Trends in incidence of dementia among patients with rheumatoid arthritis: A population-based cohort study |
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| Institution: | 1. Division of Rheumatology, Mayo Clinic, Rochester, MN, USA;2. Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA;3. Department of Neurology, Mayo Clinic, Rochester, MN, USA;1. Rheumatology Department, Reina Sofia University Hospital, Cordoba, Spain;2. Maimonides Institute of Biomedical Research of Cordoba (IMIBIC), Cordoba, Spain;3. University of Cordoba, Cordoba, Spain;4. Rheumatology Department, Cochin Hospital, Paris, France;1. Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children''s Hospital, Harvard Medical School, Boston, MA, USA;2. Department of Psychiatry, McLean Hospital, Harvard Medical School, Belmont, MA, USA;3. Faculty of Psychology and Neuroscience, Section Neuropsychology & Psychopharmacology Maastricht University, Maastricht, the Netherlands;4. Faculty of Science, Biomedical Sciences Neurobiology, University of Amsterdam, Amsterdam, the Netherlands;5. Division of Genetics and Genomics, Boston Children''s Hospital, Harvard Medical School, Boston, MA, USA;6. Division of Immunology, Boston Children''s Hospital, Harvard Medical School, Boston, MA, USA;7. Department of Radiology, Boston Children''s Hospital, Harvard Medical School, Boston, MA, USA;1. Department of Rheumatology, Lille Catholic Hospitals and Lille Catholic University, Lille, France;2. Department of Diagnostic and Interventional Radiology, Lille Catholic Hospitals and Lille Catholic University, Lille, France;3. Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, USA;4. Department of Research, Biostatistics, Lille Catholic Hospitals and Lille Catholic University, Lille, France;5. Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland;1. Rheumatology service, Hospital Universitario la Paz-IdiPaz, Madrid, Spain;2. Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin Berlin, Berlin, Germany;3. Department of Nephrology and Rheumatology, Kyorin University School of medicine, Tokyo, Japan;4. Department of Internal Medicine and Rheumatology, Juntendo University School of Medicine, Tokyo, Japan;5. Department of Rheumatology, NTT Medical Center Tokyo, Tokyo, Japan;6. Rheumatology Department, Hôpital Cochin, Université de Paris. Assistance Publique- Hôpitaux de Paris, Paris, France;7. Rheumatology Department, Reina Sofia University Hospital, IMIBIC, University of Córdoba, Córdoba, Spain;8. INSERM U1153, Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris, France;1. Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, University of Toronto Lupus Clinic, EW, 1-412, 399 Bathurst Street, Toronto, Ontario, Canada;2. Queen''s University School of Medicine, Kingston, Ontario, Canada;3. University Health Network- Toronto Rehabilitation Institute, Toronto, Ontario, Canada;4. University Health Network Centre for Mental Health, Toronto, Ontario, Canada;5. Krembil Neurosciences Centre, University of Toronto, Toronto, Ontario, Canada;6. Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada;7. Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada;8. Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada;9. Institute for Work and Health, Toronto, Ontario, Canada;10. University of California at San Francisco, San Francisco, California, USA |
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| Abstract: | ObjectiveWe aimed to assess the incidence of dementia over time in patients with incident rheumatoid arthritis (RA) as compared to non-RA referents.MethodsThis population-based, retrospective cohort study included Olmsted County, Minnesota residents with incident RA by ACR 1987 criteria, diagnosed between 1980 and 2009. We matched non-RA referents 1:1 on age, sex, and calendar year and followed all individuals until 12/31/2019. Incident dementia was defined as two codes for Alzheimer's disease and related dementias (ADRD) at least 30 days apart. Cumulative incidence of ADRD was assessed, adjusting for the competing risk of death. Cox proportional hazards models calculated hazard ratios (HR) with 95% confidence intervals (CI) for incident ADRD by decade.ResultsAfter excluding individuals with prior dementia, we included 897 persons with incident RA (mean age 56 years; 69% female) and 885 referents. The 10-year cumulative incidence of ADRD in individuals diagnosed with RA during the 1980s was 12.7% (95%CI:7.9–15.7%), 1990s was 7.2% (95%CI:3.7–9.4%), and 2000s was 6.2% (95%CI:3.6–7.8%). Individuals with RA diagnosed in 2000s had insignificantly lower cumulative incidence of ADRD than those in the 1980s (HR 0.66; 95%CI:0.38–1.16). The overall HR of ADRD in individuals with RA was 1.37 (vs. referents; 95%CI:1.04–1.81). When subdivided by decade, however, the risk of ADRD in individuals diagnosed with RA was higher than referents in the 1990s (HR 1.72, 95%CI:1.09–2.70) but not 2000s (HR 0.86, 95%CI:0.51–1.45).ConclusionsThe risk of dementia in individuals with RA appears to be declining over time, including when compared to general population referents. |
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