Gout Associated With Increased Risk for Incident Dementia in the Elderly

The results of a cohort study published in BMC Geriatrics suggest an independent association between gout and a 15% increased risk for dementia in older adults.

Investigators conducted an observational cohort study using a 5% random sample of Medicare claims from 2006 to 2012. Data were obtained from the Centers for Medicare & Medicaid Services data warehouse. A diagnosis of gout was confirmed in beneficiaries by the existence of 2 ICD-9-CM code claims at least 4 weeks apart. Dementia was similarly identified using 2 ICD-9-CM code claims at least 4 weeks apart. Multivariable-adjusted Cox proportional hazard models were used to investigate the association of gout with incident dementia, adjusting for demographic factors, comorbidities, and medications commonly used for cardiac diseases and gout.

The total study cohort included 1.71 million Medicare beneficiaries, of whom 111,656 had incident dementia. The crude incidence rates of dementia in people with and without gout were 10.9 and 17.9 per 1000 person-years, respectively. The mean time from gout diagnosis to incident dementia was 2.3 years. Compared with those who did not develop dementia, people who developed incident dementia were 5 years older, more likely to be women and more likely to be black, and had a higher prevalence of most Charlson-Romano comorbidities. In addition, hypertension, hyperlipidemia, and coronary artery disease were more frequent among those with dementia compared with those without. In multivariable-adjusted analyses, gout was independently associated with a significantly higher hazard ratio (HR) of incident dementia (HR, 1.15; 95% CI, 1.12-1.18). Compared with those aged 65 to 75 years, patients aged 75 to 85 years and ≥85 years had 3.5- and 7.8-fold higher risks for dementia. Risks were also higher among women, black people, and individuals with higher medical comorbidity.

These data suggest a 15% higher risk for dementia among elderly individuals with gout compared with those without gout. This association persisted in sensitivity analysis and suggests a clinical need for increased dementia screening among older adults with gout. Future research is necessary to elucidate the pathogenesis behind this increased risk.

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Reference

Singh JA, Cleveland JD. Gout and dementia in the elderly: a cohort study of Medicare claims. BMC Geriatrics. 2018;18:281.