Association between lithium use and the incidence of dementia and its subtypes: A retrospective cohort study

痴呆 医学 回顾性队列研究 入射(几何) 人口 队列 儿科 精神科 队列研究 流行病学 疾病 内科学 环境卫生 物理 光学
作者
Shanquan Chen,Benjamin R. Underwood,Peter B. Jones,Jonathan Lewis,Rudolf N. Cardinal
出处
期刊:PLOS Medicine [Public Library of Science]
卷期号:19 (3): e1003941-e1003941 被引量:22
标识
DOI:10.1371/journal.pmed.1003941
摘要

Background Dementia is the leading cause of death in elderly Western populations. Preventative interventions that could delay dementia onset even modestly would provide a major public health impact. There are no disease-modifying treatments currently available. Lithium has been proposed as a potential treatment. We assessed the association between lithium use and the incidence of dementia and its subtypes. Methods and findings We conducted a retrospective cohort study comparing patients treated between January 1, 2005 and December 31, 2019, using data from electronic clinical records of secondary care mental health (MH) services in Cambridgeshire and Peterborough NHS Foundation Trust (CPFT), United Kingdom (catchment area population approximately 0.86 million). Eligible patients were those aged 50 years or over at baseline and who had at least 1 year follow-up, excluding patients with a diagnosis of mild cognitive impairment (MCI) or dementia before, or less than 1 year after, their start date. The intervention was the use of lithium. The main outcomes were dementia and its subtypes, diagnosed and classified according to the International Classification of Diseases-10th Revision (ICD-10). In this cohort, 29,618 patients (of whom 548 were exposed to lithium) were included. Their mean age was 73.9 years. A total of 40.2% were male, 33.3% were married or in a civil partnership, and 71.0% were of white ethnicity. Lithium-exposed patients were more likely to be married, cohabiting or in a civil partnership, to be a current/former smoker, to have used antipsychotics, and to have comorbid depression, mania/bipolar affective disorder (BPAD), hypertension, central vascular disease, diabetes mellitus, or hyperlipidemias. No significant difference between the 2 groups was observed for other characteristics, including age, sex, and alcohol-related disorders. In the exposed cohort, 53 (9.7%) patients were diagnosed with dementia, including 36 (6.8%) with Alzheimer disease (AD) and 13 (2.6%) with vascular dementia (VD). In the unexposed cohort, corresponding numbers were the following: dementia 3,244 (11.2%), AD 2,276 (8.1%), and VD 698 (2.6%). After controlling for sociodemographic factors, smoking status, other medications, other mental comorbidities, and physical comorbidities, lithium use was associated with a lower risk of dementia (hazard ratio [HR] 0.56, 95% confidence interval [CI] 0.40 to 0.78), including AD (HR 0.55, 95% CI 0.37 to 0.82) and VD (HR 0.36, 95% CI 0.19 to 0.69). Lithium appeared protective in short-term (≤1-year exposure) and long-term lithium users (>5-year exposure); a lack of difference for intermediate durations was likely due to lack of power, but there was some evidence for additional benefit with longer exposure durations. The main limitation was the handling of BPAD, the most common reason for lithium prescription but also a risk factor for dementia. This potential confounder would most likely cause an increase in dementia in the exposed group, whereas we found the opposite, and the sensitivity analysis confirmed the primary results. However, the specific nature of the group of patients exposed to lithium means that caution is needed in extending these findings to the general population. Another limitation is that our sample size of patients using lithium was small, reflected in the wide CIs for results relating to some durations of lithium exposure, although again sensitivity analyses remained consistent with our primary findings. Conclusions We observed an association between lithium use and a decreased risk of developing dementia. This lends further support to the idea that lithium may be a disease-modifying treatment for dementia and that this is a promising treatment to take forwards to larger randomised controlled trials (RCTs) for this indication.
最长约 10秒,即可获得该文献文件

科研通智能强力驱动
Strongly Powered by AbleSci AI
更新
PDF的下载单位、IP信息已删除 (2025-6-4)

科研通是完全免费的文献互助平台,具备全网最快的应助速度,最高的求助完成率。 对每一个文献求助,科研通都将尽心尽力,给求助人一个满意的交代。
实时播报
CodeCraft应助无奈世立采纳,获得10
刚刚
Akim应助可乐加糖采纳,获得10
刚刚
儒雅的娩关注了科研通微信公众号
刚刚
1秒前
1秒前
1秒前
xlz110完成签到,获得积分10
2秒前
3秒前
负责的调料汁完成签到,获得积分10
3秒前
3秒前
YYQX完成签到,获得积分10
3秒前
Mars_1108完成签到,获得积分10
3秒前
研友_Z7WPwZ完成签到,获得积分10
3秒前
梧桐应助七月采纳,获得10
5秒前
5秒前
DRHCE发布了新的文献求助20
5秒前
iuhgnor发布了新的文献求助10
6秒前
小贝完成签到,获得积分20
6秒前
6秒前
安渝发布了新的文献求助10
6秒前
山鬼发布了新的文献求助10
7秒前
量子星尘发布了新的文献求助10
7秒前
廉洁发布了新的文献求助20
7秒前
共享精神应助研友_Z7WPwZ采纳,获得10
7秒前
8秒前
立尽西风发布了新的文献求助10
8秒前
中级中级完成签到,获得积分10
8秒前
nihao2023发布了新的文献求助20
8秒前
220044发布了新的文献求助10
9秒前
生言生语发布了新的文献求助10
10秒前
小蘑菇应助第三采纳,获得10
10秒前
乐乐应助紧张的斩采纳,获得10
10秒前
10秒前
小神完成签到,获得积分10
10秒前
nililyun完成签到,获得积分10
11秒前
TIAOTIAO完成签到,获得积分10
11秒前
曲奇饼干发布了新的文献求助10
11秒前
11秒前
小马甲应助1l2kl采纳,获得10
12秒前
yabocai发布了新的文献求助10
12秒前
高分求助中
【提示信息,请勿应助】关于scihub 10000
The Mother of All Tableaux: Order, Equivalence, and Geometry in the Large-scale Structure of Optimality Theory 3000
Social Research Methods (4th Edition) by Maggie Walter (2019) 2390
A new approach to the extrapolation of accelerated life test data 1000
北师大毕业论文 基于可调谐半导体激光吸收光谱技术泄漏气体检测系统的研究 390
Phylogenetic study of the order Polydesmida (Myriapoda: Diplopoda) 370
Robot-supported joining of reinforcement textiles with one-sided sewing heads 360
热门求助领域 (近24小时)
化学 材料科学 医学 生物 工程类 有机化学 生物化学 物理 内科学 纳米技术 计算机科学 化学工程 复合材料 遗传学 基因 物理化学 催化作用 冶金 细胞生物学 免疫学
热门帖子
关注 科研通微信公众号,转发送积分 4009871
求助须知:如何正确求助?哪些是违规求助? 3549812
关于积分的说明 11303839
捐赠科研通 3284342
什么是DOI,文献DOI怎么找? 1810591
邀请新用户注册赠送积分活动 886393
科研通“疑难数据库(出版商)”最低求助积分说明 811406