Effect of Depression and Diabetes Mellitus on the Risk for Dementia: A National Population-Based Cohort Study

Wayne Katon, Henrik Søndergaard Pedersen, Anette Riisgaard Ribe, Morten Fenger-Grøn, Dimitry Davydow, Frans Boch Waldorff, Mogens Vestergaard

100 Citationer (Scopus)

Abstract

IMPORTANCE: Although depression and type 2 diabetes mellitus (DM) may independently increase the risk for dementia, no studies have examined whether the risk for dementia among people with comorbid depression and DMishigher than the sum ofeach exposure individually. OBJECTIVE: To examine the risk for all-cause dementia among persons with depression, DM, or both compared with persons with neither exposure. DESIGN, SETTING, AND PARTICIPANTS: We performed a national population-based cohort study of 2 454 532 adults, including 477 133 (19.4%) with depression, 223 174 (9.1%) with DM, and 95 691 (3.9%) with both. We included all living Danish citizens 50 years or older who were free of dementia from January 1,2007, through December 31, 2013 (followed up through December 31, 2013). Dementia was ascertained by physician diagnosis from the Danish National Patient Register or the Danish Psychiatric Central Register and/or by prescription of a cholinesterase inhibitor or memantine hydrochloride from the Danish National Prescription Registry. Depression was ascertained by psychiatrist diagnosis from the Danish Psychiatric Central Research Register or by prescription of an antidepressant from the Danish National Prescription Registry. Diabetes mellitus was identified using the National Diabetes Register. MAINOUTCOMESAND MEASURES: We estimated the risk for all-cause dementia associated with DM, depression, or both using Cox proportional hazards regression models that adjusted for potential confounding factors (eg, demographics) and potential intermediates (eg, medical comorbidities). RESULTS: During 13 834 645 person-years of follow-up, 59 663 participants (2.4%) developed dementia;of these, 6466 (10.8%) had DM, 15 729 (26.4%) had depression, and 4022 (6.7%) had both. The adjusted hazard ratio for developing all-cause dementia was 1.83 (95% CI, 1.80-1.87) for persons with depression, 1.20 (95% CI, 1.17-1.23) for persons with DM, and 2.17 (95% CI, 2.10-2.24) for those with both compared with persons who had neither exposure. The excess risk for all-cause dementia observed for individuals with comorbid depression and DM surpassed the summed risk associated with each exposure individually, especially for persons younger than 65 years (hazard ratio, 4.84 [95% CI, 4.21-5.55]). The corresponding attributable proportion due to the interaction of comorbid depression and DM was 0.25 (95% CI, 0.13-0.36; P <.001) for those younger than65 years and 0.06 (95% CI, 0.02-0.10; P =.001) for those 65 years or older. CONCLUSIONS AND RELEVANCE: Depression and DM were independently associated with a greater risk for dementia, and the combined association of both exposures with the risk for all-cause dementia was stronger than the additive association.

OriginalsprogEngelsk
TidsskriftJ A M A Psychiatry
Vol/bind72
Udgave nummer6
Sider (fra-til)612-619
Antal sider8
ISSN2168-622X
DOI
StatusUdgivet - 1 jun. 2015

Emneord

  • Cohort Studies
  • Dementia
  • DEPRESSION
  • diabetes
  • Diabetes Mellitus
  • Risk
  • semrap-2015-1

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