Affiliations: [a] German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| [b] Rostock Center for the Study of Demographic Change, Rostock, Germany
| [c] Federal Institute for Drugs and Medical Devices (BfArM), Bonn, Germany
| [d] Center for Translational Medicine, University of Bonn, Bonn, Germany
| [e] University of Rostock, Institute for Sociology and Demography, Rostock, Germany
| [f]
Max Planck Institute for Demographic Research, Rostock, Germany
| [g] Department for Neurodegenerative Diseases and Geriatric Psychiatry, University of Bonn, Bonn, Germany
Correspondence:
[*]
Correspondence to: Michael Nerius, University of Rostock, Institute for Sociology and Demography, Ulmenstraße 69, 18057 Rostock, Germany. Tel.: +49 381 498 4399; E-mail: michael.nerius@uni-rostock.de.
Note: [1] These authors contributed equally to this work.
Note: [2] Joint last authors.
Abstract: Background:Recent evidence indicates an important role for neuroinflammation in the pathological cascade of Alzheimer’s disease (AD), and neuroinflammation is increasingly being recognized as a potential therapeutic target. Objective:To assess the impact of glucocorticoids on the risk of developing dementia. Methods:We used health insurance data of the largest German health insurer from 2004–2013 with a baseline sample of 176,485 persons aged 50 years and older to study the association of glucocorticoid treatment and incidence of dementia. Cox proportional-hazard models were calculated adjusting for sex, age, and comorbidities known to be major risk factors for dementia and were given as hazard ratios (HR) with 95% confidence intervals (CI). We further stratified glucocorticoid treatment by route of application and treatment duration. Results:Of the 176,485 dementia-free persons, 19,938 were diagnosed with dementia by the end of 2013. The risk of suffering from dementia was significantly lower for glucocorticoid users compared to non-users (HR = 0.81, CI = 0.78–0.84). The lowest risk was found among users of inhaled glucocorticoid (HR = 0.65, CI = 0.57–0.75), followed by nasal (HR = 0.76, CI = 0.66–0.87), other (HR = 0.84, CI = 0.80–0.88), and oral users (HR = 0.83, CI = 0.78–0.88). We found no difference in risk reduction between long- and short-term-users. Conclusion:Longitudinal German health insurance data indicate that the use of glucocorticoids is associated with a lower risk of dementia. Prospective clinical trials will be necessary to determine whether glucocorticoids can have a positive impact on neuroinflammation and thus protect persons against dementia.
