Paper abstract
Association between psychological interventions for anxiety and dementia risk: a prospective cohort study based on England-wide medical record data
Background
Previous Meta-analyses support an association between anxiety and dementia in older adults. This study aimed to examine whether psychological intervention treatments for anxiety disorders are associated with reduced rates of dementia using routinely collected medical data.
Methods
In this prospective cohort study, researchers linked eight years of follow-up data on psychotherapy services provided by the Improving Access to Psychological Therapies across England from 2012 to 2019 to medical records that included a diagnosis of dementia as defined by the International Classification of Diseases, 10th Revision (ICD-10). The inclusion criteria were as follows: (1) patients aged 65 and above; (2) patients with suspected anxiety disorder; (3) current or previously undiagnosed dementia. Cox proportional hazards models were constructed to examine whether reliable improvements in anxiety following psychological intervention were associated with future dementia onset. The primary outcome was all-cause dementia, with cases identified using ICD-10 dementia codes in the UK Hospital Incident Statistics Database, Mental Health Services Database and death data. The primary analysis was performed using hazard ratios (HR).
Results
128,077 people aged 65 and over received psychological intervention services across England, and researchers linked their data to medical records. Of the 127,064 participants with available gender data, 88,019 (69.0%) were female and 39,585 (31.0%) were male. Of the 115,989 participants with available race data, 111,225 (95.9%) were white. The mean age of the sample is 71.55 years (SD=5.69). Due to missing data on key variables or covariates, 16,119 individuals were excluded from this study and 111,958 individuals were included in the fully adjusted model. Dementia was diagnosed in 4510 of 111,958 participants (4.0%). The remaining 107,448 participants (96.0%) were censored at the date of death or reaching the final follow-up period available for analysis. People who showed reliable improvement in their anxiety disorder (3.9%) had lower rates of later dementia diagnosis than those who did not (5.1%). Reliable improvements in anxiety following psychological intervention were associated with reduced incidence of all-cause dementia (HR=0.83 [95% CI: 0.78-0.88]), Alzheimer's disease (HR=0.85 [0.77-0.94]), and vascular dementia (HR=0.80 [0.71-0.90]). Effects were not modified by anxiety disorder diagnosis.
explanation
The results show that reliable improvements in anxiety disorders with psychotherapy are associated with reduced rates of future dementia. There are several plausible explanations for this finding, and further research is needed to distinguish between these possibilities. Missing data in the sample limits the reliability of the findings.
Funding
Alzheimer's Society, Medical Research Council, Wellcome Trust, and UCLH National Institute for Health and Care Research Biomedical Research Centre.END
*Abstract translation is for reference only, and the original English text shall prevail.
