Severe psychiatric disorders are associated with increased risk of dementia

Stevenson-Hoare, Joshua, Legge, Sophie E., Simmonds, Emily, Han, Jun, Owen, Michael J. ORCID: https://orcid.org/0000-0003-4798-0862, O'Donovan, Michael ORCID: https://orcid.org/0000-0001-7073-2379, Kirov, George ORCID: https://orcid.org/0000-0002-3427-3950 and Escott-Price, Valentina ORCID: https://orcid.org/0000-0003-1784-5483 2024. Severe psychiatric disorders are associated with increased risk of dementia. BMJ Mental Health 27 (1) , e301097. 10.1136/bmjment-2024-301097

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Abstract

Background: Individuals with psychiatric disorders have an increased risk of developing dementia. Most cross-sectional studies suffer from selection bias, underdiagnosis and poor population representation, while there is only limited evidence from longitudinal studies on the role of anxiety, bipolar and psychotic disorders. Electronic health records (EHRs) permit large cohorts to be followed across the lifespan and include a wide range of diagnostic information. Objective: To assess the association between four groups of psychiatric disorders (schizophrenia, bipolar disorder/mania, depression and anxiety) with dementia in two large population-based samples with EHR. Methods: Using EHR on nearly 1 million adult individuals in Wales, and from 228 937 UK Biobank participants, we studied the relationships between schizophrenia, mania/bipolar disorder, depression, anxiety and subsequent risk of dementia. Findings: In Secure Anonymised Information Linkage, there was a steep increase in the incidence of a first diagnosis of psychiatric disorder in the years prior to the diagnosis of dementia, reaching a peak in the year prior to dementia diagnosis for all psychiatric diagnoses. Psychiatric disorders, except anxiety, were highly significantly associated with a subsequent diagnosis of dementia: HRs=2.87, 2.80, 1.63 for schizophrenia, mania/bipolar disorder and depression, respectively. A similar pattern was found in the UK Biobank (HRs=4.46, 3.65, 2.39, respectively) and anxiety was also associated with dementia (HR=1.34). Increased risk of dementia was observed for all ages at onset of psychiatric diagnoses when these were divided into 10-year bins. Conclusions: Psychiatric disorders are associated with an increased risk of subsequent dementia, with a greater risk of more severe disorders. Clinical implications: A late onset of psychiatric disorders should alert clinicians of possible incipient dementia.

Item Type:	Article
Date Type:	Published Online
Status:	Published
Schools:	Medicine
Additional Information:	License information from Publisher: LICENSE 1: URL: https://creativecommons.org/licenses/by/4.0/, Start Date: 2024-06-15, Type: open-access
Publisher:	BMJ Publishing Group
Funders:	MRC
Date of First Compliant Deposit:	19 June 2024
Date of Acceptance:	31 May 2024
Last Modified:	01 Jul 2024 15:57
URI:	https://orca.cardiff.ac.uk/id/eprint/169909

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