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      Relationship between dementia and ankylosing spondylitis: A nationwide, population-based, retrospective longitudinal cohort study

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          Abstract

          Among a variety of comorbidities of ankylosing spondylitis (AS), the association between dementia and AS by using an extensive dataset from the Korean National Health Insurance System was evaluated in this study. We extracted 15,547 newly diagnosed AS subjects among the entire Korean population and excluded wash-out patients (n = 162) and patients that were inappropriate for cohort match (n = 1192). Finally, 14,193 subjects were chosen as the AS group, and through 1:5 age- and sex-stratified matching, 70,965 subjects were chosen as the control group. We evaluated patient demographics, household incomes, and comorbidities, including hypertension, diabetes, and dyslipidemia. The prevalence of overall dementia (1.37%) and Alzheimer’s dementia (AD) (0.99%) in the AS group was significantly higher than in the control group (0.87% and 0.63%), respectively. The adjusted hazard ratio of the AS group for overall dementia (1.758) and AD (1.782) showed statistical significance also. On the other hand, the prevalence of vascular dementia did not differ significantly between the two groups. Subgroup analyses revealed the following risk factors for dementia in the AS group: male gender, greater than 65 years in age, fair income (household income greater than 20% of the median), urban residency, no diabetes, and no hypertension. From the nationwide, population-based, retrospective, longitudinal cohort study, AS patients showed a significantly higher prevalence of overall dementia and Alzheimer’s dementia. Comprehensive patient assessment using our subgroup analysis could help to prevent dementia in patients suffering from AS.

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          The Prevalence and Incidence of Dementia Due to Alzheimer's Disease: a Systematic Review and Meta-Analysis.

          Updated information on the epidemiology of dementia due to Alzheimer's disease (AD) is needed to ensure that adequate resources are available to meet current and future healthcare needs. We conducted a systematic review and meta-analysis of the incidence and prevalence of AD.
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            Comorbidity profiles among patients with ankylosing spondylitis: a nationwide population-based study.

            Ankylosing spondylitis (AS) is a systemic inflammatory disease that can result in chronic pain and disability. This study aimed to analyse the prevalence and risk of medical comorbidities in patients with AS compared with the general population. 11 701 patients with AS and 58 505 matching controls were selected for analysis from the National Health Insurance Research Dataset (NHIRD) in Taiwan. The Elixhauser comorbidity index was used for selecting medical comorbidities. Pearson chi2 tests and conditional logistic regression a nalyses were performed to examine the prevalence and risk of comorbidities between these two groups. Patients with AS were at increased risk for multiple systemic comorbidities including cardiovascular, neurological, pulmonary, gastrointestinal, endocrine, haematological and mental illness. The most prevalent comorbidities in patients with AS were hypertension (16.4%), peptic ulcers (13.9%) and headaches (10.2%). The results show that patients with AS have a higher prevalence of multiple comorbidities than the general population in Taiwan. These findings are consistent with previous studies done in Western populations. The results could be useful for both the clinical management of patients with AS and for researching the underlying pathological mechanisms.
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              Gender-attributable differences in outcome of ankylosing spondylitis: long-term results from the Outcome in Ankylosing Spondylitis International Study.

