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“The VHA [Veterans Health Administration] serves an aging patient population, and it is important to understand risk factors for incident dementia among VHA patients,” wrote Eileen Ahearn, M.D., Ph.D., of the William S. Middleton Department of Veterans Affairs (VA) Hospital in Madison, Wisconsin, and colleagues. “The study reported here confirmed prior studies indicating that individuals with bipolar disorder or schizophrenia have increased risk of dementia onset, even when the analysis controls for general medical comorbidities.”
Using the VHA’s medical database, Ahearn and colleagues identified over 3.6 million veterans without a dementia diagnosis who received VHA health care services between 2004 and 2005. The researchers then evaluated whether these patients (93% men; 7% women) had been diagnosed with either bipolar disorder or schizophrenia. Most of these individuals had not been diagnosed with bipolar disorder or schizophrenia and were categorized by the researchers as having no serious mental illness (SMI). The cohort was followed for up to 10 years to assess for onset or incident of dementia.
The mean incidence of dementia was 11.2 cases per 1,000 person-years for men with no SMI, 11.5 cases per 1,000 person-years for men with bipolar disorder, and 15.1 cases per 1,000 person-years for men with schizophrenia. The mean incidence of dementia was 4.0 cases per 1,000 person-years for women with no SMI, 4.1 cases per 1,000 person-years for women with bipolar disorder, and 8.4 cases per 1,000 person-years for women with schizophrenia.
After adjusting for age, substance use, and comorbid conditions associated with dementia risk (including diabetes and hypertension), Ahearn and colleagues found that the incidence rate ratios for dementia were 2.92 for veterans with a baseline diagnosis of schizophrenia and 2.26 for those with a baseline diagnosis of bipolar disorder, compared with veterans with no SMI. Veterans diagnosed with schizophrenia or bipolar disorder also developed dementia at a younger age (68.5 and 67.9, respectively) compared with those with no SMI (78.8).
“Primary care and mental health clinicians should be educated about the elevated risk of dementia among VHA patients with schizophrenia or bipolar disorder,” Ahearn and colleagues wrote. “They should be alert to memory or other cognitive complaints in this patient population and should initiate an evaluation for dementia when there are signs or symptoms of possible cognitive impairment.”
(Image: iStock/Ridofranz)
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