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Inflammatory bowel disease
Original research
Inflammatory bowel disease is associated with higher dementia risk: a nationwide longitudinal study
  1. Bing Zhang1,2,
  2. Hohui E Wang3,
  3. Ya-Mei Bai1,4,5,
  4. Shih-Jen Tsai1,4,5,
  5. Tung-Ping Su1,4,5,
  6. Tzeng-Ji Chen6,7,
  7. Yen-Po Wang5,8,9,
  8. Mu-Hong Chen1,4,5
  1. 1 Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
  2. 2 Div Gastroenterology, University of California San Francisco, San Francisco, California, USA
  3. 3 Psychiatry, University of California San Francisco, San Francisco, California, USA
  4. 4 Division of Psychiatry, School of Medicine, National Yang-Ming University, Taipei, Taiwan
  5. 5 Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan
  6. 6 Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
  7. 7 Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan
  8. 8 Div Gastroenterology, Taipei Veterans General Hospital, Taipei, Taiwan
  9. 9 Endoscopy Center For Diagnosis and Treatment, Taipei Veterans General Hospital, Taipei, Taiwan
  1. Correspondence to Dr Mu-Hong Chen, Psychiatry, Taipei Veterans General Hospital, Taipei 11217, Taiwan; kremer7119{at}gmail.com; Dr Yen-Po Wang, Div Gastroenterology, Taipei Veterans General Hospital, Taipei 11217, Taiwan; ulnafu{at}gmail.com

Abstract

Objective Increasing evidence supports reciprocal communication between the enteric and the central nervous system in disease, termed the ‘gut–brain axis’. Recent findings suggest a connection between IBD and development of Parkinson’s disease. The role of IBD in dementia, another insidious neurodegenerative disorder, has not been explored.

Design Using the Taiwanese National Health Insurance Research Database, we performed comparative analysis of 1742 patients with IBD ≥45 years old against 17 420 controls to assess dementia risk following IBD diagnosis. Controls were matched on bases of sex, access to healthcare, income and dementia-related comorbidities. All individuals were followed for dementia diagnosis for up to 16 years. Subanalyses included the relationship between sex, ulcerative colitis (UC) and Crohn’s disease (CD), and dementia risk.

Results Overall incidence of dementia among patients with IBD was significantly elevated (5.5% vs 1.4% among controls). Patients with IBD were diagnosed with dementia at 76.24 years old on average, compared with 83.45 among controls. The HR of developing dementia among patients with IBD was 2.54 (95% CI 1.91 to 3.37). Among dementia types, the risk of developing Alzheimer’s dementia demonstrated the greatest increase. Dementia risk did not differ between sex differences nor UC versus CD.

Conclusion This population-based cohort study demonstrates significant association between IBD and subsequent development of dementia. Dementia was diagnosed at an earlier age among patients with IBD, and disease risk appeared to increase with IBD chronicity. These findings highlight the need for future research to elucidate the relationship between IBD and dementia.

  • IBD
  • enteric bacterial microflora
  • inflammation
  • neurobiology

https://doi.org/10.1136/gutjnl-2020-320789

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    Footnotes

    • Contributors BZ, HEW, Y-PW and M-HC designed the study and performed literature search. Y-MB, S-JT, T-PS, T-JC and M-HC analysed the data. BZ, HEW, Y-PW and M-HC drafted the first version of the manuscript. All authors interpreted the data, contributed substantially to the manuscript, and approved the final manuscript for submission. All authors are responsible for the integrity, accuracy and presentation of the data.

    • Funding This study was supported by grants from Taipei Veterans General Hospital (V103E10-001, V104E10-002, V105E10-001-MY2-1, V105A-049, V106B-020, V107B-010, V107C-181, V108B-012), Yen Tjing Ling Medical Foundation (CI-109-21, CI-109-22) and Ministry of Science and Technology, Taiwan (107-2314-B-075-063-MY3, 108-2314-B-075-037). BZ is supported by funding from the National Institute of Health, grant number 5T32DK007007-45.

    • Disclaimer The funding sources did not participate nor influence the study design, data collection and analysis, findings, or reporting of the current study.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Patient consent for publication Not required.

    • Ethics approval This study was approved by the Taipei Veterans General Hospital institutional review board.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data may be obtained from a third party and are not publicly available. No data are available. All data are available upon request and approval from the Taiwan National Health Insurance Research Database.