim; Bolormaa Ochirpurev; Sang-Yong Eom; In Ah Choi; Gawon Ju; Ji Hyoun Kim

doi:10.1371/journal.pone.0248395

Association between dementia and systemic rheumatic disease: A nationwide population-based study

PLoS One. 2021 Mar 12;16(3):e0248395. doi: 10.1371/journal.pone.0248395. eCollection 2021.

Authors

Hyemi Park¹, Dong-Hyuk Yim^{2

3}, Bolormaa Ochirpurev³, Sang-Yong Eom³, In Ah Choi^{4

5}, Gawon Ju¹, Ji Hyoun Kim⁴

Affiliations

¹ Department of Psychiatry, Chungbuk National University Hospital, Cheongju, Korea.
² Center for Environmental Medicine, Chungbuk National University, Cheongju, Korea.
³ Department of Preventive Medicine, College of Medicine, Chungbuk National University, Cheongju, Korea.
⁴ Division of Rheumatology, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea.
⁵ Division of Rheumatology, Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea.

Abstract

Objectives: Systemic rheumatic disease is characterized by autoimmunity and systemic inflammation and affects multiple organs. Few studies have investigated whether autoimmune diseases increase the risk of dementia. Herein, we evaluate the relationship between systemic rheumatic disease and dementia through a population-based study using the Korean National Health Insurance Service (NHIS) claims database.

Methods: We conducted a nationwide population-based study using the Korean NHIS database, consisting of individuals who submitted medical claims from 2002-2013. Dementia was defined as having an acetylcholinesterase inhibitors (AChEIs) prescription along with symptoms satisfying the Alzhemier's disease (AD) International Classification of Diseases (ICD)-10 codes (F00 or G30), or vascular dementia (VaD; ICD-10 or F01) criteria. Control subjects were matched to the dementia patients by age and sex. The study group was limited to those diagnosed with rheumatic disease at least 6 months prior to diagnosis of dementia. Rheumatic disease was defined by the following ICD-10 codes: Rheumatoid arthritis (RA: M05), Sjögren's syndrome (SS: M35), systemic lupus erythematosus (SLE: M32), and Behcet's disease (BD: M35.2).

Results: Of the 6,028 dementia patients, 261 (4.3%) had RA, 108 (1.6%) had SS, 12 (0.2%) had SLE, and 6 (0.1%) had BD. SLE history was significantly higher in dementia patients (0.2%) than in controls (0.1%) and was associated with dementia (odds ratio [OR], 2.48; 95% confidence interval [CI], 1.19-5.15). In subgroup analysis, SLE significantly increased dementia risk, regardless of dementia type (AD: OR, 2.29; 95% CI, 1.06-4.91; VaD: OR, 4.54; 95% CI, 1.36-15.14). However, these associations were not sustained in the mild CCI or elderly group.

Conclusion: SLE was independently associated with a higher risk of dementia, including AD and VaD when compared to the control group, even after adjustment. SLE patients (<65 years old) are a high-risk group for early vascular dementia and require screening for early detection and active prevention.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Databases, Factual*
Dementia* / classification
Dementia* / complications
Dementia* / epidemiology
Female
Humans
Insurance Claim Review
Male
Middle Aged
Republic of Korea / epidemiology
Rheumatic Diseases* / classification
Rheumatic Diseases* / complications
Rheumatic Diseases* / epidemiology

Grants and funding

This work was supported by the research grant from Chungcheongbuk-do, the Chungbuk-type Biohealth Industry's Big Data Platform project. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.