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.

中文翻译：

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严重的精神疾病与痴呆风​​险增加有关。


背景技术患有精神疾病的个体患痴呆症的风险增加。大多数横断面研究存在选择偏差、诊断不足和人群代表性差的问题，而关于焦虑、双相情感障碍和精神障碍作用的纵向研究证据有限。电子健康记录 (EHR) 允许在整个生命周期中跟踪大量人群，并包含广泛的诊断信息。目的 在两个基于 EHR 的大型人群样本中评估四组精神疾病（精神分裂症、躁郁症/躁狂症、抑郁症和焦虑症）与痴呆之间的关联。方法 我们使用 EHR 对威尔士近 100 万成年人以及 228,937 名英国生物银行参与者进行研究，研究了精神分裂症、躁狂/躁郁症、抑郁症、焦虑症和随后的痴呆风险之间的关系。在安全匿名信息链接中，在诊断痴呆症之前的几年中，首次诊断精神疾病的发生率急剧增加，所有精神疾病诊断在痴呆症诊断之前的一年达到峰值。除焦虑外，精神疾病与随后的痴呆症诊断高度显着相关：精神分裂症、躁狂/双相情感障碍和抑郁症的 HR 分别= 2.87、2.80、1.63。英国生物银行也发现了类似的模式（HR 分别为 4.46、3.65、2.39），焦虑也与痴呆相关（HR=1.34）。当将精神病学诊断分为 10 年区间时，所有年龄段的人患痴呆症的风险都会增加。 结论 精神疾病与随后患痴呆症的风险增加有关，并且患更严重疾病的风险更大。临床意义 晚发的精神疾病应提醒临床医生可能出现早期痴呆。