CVD, mood disorders up risk of dementia in RA patients

Among patients with rheumatoid arthritis (RA), those with clinically active RA, cardiovascular or cerebrovascular disease (CVD), hypertension, depression, and anxiety are at greater risk of dementia, reveals a study. Among CVD events, ischaemic stroke and heart failure are significantly associated with an increased dementia risk.

“Apart from age, hypertension, depression, and anxiety, all of which are universally recognized risk factors for dementia, clinically active RA and presence of CVD were associated with an elevated risk of dementia incidence among patients with RA,” the researchers said.

The research team conducted a retrospective population-based cohort study, including 886 patients (mean age 65.1 years, 65.2 percent female), who met the 1987 American College of Rheumatology criteria for incident RA between 1980 and 2014 and were followed until death/migration or 31 December 2019. Those with dementia prior to RA incidence were excluded.

Incident dementia was defined as two relevant International Classification of Diseases, 9th or 10th revision codes at least 30 days apart. Using medical records, the researchers abstracted data on sociodemographics, disease characteristics, cardiovascular/cerebrovascular disease (CVD) risk factors, and comorbidities.

Of the eligible RA patients, 103 developed dementia during a median follow-up of 8.5 years. [J Rheumatol 2023;50:48-55]

After adjusting for age, sex, and calendar year of RA incidence, the following factors correlated with an elevated dementia risk: older age at RA incidence (hazard ratio [HR], 1.14 per 1-year increase, 95 percent confidence interval [CI], 1.12‒1.17), rheumatoid nodules (HR, 1.76, 95 percent CI 1.05‒2.95), hypertension (HR, 1.84, 95 percent CI, 1.19‒2.85), presence of large joint swelling (HR, 2.03, 95 percent CI, 1.14‒3.60), depression (HR, 2.63, 95 percent CI, 1.76‒3.93), anxiety (HR, 1.86, 95 percent CI, 1.16‒2.97), and any CVD (HR, 2.25, 95 percent CI, 1.38‒3.66).

Among CVD events, ischaemic stroke (HR, 3.16, 95 percent CI, 1.84‒5.43) and heart failure (HR, 1.82, 95 percent CI, 1.10‒3.00) were associated with an increased risk of dementia.

Notably, the significant association of all the factors mentioned above persisted even after adjusting for CVD risk factors and any CVD.

“Our study has important clinical implications. We have defined features of a high-risk phenotype for dementia incidence among patients with RA. An elderly patient with RA who has high disease activity, an unfavourable CVD risk profile, and/or a mood disorder is at high risk for dementia,” the researchers said.

“Awareness of these risk factors among clinicians caring for patients with RA, vigilant screening, and appropriately addressing these risk factors may help improve cognitive outcomes in patients with RA,” they added.

The study was limited by the inclusion of mostly White patients (90 percent), the retrospective nature of the study, and the use of one code-based definition of dementia. In addition, the research team did not have data on patients who had mild cognitive impairment, and they did not examine the risk for dementia subtypes.