              To investigate gender-attributable differences regarding clinical outcome [disease activity, physical function and quality of life (QoL)] and radiographic damage in patients with AS over time.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: InvestigationRole: MethodologyRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: InvestigationRole: MethodologyRole: SoftwareRole: VisualizationRole: Writing – original draft
                Role: ConceptualizationRole: Data curationRole: InvestigationRole: MethodologyRole: Project administrationRole: Resources
                Role: Data curationRole: Formal analysisRole: MethodologyRole: Validation
                Role: ConceptualizationRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: SupervisionRole: Writing – review & editing
                Role: ConceptualizationRole: InvestigationRole: ResourcesRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – review & editing
                Role: Data curationRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: SoftwareRole: Validation
                Role: ConceptualizationRole: InvestigationRole: MethodologyRole: SoftwareRole: SupervisionRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: Project administrationRole: ResourcesRole: ValidationRole: Writing – review & editing
                Role: Data curationRole: Funding acquisitionRole: Project administrationRole: SoftwareRole: ValidationRole: Visualization
                Role: InvestigationRole: MethodologyRole: SupervisionRole: Writing – review & editing
                Role: ConceptualizationRole: Funding acquisitionRole: MethodologyRole: ResourcesRole: SupervisionRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                31 January 2019
                2019
                : 14
                : 1
                : e0210335
                Affiliations
                [1 ] Department of Orthopaedic Surgery, Soonchunhyang University Hospital, Bucheon-si, Gyeonggi-do, South Korea
                [2 ] Department of Orthopedics, Korea University Hospital, Ansan, Danwon-gu, Ansan-si, Gyeonggi-do, South Korea
                [3 ] Department of Orthopaedic Surgery, Soonchunhyang University Hospital, Yongsan-gu, Seoul, South Korea
                [4 ] Department of Biostatistics, College of Medicine, Catholic University, Jongno-gu, Seoul, South Korea
                [5 ] Scoliosis Research Institute, Department of Orthopedics, Korea University Medical College, Guro Hospital, Guro-gu, Seoul, South Korea
                [6 ] Department of Orthopaedic Surgery, Korea University, College of Medicine, Anam Hospital, Seongbuk-gu, Seoul, South Korea
                Universiti Sains Malaysia, MALAYSIA
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                ‡ These authors contributed equally to this study as the co-first authors.

                Author information
                http://orcid.org/0000-0003-4948-4539
                Article
                PONE-D-18-29903
                10.1371/journal.pone.0210335
                6354978
                30703142
                42517d56-04cf-4e62-9285-de8b5c3a618f
                © 2019 Jang et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 15 October 2018
                : 20 December 2018
                Page count
                Figures: 3, Tables: 2, Pages: 12
                Funding
                Funded by: funder-id http://dx.doi.org/10.13039/501100002560, Soonchunhyang University;
                Award Recipient :
                The Manuscript submitted does not contain information about medical device(s)/drug(s). This work was supported by the Soonchunhyang University Research Fund. No relevant financial activities outside the submitted work.
                Categories
                Research Article
                Medicine and Health Sciences
                Clinical Medicine
                Clinical Immunology
                Autoimmune Diseases
                Ankylosing Spondylitis
                Biology and Life Sciences
                Immunology
                Clinical Immunology
                Autoimmune Diseases
                Ankylosing Spondylitis
                Medicine and Health Sciences
                Immunology
                Clinical Immunology
                Autoimmune Diseases
                Ankylosing Spondylitis
                Medicine and Health Sciences
                Mental Health and Psychiatry
                Dementia
                Alzheimer's Disease
                Medicine and Health Sciences
                Neurology
                Dementia
                Alzheimer's Disease
                Medicine and Health Sciences
                Neurology
                Neurodegenerative Diseases
                Alzheimer's Disease
                Medicine and Health Sciences
                Mental Health and Psychiatry
                Dementia
                Medicine and Health Sciences
                Neurology
                Dementia
                Medicine and Health Sciences
                Neurology
                Cerebrovascular Diseases
                Vascular Dementia
                Medicine and Health Sciences
                Mental Health and Psychiatry
                Dementia
                Vascular Dementia
                Medicine and Health Sciences
                Neurology
                Dementia
                Vascular Dementia
                Medicine and Health Sciences
                Vascular Medicine
                Blood Pressure
                Hypertension
                Medicine and Health Sciences
                Endocrinology
                Endocrine Disorders
                Diabetes Mellitus
                Medicine and Health Sciences
                Metabolic Disorders
                Diabetes Mellitus
                Medicine and Health Sciences
                Diagnostic Medicine
                Alzheimer's Disease Diagnosis and Management
                Medicine and Health Sciences
                Metabolic Disorders
                Dyslipidemia
                Custom metadata
                All subjects provided written informed consent, and the Institutional Review Board of the NHIS institutional review board (number: NHIS-2018-1-115).Data are available from the Korea National Health Insurance Sharing Service ( https://nhiss.nhis.or.kr/bd/ay/bdaya001iv.do;jsessionid=KiOt6ilaTGXMmR1mbeeA9Ax7nJjIYDsKr4UJAJvHhNyo511E0PovM1WfrGSaegL6.primrose22_servlet_engine1, Tel.: (82) 33-736-2432, 2433) for researchers who meet the criteria for access to confidential data.

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