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. 2023 Jan;50(1):48-55.
doi: 10.3899/jrheum.220200. Epub 2022 Jul 15.

Risk Factors for Dementia in Patients With Incident Rheumatoid Arthritis: A Population-Based Cohort Study

Chanakya Kodishala  1 , Cassondra A Hulshizer  2 , Vanessa L Kronzer  1 , John M Davis 3rd  1 , Vijay K Ramanan  3 , Maria Vassilaki  4 , Michelle M Mielke  5 , Cynthia S Crowson  6 , Elena Myasoedova  7
Affiliations

Risk Factors for Dementia in Patients With Incident Rheumatoid Arthritis: A Population-Based Cohort Study

Chanakya Kodishala et al. J Rheumatol. 2023 Jan.

Abstract

Objective: Growing evidence suggests that patients with rheumatoid arthritis (RA) have increased risk for dementia. We assessed risk factors for incident dementia in an inception cohort of patients with RA.

Methods: This retrospective population-based cohort study included residents of 8 counties in Minnesota who were ≥ 50 years of age when they met 1987 American College of Rheumatology criteria for incident RA between 1980 and 2014 and were followed until death/migration or December 31, 2019. Patients with dementia before RA incidence were excluded. Incident dementia was defined as 2 relevant International Classification of Diseases, 9th or 10th revision codes at least 30 days apart. Data on sociodemographics, disease characteristics, cardiovascular/cerebrovascular disease (CVD) risk factors, and comorbidities were abstracted from medical records.

Results: The study included 886 patients with RA (mean age 65.1 yrs, 65.2% female). During the follow-up period (median 8.5 yrs), 103 patients developed dementia. After adjusting for age, sex, and calendar year of RA incidence, older age at RA incidence (HR 1.14 per 1 year increase, 95% CI 1.12-1.17), rheumatoid nodules (HR 1.76, 95% CI 1.05-2.95), hypertension (HR 1.84, 95% CI 1.19-2.85), presence of large joint swelling (HR 2.03, 95% CI 1.14-3.60), any CVD (HR 2.25, 95% CI 1.38-3.66), particularly ischemic stroke (HR 3.16, 95% CI 1.84-5.43) and heart failure (HR 1.82, 95% CI 1.10-3.00), anxiety (HR 1.86, 95% CI 1.16-2.97), and depression (HR 2.63, 95% CI 1.76-3.93) were associated with increased risk of dementia. After adjusting for CVD risk factors and any CVD, all covariates listed above were still significantly associated with risk of dementia.

Conclusion: Apart from age, hypertension, depression, and anxiety, all of which are universally recognized risk factors for dementia, clinically active RA and presence of CVD were associated with an elevated risk of dementia incidence among patients with RA.

Keywords: cardiovascular disease; dementia; depression; disease activity; rheumatoid arthritis.

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Conflict of interest statement

Conflict of Interest:

CK: none, CAH: none, VLK: none, JMD: Research grant from Pfizer, VKR: none, MV: Received research funding from F. Hoffmann-La Roche Ltd and Biogen; consultant for F. Hoffmann-La Roche Ltd; receives research funding from NIA and has equity ownership in Abbott Laboratories, Johnson and Johnson, Medtronic, and Amgen, MMM: Consulted for Biogen, Brain Protection Company, and LabCorp. Receives research funding from NIH and DOD, CSC: none, EM: none

Figures

Figure 1.
Figure 1.
Cumulative incidence of dementia after rheumatoid arthritis incidence
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