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Internalize at your peril: internalizing disorders as risk factors for dementia—cohort study

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Abstract

Few studies examined comorbid anxiety and depression’s independent association with dementia. We assessed internalizing disorders as risk factors for dementia to avoid pitfalls inherent in separating anxiety and depression. Retrospectively designed prospective comparative cohort study using New Zealand’s (NZ) National Minimum Dataset of hospital discharges. Hazards ratios (HRs), estimated from parametric survival models, compared the time to incident dementia after a minimal latency interval of 10 years between those with and without prior diagnosis of an internalizing disorder. A total of 47,932 patients aged 50–54 years were discharged from a publicly funded hospital events in NZ between 1988 and 1992. Of these, 37,631 (79%) met eligibility criteria, and incident dementia was diagnosed in 1594. Rates of incident dementia were higher among patients with an earlier diagnosis of internalizing disorders (572 vs 303 per 100,000 person years at risk (PYAR)). After adjustment for age, sex, ethnicity, and region, those with internalizing disorders were estimated to have a higher risk of developing dementia than those without (adjusted HR = 1.57, 95% CI 1.17–2.10). Females with an earlier diagnosis of internalizing disorders were estimated to have almost twice the risk of developing dementia (adjusted HR 1.80, 95% CI 1.25–2.59). Internalizing disorders affect one in five adults globally. Our findings suggest a significant increase in risk of dementia more than 10 years after the diagnosis of internalizing disorder.

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Data availability

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

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Funding

University of Otago, New Researcher Start-Up Award.

Author information

Authors and Affiliations

  1. School of Medicine, Dept. of Psychological Medicine, University of Otago, PO Box 56, Dunedin, New Zealand

    Yoram Barak & Paul Glue

  2. School of Medicine, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand

    David Barson & Gabrielle Davie

  3. Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel

    Diana Paleacu

Authors
  1. Yoram Barak
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  2. David Barson
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  3. Gabrielle Davie
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  4. Paul Glue
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  5. Diana Paleacu
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Contributions

YB: conception and design of the study and drafting a significant portion of the manuscript and figures. DB: design of the study, acquisition, and analysis of data drafting a significant portion of the figures. GD: design of the study, acquisition, and analysis of data and drafting a significant portion of the figures PG: conception and design of the study and drafting a significant portion of the manuscript and figures.

DP: conception and design of the study and drafting a significant portion of the manuscript and figures.

Corresponding author

Correspondence to Yoram Barak.

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The authors declare that they have no conflict of interest.

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University of Otago Ethics Committee reference number HD18/002.

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The relationship between internalizing disorders and incident dementia after a minimal latency interval of 10 years was evaluated. Of patients aged 50-54y discharged from general hospitals between 1988 and 1992, after 10 years, 694 with internalizing disorder and 36,937 patients without served as our cohort. Incident dementia was more common amongst patients with an earlier diagnosis of internalizing disorders (7.3% vs 4.2%). Internalizing disorders were independently predictive of a 57% higher risk of developing dementia. Gender differences were significant with females with an earlier diagnosis of an internalizing disorders estimated to have almost twice the risk of developing dementia (adjusted HR 1.80, 95%CI 1.25-2.59).

Highlights

1) What is the primary question addressed by this study? Are internalizing disorders a risk factor for dementia?

2) What is the main finding of this study? Internalizing disorders were independently predictive of a higher risk of developing dementia, adjusted Hazard Ratio = 1.57 (CI: 1.17–2.10).

3) What is the meaning of the finding? Through analyzing internalizing disorders several of the pitfalls in studying the relationship between depression and or anxiety and incident dementia are overcome.

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Barak, Y., Barson, D., Davie, G. et al. Internalize at your peril: internalizing disorders as risk factors for dementia—cohort study. GeroScience 43, 253–261 (2021). https://doi.org/10.1007/s11357-020-00285-y

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  • DOI: https://doi.org/10.1007/s11357-020-00285-y

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