Diabetes, Hypertension, and the Risk of Dementia

Article type: Research Article

Authors: Yen, Fu-Shun^a | Wei, James Cheng-Chung^{b; c; d} | Yip, Hei-Tung^{e; f} | Hwu, Chii-Min^{g; h; *} | Hsu, Chih-Cheng^{i; j; k; l; *}

Affiliations: [a] Dr. Yen’s Clinic, Gueishan District, Taoyuan, Taiwan | [b] Department of Allergy, Immunology & Rheumatology, Chung Shan Medical University Hospital, Taichung City, Taiwan | [c] Institute of Medicine, Chung Shan Medical University, Taichung City, Taiwan | [d] Graduate Institute of Integrated Medicine, China Medical University, South District, Taichung City, Taiwan | [e] Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan | [f] College of Medicine, China Medical University, Taichung City, Taiwan | [g] Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan | [h] Section of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Beitou District, Taipei, Taiwan | [i] Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Miaoli County, Taiwan | [j] Department of Health Services Administration, China Medical University, Taichung, Taiwan | [k] Department of Family Medicine, Min-Sheng General Hospital, Taoyuan, Taiwan | [l] National Center for Geriatrics and Welfare Research, National Health Research Institutes, Yunlin, Taiwan

Correspondence: [*] Correspondence to: Chii-Min Hwu, Faculty of Medicine, National Yang-Ming Chiao Tung University School of Medicine, No. 201, Sec. 2 Shi-Pai Rd., Chung-Cheng Building 11F Room 522, Taipei 112, Taiwan. Tel.: +886 2 28757516; Fax: +886 2 28751429; E-mail: chhwu@vghtpe.gov.tw and Chih-Cheng Hsu, National Center for Geriatrics and Welfare Research, National Health Research Institutes, 35 Keyan Road, Zhunan, Miaoli County 35053, Taiwan. Tel.: +886 37 246166 #36336; Fax: +886 37 586261; E-mail: cch@nhri.edu.tw.

Abstract: Background:Type 2 diabetes (T2D) and hypertension (HTN) are well-known modifiable risk factors for dementia, but their intricate attributes accounting for dementia development has not been clearly delineated. Objective:We conducted this study to investigate and compare the effects of T2D and HTN on dementia risk. Methods:We screened data of matched pairs of patients with T2D or HTN between January 1, 2000 and December 31, 2017 from Taiwan’s National Health Insurance Research Database. Fine and Gray’s subdistribution hazard models were used for calculating the risk of dementia. Results:Patients with T2D and subsequent HTN were associated with significantly higher risks of all-cause dementia (aHR 1.51, 95% CI 1.25–1.83) and vascular dementia (aHR 2.30, 95% CI 1.71–3.13) compared with those without subsequent HTN. Patients with HTN and subsequent T2D were associated with significantly higher risks of all-cause dementia (aHR 1.15, 95% CI 1.08–1.21), vascular dementia (aHR 1.25, 95% CI 1.62–1.34), and other dementia (aHR 1.31, 95% CI 1.03–1.66) compared with those without subsequent HTN. The subgroups of male and female patients, age of 50–69 and 70–90 years with subsequent comorbidity were associated with significantly higher risks of all-cause dementia and vascular dementia than those without subsequent comorbidity. Conclusion:This nationwide cohort study demonstrated that patients with T2D and subsequent HTN had association with higher risks of all-cause dementia and vascular dementia, and those with HTN and subsequent T2D were associated with higher risks of all-cause dementia, vascular dementia, and other dementia.

Keywords: All-cause dementia, Alzheimer’s disease, other dementia, vascular dementia

DOI: 10.3233/JAD-220207

Journal: Journal of Alzheimer's Disease, vol. 89, no. 1, pp. 323-333, 2022